SYSTEMATIC REVIEW article
Front. Med.
Sec. Nephrology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1594202
Association of finerenone with prognosis and safety in diabetic kidney disease patients: an undated meta-analysis based on four RCTs
Provisionally accepted
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Background: Although current guidelines have recommended finerenone as a firstline 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).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.
Keywords: Diabetic kidney disease, finerenone, Mortality, Systematic review, metaanalysis
Received: 15 Mar 2025; Accepted: 17 Jun 2025.
Copyright: © 2025 Zhang, Zhang, Bai, Li and Yifei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhong Yifei, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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