Key result
Finerenone reduces all-cause mortality ~11% vs. placebo in patients with diabetic kidney disease.
Why the study?
Although guidelines recommend finerenone as a first-line agent for diabetic kidney disease, its effect on all-cause and cardiovascular mortality remains unclear.
Does finerenone reduce all-cause and cardiovascular mortality in patients with diabetic kidney disease?
Meta-Analysis (n=13,943)
Yes
Does finerenone reduce all-cause and cardiovascular mortality in patients with diabetic kidney disease?
Effect estimate: RR 0.894 (95% CI 0.802-0.998)
In patients with diabetic kidney disease, finerenone significantly reduces both all-cause and cardiovascular mortality, though it increases the risk of hyperkalemia.
Supports finerenone in diabetic kidney disease with hyperkalemia monitoring; confirms mortality reduction in Level 1 meta-analysis.
Background: Although current guidelines have recommended finerenone as a first-line agent for patients with diabetic kidney disease (DKD), it is unclear what effect finerenone has on all-cause and cardiovascular mortality. This study aimed to assess the impact of finerenone on the prognosis and safety of patients with DKD. Methods: A systematic search was performed in PubMed, Embase, Scopus, and Web of Science. We included randomized controlled trials involving patients diagnosed with DKD that had finerenone versus placebo. The number of deaths, including any cause and cardiovascular causes, hyperkalemia, and adverse events, were collected for the finerenone and placebo groups. Data were summarized as risk ratio (RR) with 95% confidence interval (95% CI). Results: Four trials (13,943 participants) were included in the meta-analysis. Results of the restricted maximum likelihood-adjusted random-effects model showed that finerenone was associated with a reduced risk of all-cause (RR: 0.894; 95% CI 0.802-0.998) and cardiovascular mortalities (RR: 0.824; 95% CI 0.685-0.990) in DKD patients. Finerenone predisposed to hyperkalemia compared with placebo (RR: 2.280; 95% CI 1.937-2.682). Conclusion: This meta-analysis provides key information on the prognosis and safety of finerenone in DKD patients. These results help to supplement the clinical evidence for finerenone. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, CRD42023463227.
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Zhang et al. (2025) conducted a meta-analysis in Diabetic kidney disease (n=13,943). Finerenone vs. Placebo was evaluated on All-cause mortality (RR 0.894, 95% CI 0.802-0.998). Finerenone reduced the risk of all-cause mortality by 10.6% (RR 0.894) compared to placebo in patients with diabetic kidney disease.
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