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Finerenone and Cardiorenal Outcomes: A Narrative Review.
Werner Fernandes1, Sanzana Tasneem1, Faizaan Latif1
1From the School of Medicine, New Vision University, Tbilisi, Georgia.
Cardiology in Review
|June 29, 2026
Summary
Finerenone offers significant cardiorenal benefits for type 2 diabetes patients with chronic kidney disease (CKD). It reduces kidney and cardiovascular events, providing organ protection beyond existing therapies.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Chronic kidney disease (CKD) affects up to 40% of type 2 diabetes patients, increasing cardiovascular risks.
- Existing treatments like renin-angiotensin system inhibitors and SGLT2 inhibitors are insufficient for many.
- Mineralocorticoid receptor overactivation contributes to inflammation and fibrosis in diabetic kidney disease.
Purpose of the Study:
- To review the cardiorenal benefits of finerenone in patients with CKD and type 2 diabetes.
- To summarize evidence on finerenone's efficacy and safety from clinical trials and real-world studies.
- To evaluate finerenone's role in reducing kidney function decline and cardiovascular events.
Main Methods:
- Narrative review of studies published between 2014 and 2025.
- Inclusion of key clinical trials: FIDELIO-DKD, FIGARO-DKD, and HF trials.
- Analysis of pooled data and relevant real-world evidence.
Main Results:
- Finerenone significantly reduces urine albumin-to-creatinine ratio (approx. 30%) and slows kidney function decline.
- Pooled analyses show a 23% reduction in serious kidney outcomes and 14% reduction in major cardiovascular events.
- Hyperkalemia occurred more frequently but was manageable with monitoring; discontinuation was uncommon.
Conclusions:
- Finerenone is a valuable addition for cardiorenal risk reduction in type 2 diabetes with CKD.
- It offers organ protection by targeting mineralocorticoid receptor-mediated inflammation and fibrosis.
- Further head-to-head trials comparing finerenone with other mineralocorticoid receptor antagonists are needed.
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