Lorundrostat may cause a clinically significant decline in renal function; a letter to the editor

Abstract

Lorundrostat is an aldosterone synthase inhibitor that can be used in patients with uncontrolled hypertension. It effectively lowers blood pressure, but there are concerns about the limited renal safety data available for lorundrostat. In order to address this issue, it is recommended that future research should incorporate more detailed kidney assessments, which would include monitoring for conditions such as proteinuria and acute kidney injury (AKI). This paper discusses the effects of lorundrostat on the estimated glomerular filtration rate (eGFR) and highlights the significant variability in these effects among individuals. The research shows that lorundrostat may cause a decline in eGFR exceeding one standard deviation above the mean change in approximately 16% of patients. In severe cases, 0.2% of patients may experience eGFR declines of ≥42 mL/min/1.73 m². These declines in eGFR could increase chronic kidney disease (CKD) stages, even in those with baseline eGFR >60 or 90 mL/min/1.73 m². In conclusion, while most lorundrostat patients do not experience severe eGFR declines, there is still a risk of clinically meaningful declines and CKD progression, particularly among susceptible individuals. Further research is needed to confirm these findings and identify renal risk factors in uncontrolled hypertension patients who receive aldosterone synthase inhibition.

Keywords: Lorundrostat, Renal function, eGFR, AKI, CKD