This agent blocks sodium reabsorption through the mineralocorticoid receptor and also reduces overactivation of this receptor in the kidney, heart, and blood vessels.195,196 In clinical trials, it reduced CKD progression, ESKD, HF hospitalization, and other cardiovascular outcomes in patients with CKD and T2D.178 It is associated with an increased risk of hyperkalemia. This evidence concerns the gene NR3C2 and hydrops fetalis.