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

Purpose Heart failure is prevalent in the United States. Although guidelines exist for managing heart failure with reduced ejection fraction (HFrEF), there is no consensus for heart failure with mildly reduced (HFmrEF) or preserved ejection fraction (HFpEF). Recent trials have explored Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, in HFmrEF and HFpEF patients. This meta-analysis evaluates Finerenone as a treatment option. Methods A systematic search was conducted in PubMed and Embase for randomized controlled trials (RCTs) examining Finerenone's effects on cardiovascular and renal outcomes. The analysis included three RCTs: FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF, with 19,027 participants. Primary outcomes were cardiovascular death, heart failure hospitalization, and renal failure. Secondary outcomes included safety and adverse events like acute kidney injury and hyperkalemia. Meta-analyses used hazard ratios (HR), confidence intervals (CI), and risk ratios (RR). Results Finerenone reduced heart failure hospitalization risk by 20% (HR 0.80, 95% CI: 0.72–0.90, p < 0.0001) with no heterogeneity (I² = 0%). A 14% reduction in all-cause mortality was observed (RR 0.86, 95% CI: 0.77–0.97, p = 0.01). However, 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). Conclusion This meta-analysis shows Finerenone significantly reduces heart failure hospitalizations and all-cause mortality in patients with chronic kidney disease and heart failure. Further research is needed to assess its impact on cardiovascular death and renal failure.