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Review
. 2023 Aug 16;85(10):4973-4980.
doi: 10.1097/MS9.0000000000001180. eCollection 2023 Oct.

Efficacy and safety of finerenone in chronic kidney disease and type 2 diabetes patients: a systematic review and meta-analysis

Affiliations
Review

Efficacy and safety of finerenone in chronic kidney disease and type 2 diabetes patients: a systematic review and meta-analysis

Farah Yasmin et al. Ann Med Surg (Lond). .

Abstract

Background and objectives: The incidence of morbidity and mortality in patients with type 2 diabetes mellitus is substantially correlated with cardiovascular disease and chronic kidney disease. The current guidelines recommend the use of renin-angiotensin system blockers, but recent studies probed into the effects of finerenone to mitigate the risk of cardiorenal events. This meta-analysis was performed to demonstrate the effects of finerenone on cardiorenal events, comprising cardiovascular mortality, heart failure, change in estimated glomerular filtration rate, and serum potassium levels.

Methods: After screening with our eligibility criteria, 350 articles were identified with an initial literature search on multiple databases, including PubMed, Science Direct, and Cochrane Central. Seven randomized controlled trials with a total of 15 462 patients (n=8487 in the finerenone group; n=6975 in the control group) were included.

Results: Patients receiving finerenone were at a reduced risk for cardiovascular mortality [HR: 0.84 (0.74, 0.95)], heart failure [OR: 0.79 (0.68, 0.92)], decrease in estimated glomerular filtration rate by 40% [OR: 0.82 (0.74, 0.91)] and by 57% [OR: 0.70 (0.59, 0.82)]; and a higher incidence of moderate hyperkalemia [OR: 2.25 (1.78, 2.84)].

Conclusion: Finerenone, owing to its better mineralocorticoid affinity, and a much lower risk of adverse effects, promises to be a much better alternative than other renin-angiotensin system blockers available for the treatment of chronic kidney disease patients with type 2 diabetes. Further trials should be conducted to provide more definitive evidence to assess the safety and efficacy of finerenone compared to spironolactone and eplerenone.

Keywords: chronic kidney disease (CKD); finerenone; meta-analysis; mineralocorticoid receptor antagnosits (MRA); type 2 diabetes.

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Conflict of interest statement

I undersign, certificate that I do not have any financial or personal relationships that might bias the content of this work.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
CV Mortality in patients treated with finerenone or control. Red squares and their corresponding lines are the point estimates and 95% CI per study. Black diamonds represent the pooled effect estimate.
Figure 2
Figure 2
Heart Failure in patients treated with finerenone or control. Blue squares and their corresponding lines are the point estimates and 95% CI per study. Black diamonds represent the pooled effect estimate.
Figure 3
Figure 3
Decrease in eGFR by 40% in patients treated with finerenone or control. Blue squares and their corresponding lines are the point estimates and 95% CI per study. Black diamonds represent the pooled effect estimate.
Figure 4
Figure 4
Decrease in eGFR by 57% in patients treated with finerenone or control. Blue squares and their corresponding lines are the point estimates and 95% CI per study. Black diamonds represent the pooled effect estimate.
Figure 5
Figure 5
Change in eGFR (ml/min/1.73m2) in patients treated with finerenone or control. Green squares and their corresponding lines are the point estimates and 95% CI per study. Black diamonds represent the pooled effect estimate.
Figure 6
Figure 6
Moderate Hyperkalemia in patients treated with finerenone or control. Blue squares and their corresponding lines are the point estimates and 95% CI per study. Black diamonds represent the pooled effect estimate.
Figure 7
Figure 7
Mild Hyperkalemia in patients treated with finerenone or control. Blue squares and their corresponding lines are the point estimates and 95% CI per study. Black diamonds represent the pooled effect estimate.
Figure 8
Figure 8
Risk of Bias Assessment.

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