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

doi:10.21203/rs.3.rs-5295822/v1

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.

Finerenone

heart failure

meta-analysis

chronic kidney disease

mineralocorticoid receptor antagonist

cardiovascular outcomes

Chronic Kidney Disease (CKD) and Heart Failure (HF) are two of the most common chronic diseases in the United States with a prevalence of 35.5 million and 6.7 million, respectively [1, 2]. These two conditions are inherently connected and affect each other bidirectionally. Patients with CKD are more likely to die from cardiovascular disease than to progress to end-stage renal disease [3]. Accordingly, the emerging concept of the Cardiovascular-Kidney-Metabolic syndrome [4] is gaining increasing traction, further illustrating the physiologic link between the cardiac and renal systems. The associated healthcare costs with these conditions are significant, with 23.5% of Medicare spending being devoted to patients with CKD in 2020, signifying a need for improved long-term management [5].

The pharmacologic management of Heart Failure with Reduced Ejection Fraction (HFrEF) is well-documented. In the 2022 American College of Cardiology guidelines for management of heart failure, four pillars of pharmacotherapy have a class A recommendation: Renin-Angiotensin System (RAS) inhibitors, beta blockers, steroidal mineralocorticoid receptor antagonists, and sodium-glucose transporter 2 inhibitors. In contrast, the management of heart failure with preserved ejection fraction (HFpEF) and heart failure with mildly-reduced ejection fraction (HFmrEF) remains less clear as there are no class A recommendations for either of these clinical entities [6]. As such, more research is needed to further investigate the optimal therapy for these conditions.

On the other hand, the newest iteration of the Kidney Disease Improving Global Outcomes (KDIGO) guidelines for chronic kidney disease were published in 2024 [7]. Of interest, these guidelines now support add-on therapy with the non-steroidal mineralocorticoid receptor antagonist, Finerenone, for patients with CKD in the setting of suboptimally controlled Diabetes Mellitus (DM) type 2 on maximally-tolerated RAS blockade. This new recommendation is based upon two main trials: Effects of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes (FIDELIO-DKD) and Cardiovascular Events with Finererone in Kidney Disease and Type 2 Diabetes (FIGARO-DKD) [8, 9]. Subsequent to the publication of these trials showcasing the effect of Finerenone on CKD, a third trial named Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (FINEARTS-HF) was conducted to evaluate the effects of Finerenone on HFmrEF and HFpEF. Therefore, we conducted this meta-analysis to further evaluate the effects of the novel nonsteroidal mineralocorticoid receptor antagonist as a new treatment option for HFmrEF and HFpEF.

Data Source and Searches

We followed the PRISMA guidelines [10] and have summarized our search process in Figure 1. Adhering to the PRISMA checklist, we ensured comprehensive and transparent reporting of our systematic review, as seen in the supplementary file. Two investigators (JC.RM, and M.S.) developed the search strategy, which was revised and approved by the other investigators. We searched the following databases until September 1, 2024: PubMed-MEDLINE and EMBASE-OVID. The search strategy is shown in the supplementary file. There was no language limitation.

Study Selection

We included only RCTs in English reporting cardiovascular outcomes of Finerenone as treatment versus placebo. We excluded studies that did not match our population, intervention, and outcomes. Three investigators (JC.RM, M.S., and A.K.) independently screened each record title and abstract for potential inclusion. They then assessed full texts of selected abstracts. Discrepancies were resolved through discussion or by another investigator (A.B.).

Outcomes

The primary outcomes included death from cardiovascular causes, hospitalization for heart failure, death from any cause, and renal failure. The secondary outcomes focused on safety and adverse events, which included any serious adverse event, acute kidney injury, investigator-reported hyperkalemia, hyperkalemia related to the trial regimen, urinary tract infections, and pneumonia.

