Why the study?
Clinical data evaluating esaxerenone in hypertensive patients with diabetic kidney disease were lacking.
Does esaxerenone reduce blood pressure and albuminuria in hypertensive patients with diabetic kidney disease on RAS inhibitors?
Does esaxerenone reduce blood pressure and albuminuria in hypertensive patients with diabetic kidney disease on RAS inhibitors?
Esaxerenone effectively lowers blood pressure and reduces albuminuria in hypertensive patients with diabetic kidney disease and moderate renal dysfunction without causing clinically relevant hyperkalemia.
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May support esaxerenone in DKD hypertension; leaves open need for RCTs on outcomes and safety.
Clinical data of esaxerenone in hypertensive patients with diabetic kidney disease (DKD) are lacking. We evaluated the efficacy and safety of esaxerenone in patients with DKD and an inadequate response to blood pressure (BP)-lowering treatment. In this multicenter, open-label, prospective study, patients were divided into urinary albumin-to-creatinine ratio subcohorts (UACR < 30, 30 to < 300, and 300 to < 1000 mg/gCr). Esaxerenone was initiated at 1.25 mg/day and followed by incremental dose escalation based on BP and serum potassium level monitoring. The treatment period was 12 weeks. The primary endpoint was change in morning home systolic BP/diastolic BP (SBP/DBP) from baseline to end of treatment (EOT). Secondary endpoints included achievement rate of target BP, change in UACR from baseline, and safety. In total, 113 patients were enrolled. Morning home SBP/DBP significantly decreased from baseline to EOT in the total population (− 11.6/− 5.2 mmHg, both p < 0.001) and in all UACR subcohorts (all p < 0.001). The target BP achievement rate was 38.5%. Significant reductions in bedtime home and office BPs were also shown in the total population and all UACR subcohorts. UACR significantly improved from baseline to EOT in the total (− 50.9%, p < 0.001) and all UACR subcohorts (all p < 0.001). Incidence of serum potassium elevation as drug-related treatment emergent adverse events was 2.7%. The change from baseline in estimated glomerular filtration rate (eGFR) was − 4.8 mL/min/1.73 m 2 . Esaxerenone demonstrated a BP-lowering effect and improved albuminuria. The effects were consistent regardless of the severity of albuminuria without clinically relevant serum potassium elevation and eGFR reduction. jRCTs06119002.
Uchida et al. (2022) studied this question.
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