Immunoglobulin A nephropathy (IgAN) is a leading cause of chronic kidney disease worldwide, creating a significant need for novel, effective therapies. Finerenone has demonstrated renal protective benefits in diabetic kidney disease, but its efficacy and safety profile specifically in IgAN require comprehensive evaluation. This study aimed to systematically assess the therapeutic potential and safety of finerenone in patients with IgAN. A systematic literature search of PubMed, Embase, and the Cochrane Library was conducted up to November 25, 2025. Cohort studies involving adults with biopsy-proven IgAN, comparing finerenone plus standard care against standard care alone with at least 6 months of follow-up, were included. Data on urine protein-to-creatinine ratio (UPCR), estimated glomerular filtration rate (eGFR), and adverse events (hyperkalemia) were extracted. The meta-analysis revealed that finerenone treatment significantly reduced proteinuria compared to control (MD -12.98, 95% CI: -16.04 to -9.93; P < 0.00001) and significantly improved renal function, indicated by an increase in eGFR (MD 4.41, 95% CI: 2.94 to 5.89; P < 0.00001). Statistical heterogeneity was negligible (I² = 0%) for both efficacy outcomes. Regarding safety, finerenone was associated with a non-significant increase in the risk of hyperkalemia (OR 2.12, 95% CI: 0.27 to 16.80; P = 0.48), though the confidence interval was wide, indicating uncertainty due to a low event rate. In this meta-analysis, finerenone demonstrated significant benefits on short-term surrogate endpoints in patients with IgAN.
Wu et al. (Tue,) studied this question.