Data Extraction

Three investigators (JC.RM., M.S., A.K.) independently extracted data on the following variables: study design, study population, intervention group size, control group size, primary outcomes, secondary outcomes, and follow-up duration. Discrepancies in data extraction were resolved by discussion or by another investigator (A.B.). Baseline characteristics included demographics, clinical history, laboratory values, and medication use. Specifically, we summarized age, sex distribution, and racial composition (White, Black, Asian, Other, with missing data noted). Clinical history included duration of diabetes, systolic blood pressure, and the presence of cardiovascular disease. Kidney function was assessed using estimated glomerular filtration rate (eGFR), categorized into ≥60, 45 to <60, 25 to <45, and <25 ml/min/1.73 m².The urinary albumin-to-creatinine ratio was reported as a median with interquartile range (IQR) and categorized into <30, 30 to <300, and ≥300, including missing data. Baseline serum potassium levels were measured in mmol/liter. Medication use at baseline was recorded, including the use of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, other renin-angiotensin system inhibitors, diuretics, statins, potassium-lowering agents, glucose-lowering therapies (including insulin, glucagon-like-peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors). Further details on these characteristics are provided in the baseline characteristics section.

Risk of Bias Assessment

Two investigators (M.S. and A.K.), independently assessed the risk of bias (RoB) by using the Cochrane RoB 2.0 tool for RCTs [11]; disagreements were resolved by discussion with a third investigator (A.B.). RoB 2.0 evaluates five bias domains: randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome and selection of the reported result. The risk of bias assessment can be viewed in supplementary file.

Statistical Analysis

Our systematic review followed the 2020 PRISMA guidelines [10], and the analyses were conducted using the meta package in RevMan [12]. For the primary outcomes, we used a generic inverse variance random effects model, analyzing logged hazard ratios (HR) and confidence intervals (CI) for the two outcomes: death from cardiovascular causes and hospitalization for heart failure, as all three studies provided HRs for these measures. For death from any cause and renal failure, we employed a dichotomous random effects model, reporting outcomes as risk ratios (RR) because the FINEARTS-HF study did not provide HRs for these outcomes [13]. Adverse events were also analyzed as dichotomous outcomes using a random effects model and reported as RR.

We assessed heterogeneity among studies using the I² statistic, with I² values greater than 60% indicating substantial heterogeneity. The quality of evidence was determined using the GRADE methodology, which examines five key domains: risk of bias, inconsistency, indirectness, imprecision, and publication bias [14]. Publication bias was not assessed with Egger’s test, given a likely unreliable result with only three studies [15].

Selection of Studies

Three studies were included in the final analysis and figure 1 shows study selection process.

Characteristics of Included Studies

The study characteristics are summarized in table 1. The FIDELIO-DKD and FIGARO-DKD studies involved patients with CKD and type 2 diabetes mellitus, administering finerenone at 10 mg daily for eGFR 25-60 mL/min/1.73 m² and 20 mg for those above 60 mL/min/1.73 m². FIDELIO-DKD enrolled 5,674 participants, while FIGARO-DKD included 7,352. The FINEARTS-HF study, which focused on HFmrEF and HFpEF, enrolled 6,001 participants, administering finerenone at 20 mg daily for eGFR 30-60 mL/min/1.73 m² and 40 mg for higher eGFR. In total, 19,027 participants were included across the studies. Primary outcomes generally included kidney failure, cardiovascular death, nonfatal MI, stroke, and heart failure hospitalization, with secondary outcomes examining kidney function and heart failure symptom changes over follow-up periods of 31.2 to 40.8 months (table 1).

Baseline Characteristics

The baseline characteristics are summarized in table 2. The Effects of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes (FIDELIO-DKD) and Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes (FIGARO-DKD) studies focused on patients with chronic kidney disease and type 2 diabetes mellitus, with participants typically having moderate to severe kidney impairment (eGFR 25-60 mL/min/1.73 m²) and a majority presenting with albuminuria. Many were already on renin-angiotensin system inhibitors [16,17]. The populations in these studies were mostly older adults, averaging in their mid-60s, with a majority being male. In the Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (FINEARTS-HF) trial, targeting HFmrEF and HFpEF patients, participants had eGFRs ranging from 30-60 mL/min/1.73 m² in the lower dose group and above 60 mL/min/1.73 m² in the higher dose group [13]. This group had high rates of comorbidities, including hypertension and dyslipidemia. Overall, the trial populations were well-balanced between treatment and control arms, with no significant differences in key characteristics, allowing for a fair comparison of outcomes.

