Efficacy and Safety of Finerenone for Renal and Cardiovascular Events in DiabeticKidney Disease: A Meta-analysis

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 < 0.00001) but experienced a greater decline in estimated glomerular filtration rate (eGFR) (p < 0.00001). However, finerenone significantly reduced the risk of a ≥40% decline in eGFR (p < 0.0001), a ≥57% decline in eGFR (p < 0.0001), progression to end-stage kidney disease (p = 0.04), composite cardiac outcomes (p = 0.001), and hospitalization for heart failure (p = 0.004) compared with control. No significant differences were observed in cardiovascular mortality, myocardial infarction, or all-cause hospitalization (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.