Does finerenone reduce renal and cardiovascular events in patients with diabetic kidney disease?
Finerenone provides significant renal and cardiovascular benefits, including reduced heart failure hospitalization and kidney disease progression, in patients with diabetic kidney disease, though it increases the risk of hyperkalemia.
Objective: Diabetic kidney disease (DKD) is a major global health concern, and finerenone is a potentially effective drug for its treatment. This meta-analysis was conducted to assess the clinical efficacy and safety of finerenone in patients with DKD. Methods: The PubMed, Embase, Cochrane Library, and Web of Science databases were searched from inception to October 8, 2024, for randomized controlled trials (RCTs) evaluating finerenone in patients with DKD. Data were extracted and analyzed. Risk of bias was assessed using the Cochrane Collaboration’s risk-of-bias tool in Review Manager 5.3. Publication bias was examined using Begg’s test, Egger’s test, and funnel plots in Stata version 14.0. Results: Seven RCTs involving 15,527 patients (n = 8,536 in the finerenone group; n = 6,991 in the control group) met the inclusion criteria. Regarding efficacy, the finerenone group showed a significantly greater reduction in urinary albumin-to-creatinine ratio from baseline (p 0.05). Safety analysis revealed comparable rates of total adverse events between groups (p > 0.05). However, finerenone was associated with higher incidences of studydrug- related adverse events and hyperkalemia, but a lower risk of total serious adverse events. Discussion: Finerenone significantly reduces renal and cardiovascular risks in DKD patients, including kidney disease progression and heart failure hospitalization, despite a higher incidence of hyperkalemia. These findings support its role as a promising therapy, especially for patients intolerant to steroidal agents, and highlight the importance of potassium monitoring in clinical practice. Conclusion: This meta-analysis suggests that finerenone provides significant renal and cardiovascular benefits in patients with DKD without causing intolerable adverse effects, supporting its potential as a novel therapeutic option. These findings warrant further confirmation through rigorously designed, large-scale RCTs.
Chen et al. (Tue,) studied this question.