Risk of Bias of Included Studies

Risk of bias analysis indicated a low risk of bias across all domains for the FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF studies. Specifically, there was a low risk of bias related to the randomization process, deviations from intended intervention, missing outcome data, measurement of the outcome, and selection of the reported result. The overall risk of bias was judged to be low for all studies. The GRADE approach determined high certainty for most outcomes except for kidney failure, which was rated as moderate certainty due to high heterogeneity (I² > 60%). These details are in the supplementary file.

Outcomes

Finerenone reduced the risk of heart failure hospitalization by 20% (RR 0.80, 95% CI: 0.72 to 0.90, p<0.0001) compared to placebo without any heterogeneity (I² = 0%). Finerenone was associated with a significant reduction in all-cause mortality (RR 0.86, 95% CI: 0.77 to 0.97). consistent across the included studies (I² = 0%). There were no significant differences in renal failure (RR 1.05, 95% CI: 0.65 to 1.68) and death from CV causes (HR 0.91, 95% CI: 0.82 to 1.01) with Finerenone as compared to placebo. However, there was substantial heterogeneity among the studies (I² = 83%). Regarding death from any cause, the primary outcomes are summarized in table 3 and represented in the forest plots shown in figure 2.

The secondary outcomes are summarized in table 4 and in the forest plots shown in figure 3. For any serious adverse event, Finerenone was associated with a significant 5% risk reduction compared to the control group (RR 0.95, 95% CI: 0.91 to 0.98), consistent across the included studies (I² = 0%). Additionally, increased hyperkalemia related to trial regimen (RR 2.31, 95% CI: 1.98 to 2.69) and investigator-reported hyperkalemia (RR 2.09, 95% CI: 1.90 to 2.30) were statistically significant and consistent across the included studies (I² = 0%).

Finerenone had no significant risk reduction on incidence of acute kidney injury (RR 1.10, 95% CI: 0.78 to 1.53), though there was considerable heterogeneity (I² = 67%). This finding is perceived to be due to the results of the FINEARTS-HF study, which showed a significantly increased risk of acute kidney injury, contrary to the non-statistically significant reduced risk from the other two included studies [13]. Finerenone did not significantly reduce the risk of urinary tract infection between groups (RR 1.00, 95% CI: 0.88 to 1.14), consistent across the included studies (I² = 0%). Finally, Finerenone reduced the risk of heart failure by 28% (RR 0.72, 95% CI: 0.63 to 0.82), consistent across the included studies (I² = 0%).

This meta-analysis combined data from three major RCTs evaluating the efficacy of Finerenone in patients with CKD and associated heart failure, especially with HFmrEF and HFpEF. The key finding of our study is that Finerenone significantly decreases the risk of hospitalization for heart failure by 20%. This result was of special interest because evidence based therapeutic options for HFmrEF and HFpEF are limited. Further evidence of the potential role of finerenone as a useful therapeutic agent in this population is represented by the 14% reduction in all-cause mortality., On the other hand, the effectiveness of finerenone on cardiovascular mortality did not attain statistical significance. Therefore, this finding exposes that though finerenone may reduce heart failure hospitalizations along with all-cause mortality, it does not change cardiovascular-specific mortality overall. Additionally, there was no statistically significant effect on renal failure outcomes across the studies. These may relate to the various populations studied, particularly those trials that included patients with different stages of CKD and different severities of heart failure. However, all the included studies have reasonable sample size, high design quality and low risk of bias.

The safety profile for Finerenone, as reflected in this meta-analysis, is mixed. While it reduces serious adverse events by 5%, it significantly increases the incidence of hyperkalemia. This side effect is consistent with the well-described pharmacologic effect of mineralocorticoid receptor antagonists. Hyperkalemia is a concerning adverse event, and its development in patients with CKD may limit widespread use of Finerenone in this population. The other adverse outcomes, including acute kidney injury and urinary tract infections, were not significantly different between Finerenone and placebo, thereby reflecting a favorable safety profile for both renal function and infection risk.

