Effect of Finerenone in Cardiovascular and Renal Outcomes: A Systematic Review and Meta-analysis

Heart failure (HF) management is well-defined for reduced ejection fraction (HFrEF) but less so for mildly reduced (HFmrEF) or preserved ejection fraction (HFpEF). This meta-analysis evaluates the impact of Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, on cardiovascular and renal outcomes in these patient populations. A systematic search in PubMed and Embase identified randomized controlled trials (RCTs) on Finerenone's cardiovascular and renal effects. Three RCTs were included—FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF—encompassing 19,027 participants. Primary outcomes included cardiovascular death, HF hospitalization, and renal failure. Secondary outcomes focused on safety and adverse events like acute kidney injury and hyperkalemia. Meta-analyses were performed using hazard ratios (HR), confidence intervals (CI), and Relative Risk (RR). Finerenone was associated with a 20% reduction in HF hospitalization risk (HR 0.80, 95% CI: 0.72–0.90) and a 14% reduction in all-cause mortality (RR 0.86, 95% CI: 0.77–0.97). Finerenone did not significantly reduce cardiovascular death (HR 0.91, 95% CI: 0.82–1.01, p = 0.06). Renal failure rates were similar between Finerenone and placebo (RR 1.05, 95% CI: 0.65–1.68). Hyperkalemia incidence was significantly higher with Finerenone, with a RR of 2.31 (95% CI: 1.98–2.69). This meta-analysis shows that Finerenone significantly reduces HF hospitalizations and all-cause mortality in patients with chronic kidney disease and heart failure. Further studies are needed to clarify its effects on cardiovascular death and renal failure.