Meta-analysis of the efficacy and safety of Finerenone in diabetic kidney disease

Objective: This study is aimed to systematically evaluate the efficacy and safety of Finerenone (BAY 94-8862) in the treatment of diabetic kidney disease. Method: Databases including PubMed, Embase, and Web of science were searched for randomized controlled trials that assessed Finerenone in patients with diabetic kidney disease and were published up to January 7, 2025. The quality evaluation of literatures and meta-analysis were performed using RevMan 5.4 software and independently operated by 2 experimenters. Results: Seven randomized controlled trials involving 33,455 patients were included. The efficacy outcomes were the ratio of urine albumin creatine ratio at posttreatment versus at baseline (mean difference: −0.30; 95% confidence interval CI; −0.32, −0.27; P < .00001; I 2 = 0%), the primary composite outcome (hazard ratio HR: 0.81; 95% CI 0.76, 0.87; P < .00001; I 2 = 13%), the secondary composite outcome (HR: 0.82; 95% CI 0.74, 0.91; P = .0001; I 2 = 0%), kidney failure (HR: 0.76; 95% CI 0.70, 0.83; P < .00001; I 2 = 0%), and the risk of end stage kidney disease (HR: 0.87; 95% CI 0.77, 0.99; P = .03; I 2 = 46%). The safety outcome was the incidence of adverse events (risk ratio: 1.00; 95% CI 0.99, 1.00; P = .38; I 2 = 0%) and the number of patients suffering from hyperkalemia (risk ratio: 2.19; 95% CI 2.04, 2.34; P < .00001; I 2 = 0%). Conclusion: Results of meta-analysis showed that Finerenone could significantly reduce urine albumin creatine ratio levels. It has a protective effect on kidney, delaying the progression of chronic kidney disease and reducing the risk of end stage kidney disease. Furthermore, there was no difference in the risk of overall adverse events.