A meta-analysis of the effects of finerenone on cardio-renal outcomes in patients with type 2 diabetes mellitus or chronic kidney disease

ObjectiveTo evaluate the effects of finerenone on cardio-renal outcomes in patients with type 2 diabetes mellitus （T2DM） or chronic kidney disease （CKD） by meta-analysis， and to provide evidence support for clinical treatment.MethodsClinical trials about the use of finerenone in treating T2DM or CKD published before February 2024 were searched in Chinese and English language databases， including the CNKI， Wanfang， VIP， The Cochrane Library， Web of Science， Pubmed， Embase and others. According to the inclusion and exclusion criteria， eligible trials were included. Cochrane risk bias assessment tool was used for quality assessment， and RevMan 5.3 statistical software was used for Meta-analysis.ResultsA total of 9 clinical trials involving 67，785 patients were included. The results of Meta-analysis showed that finerenone could significantly reduce the combined cardiovascular outcomes of T2DM or CKD （<italic>OR</italic>=0.81， 95%<italic>CI</italic>： 0.78-0.85， <italic>P</italic>&lt;0.00001） and renal outcomes （<italic>OR</italic>=0.80， 95%<italic>CI</italic>： 0.73-0.87， <italic>P</italic>&lt;0.00001）. Finerenone significantly decreased cardiovascular mortality （<italic>OR</italic>=0.86， 95%<italic>CI</italic>： 0.80-0.92， <italic>P</italic>&lt;0.00001）， incidence of non-fatal myocardial infarction（<italic>OR</italic>=0.88， 95%<italic>CI</italic>： 0.78-0.99， <italic>P</italic>=0.04）， hospitalization for heart failure （<italic>OR</italic>=0.76， 95%<italic>CI</italic>： 0.69-0.84， <italic>P</italic>&lt;0.00001）， incidence of renal failure （<italic>OR</italic>=0.82， 95%<italic>CI</italic>： 0.74-0.91， <italic>P</italic>=0.0002）， incidence of end-stage renal disease （<italic>OR</italic>=0.78， 95%<italic>CI</italic>： 0.69-0.89， <italic>P</italic>=0.0002）. Persistent glomerular filtration rate （eGFR） decline&lt;15 mL·min^-1·（1.73 m²）^-1（<italic>OR</italic>=0.79， 95%<italic>CI</italic>： 0.70-0.89， <italic>P</italic>&lt;0.0001）， and proportion of patients with sustained eGFR decline≥40% from baseline （<italic>OR</italic>=0.83， 95%<italic>CI</italic>： 0.77-0.89， <italic>P</italic>&lt;0.0001）， and sustained eGFR decline≥57% from baseline （<italic>OR</italic>=0.69， 95%<italic>CI</italic>： 0.63-0.76， <italic>P</italic>&lt;0.00001） were risk factors for cardiorenal endpoint events in T2DM or CKD patients treated with finerenone.ConclusionFinerenone can reduce the risk of cardiorenal endpoint events in T2DM or CKD patients， and can effectively improve the renal function of patients with cardiorenal protection.