Abstract
Patients with advanced-stage chronic kidney disease (CKD) have a high burden of disease, which is compounded by serious comorbidities, including diabetes, cardiovascular disease (CVD), and, most commonly, hypertension. Control of hypertension is vital in patients with advanced CKD to reduce the associated risks of morbidity and mortality, but treatment options are limited, largely due to safety concerns for the use of existing antihypertensive agents in patients with poor renal function. During interviews conducted by EMJ in November 2022, two leading specialists in nephrology and cardiology, George Bakris, American Heart Association Comprehensive Hypertension Center, Department of Medicine, The University of Chicago Medicine, Illinois, USA, and Faiez Zannad, Clinical Investigation Centre (CIC 1493 Inserm-CHU), Université de Lorraine, Nancy, France; and Regional and University Hospital Center (CHRU) Nancy, France, discussed the challenges of treating uncontrolled hypertension in advanced CKD. These two experts described the complicated relationship between cardiovascular and renal disease, and identified significant unmet needs for patients with uncontrolled hypertension and advanced CKD. In this context, new agents in the field were viewed with interest, including the emerging class of non-steroidal mineralocorticoid receptor antagonists (MRA). The experts highlighted data from recent studies on the novel non-steroidal MRA, ocedurenone (KBP-5074), and discussed its potential as a treatment for uncontrolled hypertension in patients with advanced CKD.