Mineralocorticoid receptor antagonists (MRA) can reduce cardiovascular morbidity and mortality in patients with heart failure and ischemic heart disease. In addition, these agents have been used in patients with diabetic nephropathy to control proteinuria and slow down chronic kidney disease (CKD) progression. Current guidelines recommend against the use of MRAs in patients with advanced CKD. However, there is growing interest on their use in this population that has unmet needs (high cardiovascular morbidity and mortality) and unique challenges (risk of acute kidney injury or hyperkalemia). This narrative review discusses the emerging role of MRAs for the management of cardiovascular disease and/or the prevention of CKD progression, highlighting results from randomized controlled trials and presenting real-world data from available registries. Results from recent trials in patients on maintenance dialysis are also discussed.

盐皮质激素受体拮抗剂 (MRA) 可以降低心力衰竭和缺血性心脏病患者的心血管发病率和死亡率。此外，这些药物已用于糖尿病肾病患者以控制蛋白尿和减缓慢性肾病 (CKD) 进展。目前的指南建议不要在晚期 CKD 患者中使用 MRA。然而，人们对它们在需求未得到满足（心血管发病率和死亡率高）和独特挑战（急性肾损伤或高钾血症风险）的人群中的使用越来越感兴趣。这篇叙述性综述讨论了 MRA 在管理心血管疾病和/或预防 CKD 进展方面的新作用，突出了随机对照试验的结果，并提供了来自可用注册的真实世界数据。