Finerenone Targeting the Mineralocorticoid Receptor: Therapeutic Potential for Cardiorenal Syndrome

Cardiorenal syndrome (CRS) is a complex clinical and pathological condition characterized by the dysfunction of either the heart or the kidney, leading to subsequent dysfunction in the other organ in the context of acute or chronic functional impairment. Given the escalating incidence and mortality rates of CRS particularly against the backdrop of an aging population and the rising prevalence of cardiovascular diseases, underscore the need for a deeper understanding of its underlying pathogenesis. Recently, the role of mineralocorticoid receptors (MR) in CRS has garnered significant research attention. Evidence suggests that aberrant activation of MR not only disrupts water and sodium homeostasis, resulting in abnormal blood volume expansion, but also triggers inflammatory responses, tissue fibrosis, and hyperactivation of the sympathetic nervous system and renin-angiotensin-aldosterone system. These intricate pathophysiological processes exert profound negative impacts on cardiac and renal functions. Finerenone, a novel non-steroidal selective mineralocorticoid receptor antagonist (MRA), has demonstrated significant therapeutic potential and unique pharmacological mechanism in the treatment of cardiorenal syndrome, especially chronic kidney disease (CKD) associated with type 2 diabetes mellitus (T2DM) in recent years. In this review, we summarize the mechanisms by which finerenone interacts with MR and its promising therapeutic role in cardiorenal syndrome.