Finerenone and Its Cardiorenal Protective Effects: A Meta-Analysis of 21,731 Patients From Randomized Trials

Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, has emerged as a promising therapy for patients with diabetes, chronic kidney disease, heart failure (HF), or diabetes. We aimed to summarize the current evidence on its cardiovascular (CV) and renal benefits. A systematic search of PubMed, Cochrane CENTRAL, Embase, and ClinicalTrials.gov was conducted up to July 21, 2024. Randomized controlled trials assessing finerenone's effects on CV and renal outcomes were pooled using a random-effects model, with results expressed as risk ratios (RRs) or mean differences (MDs) with corresponding 95% confidence intervals. Nine randomized controlled trials with 21,731 participants were included. Finerenone significantly reduced all-cause mortality (RR, 0.92; P = 0.03), major adverse CV events (RR, 0.85; P < 0.00001), and HF hospitalizations (RR, 0.82; P < 0.00001). It lowered the risk of sustained ≥57% estimated glomerular filtration rate decline (RR, 0.70; P = 0.01), slowed overall estimated glomerular filtration rate deterioration (MD, -1.65; P = 0.02), and reduced urine albumin-to-creatinine ratio (MD, -0.28; P < 0.00001). CV death showed a nonsignificant reduction (RR, 0.90; P = 0.05), while myocardial infarction risk (P = 0.37), adverse events (P = 0.40), and discontinuations (P = 0.45) were similar between groups. However, hyperkalemia risk was higher with finerenone (RR, 2.05; P < 0.00001). Finerenone provides significant cardiorenal benefits, reducing CV events, HF hospitalizations, and kidney disease progression in patients with chronic kidney disease, HF, and diabetes, with a favorable safety profile aside from increased hyperkalemia risk. These findings support its role as an effective add-on to standard cardiorenal therapies.