AUTHOR=Zhang Zixuan , Zhang Fan , Bai Yan , Li Jiao , Zhong Yifei 

TITLE=Association of finerenone with prognosis and safety in diabetic kidney disease patients: an undated meta-analysis based on four RCTs

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1594202

DOI=10.3389/fmed.2025.1594202

ISSN=2296-858X

ABSTRACT=BackgroundAlthough 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.MethodsA 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).ResultsFour 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).ConclusionThis 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 registrationhttps://www.crd.york.ac.uk/PROSPERO/, CRD42023463227.