The Cardiorenal Protective Effects of Finerenone in Patients with Diabetes and Heart Failure: A Meta-Analysis.

Introduction: To evaluate the cardiorenal protective effects of finerenone in patients with diabetes and heart failure through a meta-analysis of randomized controlled trials (RCTs).

Methods: This meta-analysis included 12 RCTs (total n = 65,226) assessing finerenone versus placebo. Primary outcomes included cardiovascular composite endpoints (major adverse cardiovascular events [MACE]) and kidney composite outcomes (sustained eGFR decline, end-stage kidney disease, or renal mortality). Secondary outcomes encompassed total worsening heart failure events and cardiovascular mortality. Random-effects models were applied to pool hazard ratios (HRs) with 95% confidence intervals (CIs). Heterogeneity was quantified using Cochran's Q and I² statistics. Sensitivity analyses and publication bias assessments (Egger's/Begg's tests, funnel plots) were performed.

Results: Finerenone significantly reduced major adverse cardiovascular events (9 RCTs, n = 21,542; hazard ratio [HR] 0.858, 95% CI: 0.786-0.937; p = 0.001) and kidney composite outcomes (n = 23,109; HR 0.827, 95% CI: 0.760-0.901; p < 0.001), despite substantial heterogeneity (I² = 78.2% and 64.4%, respectively). Sensitivity analyses confirmed robustness, with consistent effects after sequential trial exclusion. Finerenone also reduced worsening heart failure events (n = 12,874; HR 0.790, 95% CI: 0.700-0.891; p < 0.001; I² = 4.7%), though cardiovascular mortality reduction was nonsignificant (HR 0.914, 95% CI: 0.831-1.005; p = 0.063). No publication bias was detected for primary outcomes.

Conclusion: Finerenone demonstrates consistent cardiorenal protection in patients with diabetes and heart failure, significantly reducing cardiovascular and kidney complications.