Renoprotective Effect of the Mineralocorticoid Receptor Antagonist Esaxerenone

Background: The effects of mineralocorticoid receptor antagonists, including the newly introduced esaxerenone, on renal function remain uncertain. Methods and Results: This retrospective study was performed on patients who received esaxerenone for resistant hypertension between November 2019 and June 2020. Trends in the estimated glomerular filtration rate (eGFR) were compared between the 6-month period before esaxerenone treatment (pre-treatment period) and the 6-month treatment period on esaxerenone. Twenty-six patients (15 men), with a median age of 70 years (interquartile range [IQR] 51–73 years) and a median systolic blood pressure of 146 mmHg (IQR 139–156 mmHg), were included in the study and completed 6 months of esaxerenone therapy without any adverse events. eGFR decreased significantly during the pre-treatment period (from 66.6 to 59.5 mL/min/1.73 m(2); P=0.003), whereas eGFR was unchanged during the treatment period (from 59.5 to 61.8 mL/min/1.73 m(2); P=0.15). The median change in eGFR differed significantly between the treatment and pre-treatment periods (3.8 [IQR −4.2, 6.8] vs. −6.1 [IQR −11.1, 1.8] mL/min/1.73 m(2), respectively; P=0.008). Conclusions: Esaxerenone may have renoprotective effects when administered to treat hypertension. Further studies are needed to understand which patient populations may see greater renoprotective benefits with esaxerenone.