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

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...

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Main Authors: Zixuan Zhang, Fan Zhang, Yan Bai, Jiao Li, Yifei Zhong
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-07-01
Series:Frontiers in Medicine
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Online Access:https://www.frontiersin.org/articles/10.3389/fmed.2025.1594202/full
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author Zixuan Zhang
Fan Zhang
Yan Bai
Jiao Li
Yifei Zhong
author_facet Zixuan Zhang
Fan Zhang
Yan Bai
Jiao Li
Yifei Zhong
author_sort Zixuan Zhang
collection DOAJ
description 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.
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spelling doaj-art-79c3190fd1ab41039dfd19387fa365d32025-08-20T03:30:37ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-07-011210.3389/fmed.2025.15942021594202Association of finerenone with prognosis and safety in diabetic kidney disease patients: an undated meta-analysis based on four RCTsZixuan ZhangFan ZhangYan BaiJiao LiYifei ZhongBackgroundAlthough 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.https://www.frontiersin.org/articles/10.3389/fmed.2025.1594202/fulldiabetic kidney diseasefinerenonemortalitysystematic reviewmeta-analysis
spellingShingle Zixuan Zhang
Fan Zhang
Yan Bai
Jiao Li
Yifei Zhong
Association of finerenone with prognosis and safety in diabetic kidney disease patients: an undated meta-analysis based on four RCTs
Frontiers in Medicine
diabetic kidney disease
finerenone
mortality
systematic review
meta-analysis
title Association of finerenone with prognosis and safety in diabetic kidney disease patients: an undated meta-analysis based on four RCTs
title_full Association of finerenone with prognosis and safety in diabetic kidney disease patients: an undated meta-analysis based on four RCTs
title_fullStr Association of finerenone with prognosis and safety in diabetic kidney disease patients: an undated meta-analysis based on four RCTs
title_full_unstemmed Association of finerenone with prognosis and safety in diabetic kidney disease patients: an undated meta-analysis based on four RCTs
title_short Association of finerenone with prognosis and safety in diabetic kidney disease patients: an undated meta-analysis based on four RCTs
title_sort association of finerenone with prognosis and safety in diabetic kidney disease patients an undated meta analysis based on four rcts
topic diabetic kidney disease
finerenone
mortality
systematic review
meta-analysis
url https://www.frontiersin.org/articles/10.3389/fmed.2025.1594202/full
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