Introduction:
Mineralocorticoid receptor antagonists (MRAs) are a cornerstone of chronic heart and kidney disease management. However, their use in post-renal transplant patients is limited due to side effects such as hyperkalemia, gynecomastia, and a decline in estimated glomerular filtration rate (eGFR). This retrospective study aimed to assess the safety and efficacy of finerenone, a new non-steroidal MRA (nsMRA), in post-renal transplant patients in whom spironolactone (Sp) were discontinued or not started due to side effects or hyperkalaemia.
Methods:
The study included patients who underwent renal transplantation between 2002 and 2022 and were started on nsMRA between 2022 and 2023. Patients were followed up for at least three months to one year. Data analyzed included safety profile, side effects, tolerance, and clinical efficacy in eGFR and proteinuria.
Results:
Of the 28 patients who received nsMRA, 16 had diabetes with heart failure, 4 developed heart failure secondary to acute rejection, and 8 had biopsy-proven recurrence of primary renal disease or chronic rejection with proteinuria. Age at initiation ranged from 21 to 73 years, and mean SBP and DBP pre-nsMRA were 110-180 and 72-92 mmHg, respectively. eGFR pre-nsMRA was 22-42 ml/min/1.73m² and UACR was >30A1 in 20 patients and >1.5g in 8. Serum potassium at initiation varied from 4 to 5.8 meq/dl.
At the end of 6 months post-initiation of nsMRA, potassium levels above 5.5 meq/dl were seen in three patients. No patient discontinued the drug, and all achieved a dose of 20 mg per day. There were no worsening of heart failure requiring admission, and all patients experienced a reduction in proteinuria and improvement in eGFR. No significant side effects were noted. Renal biopsies were performed in 12 patients, revealing chronic rejection in 8, membranous nephropathy (PLA2R negative) in 2, diabetic nephropathy and segmental sclerosis in 2, and one with parvovirus B19 positivity.
Conclusions:
nsMRA (finerenone) at a dose of 20 mg per day was safe and effective in post-transplant patients with heart failure and chronic rejection. The drug demonstrated improvements in eGFR and proteinuria reduction. Further prospective studies are needed to confirm these findings
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.