Нестероидный антагонист минералкортикоидных рецепторов финеренон: новый подход к лекарственной терапии хронической болезни почек

Гормональная система альдостеронсинтаза–альдостерон–минералкортикоидный рецептор играет ключевую роль в повреждении почек, прогрессировании ХБП и повышении АД у пациентов с диабетической и недиабетической нефропатией. Стероидный антагонист минералкортикоидных (МК) рецепторов спиронолактон и заменяющий его эплеренон рекомендуется включать в комбинацию с ингибиторами РАС для контроля АД и снижения потери белка с мочой гипертензивным пациентам с С1–С3а стадиями ХБП. Однако использование этих препаратов при ХБП, особенно в сочетании с ингибиторами РАС, ограничено из-за риска развития гиперкалиемии, гинекомастии и других нежелательных побочных эффектов. В последнее время ведется разработка нового поколения антагонистов МК-рецепторов, которые отличаются от своих предшественников иным механизмом действия, улучшенными фармакологическим свойствами и более благоприятным профилем безопасности. В обзоре представлены данные об особенностях фармакокинетики и фармакодинамики нового нестероидного антагониста МК-рецепторов финеренона, а также результаты клинических исследований, полученные при оценке его эффективности и безопасности применения у пациентов с ХБП диабетического и недиабетического происхождения.

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