Future Directions and Innovations in Mineralocorticoid Receptor Antagonist Therapy.

Mineralocorticoid receptor antagonists (MRAs) are important pillars in the treatment of heart failure (HF), chronic kidney disease (CKD), and diabetic kidney disease (DKD). MRAs share complementary pathways with sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in patients with cardiovascular-kidney-metabolic (CKM) syndrome. Combination therapies of MRA with SGLT2i and GLP-1RA are showing promising results in CKM than individual therapies. Further, the unique action of MRAs in antagonizing MR receptors and aldosterone, implicated in the pathophysiology of several conditions, is paving the way for clinical trials and promising results in these therapeutic areas. Disease-specific biomarkers such as UACR and eGFR are increasingly being used to individualize treatment with MRA. Utilizing MRA-specific biomarkers may open the path for precision medicine and further treatment individualization.