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Comparative Effectiveness of Finerenone Versus SGLT2 Inhibitors in Patients with HFpEF and CKD: A Real-World

Faizan Ahmed1, Saifullah Khan2, Najam Gohar3

  • 1Department of Internal Medicine, Hackensack Meridian Health, Jersey Shore University Medical Center, Neptune, NJ 07753, USA.

Biomedicines
|May 27, 2026
PubMed

Insights

Finerenone and SGLT2 inhibitors showed similar outcomes for mortality and hospitalization in patients with chronic kidney disease and heart failure. Finerenone demonstrated a potential, hypothesis-generating reduction in heart failure hospitalizations.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Finerenone and SGLT2 inhibitors offer cardiovascular and renal benefits in chronic kidney disease (CKD) and heart failure (HF).
  • Limited real-world comparative data exists for these treatments in patients with both conditions.
  • This study addresses the gap in real-world comparative effectiveness.

Purpose of the Study:

  • To compare the real-world effectiveness and safety of finerenone versus SGLT2 inhibitors.
  • To evaluate outcomes in patients with CKD stages 1-5 and heart failure (HFpEF).
  • To generate hypotheses for future prospective trials.

Main Methods:

  • Retrospective analysis of the TriNetX database.
  • Comparison of adults (≥40 years) with CKD and HFpEF on finerenone versus SGLT2 inhibitors.
  • Propensity score matching (1:1) to create comparable cohorts (n=333 each), followed by Kaplan-Meier and Cox modeling.

Main Results:

  • All-cause mortality and hospitalization rates were similar between finerenone and SGLT2 inhibitor groups at 6 months and 1 year.
  • A modest, borderline reduction in heart failure hospitalization was observed with finerenone at 1 year (HR 0.81; 95% CI 0.66-0.99).
  • No significant differences in safety outcomes were noted between the treatment groups.

Conclusions:

  • In real-world practice, finerenone demonstrated comparable safety and effectiveness to SGLT2 inhibitors for mortality and renal outcomes in CKD and HFpEF patients.
  • The observed reduction in HF hospitalizations with finerenone is hypothesis-generating and requires cautious interpretation.
  • Prospective head-to-head trials are needed to confirm findings and guide optimal treatment strategies.

Keywords:
HFpEFSGLT2 inhibitorschronic kidney diseasefinerenonepropensity score matching

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