These findings have clinical relevance in view of the increasing need for effective treatments in growing heart failure populations with preserved or mildly reduced ejection fractions. So far, treatment options for HFmrEF and HFpEF are lacking compared to well-established guidelines for HFrEF. Results of this meta-analysis would indicate that Finerenone may fill this therapeutic gap by improving heart failure-related hospital admissions, but its limited impact on cardiovascular mortality and the significant risk of hyperkalemia must be carefully weighed.

Limitations:

A key limitation of this meta-analysis is that two of the included trials, the Effects of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes (FIDELIO-DKD) and Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes (FIGARO-DKD), did not specifically focus on patients with HFmrEF or HFpEF. Instead, these studies primarily focused on patients with chronic kidney disease and type 2 diabetes, which limits the applicability of their findings to heart failure populations.

Finerenone demonstrated significant reduction in heart failure hospitalizations and all-cause mortality among patients with CKD and heart failure. However, its neutral impact on cardiovascular mortality, coupled with the risk of hyperkalemia, may limit its overall benefit. Future studies should aim at optimizing the clinical use of finerenone, either by specifying patient subgroups that would most benefit from therapy or by mitigating the risk of hyperkalemia through adjuvant therapies.

Funding

The authors did not receive any specific funding for this work.

Disclosures

None of the authors report any disclosures.

Conflicts of Interest/Competing Interests

The authors declare no conflicts of interest.

Availability of Data and Material

The data supporting the findings of this study were obtained from publicly available studies. However, the data are not available in a centralized database but can be accessed from the respective studies online.

Code Availability

The meta-analysis was conducted using the RevMan software.

Authors' Contributions

Juan Carlos Rivera-Martinez: Writing – original draft, supervision, methodology, investigation, formal analysis, conceptualization.
Michael Sabina: Writing – original draft, data curation, formal analysis, investigation, methodology.
Aqeel Khanani: Investigation, data curation, methodology, writing-original draft.
Andrew Lurie: Writing- original draft, visualization.
Amanda Rigdon: Visualization, writing-original draft.
Waiel Abusnina: Writing- review & editing.
Anas Bizanti: Data curation, writing-original draft.
Timir Paul: Writing- review & editing.

Ethics Approval

Not applicable. This meta-analysis did not require ethical approval.

Consent to Participate

Not applicable. This study did not involve human participants.

Consent for Publication

All authors provided consent for publication.

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Table 1. Study Characteristics

Study	Study design	Study population	Sample Size	Intervention	Control	Primary outcomes	Secondary outcomes	Follow up duration (months)
FIDELIO-DKD (2020)	RCT	CKD and type 2 diabetes mellitus	5674	eGFR 25-60 mL/min/1.73 m²: Finerenone 10 mg daily eGFR ≥60 mL/min/1.73 m²: Finerenone 20 mg daily	Placebo	Composite of kidney failure, a sustained decrease of at least 40% in the eGFR from baseline over a period of at least 4 weeks, or death from renal causes	1) Composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. 2) Death from any cause 3) Hospitalization for any cause 4) Change in the urinary albumin-to-creatinine ratio from baseline to month 4 5) Composite of kidney failure, a sustained decrease of at least 57% in the eGFR from baseline maintained for at least 4 weeks, or death from renal causes	31.2 months
FIGARO-DKD (2021)	RCT	CKD and type 2 diabetes mellitus	7352	eGFR 25-60 mL/min/1.73 m²: Finerenone 10 mg daily eGFR ≥60 mL/min/1.73 m²: Finerenone 20 mg daily	Placebo	Composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure.	1) Composite of the first occurrence of kidney failure, a sustained decrease from baseline of at least 40% in the eGFR for a period of at least 4 weeks, or death from renal causes. 2) Kidney failure 3) End-stage kidney disease Other 4) Hospitalization for any cause 5) Death from any cause, assessed in a time-to-event analysis 6) Change in the urinary albumin-to-creatinine ratio from baseline to month 4 7) kidney composite outcome of the first onset of kidney failure, a sustained decrease from baseline of at least 57% in the eGFR for a period of at least 4 weeks or death from renal causes.	40.8 months
FINEARTS-HF (2024)	RCT	Heart failure with mildly reduced or preserved ejection fraction	6001	eGFR 30-60 mL/min/1.73 m²: Finerenone 20 mg daily eGFR ≥60 mL/min/1.73 m²: Finerenone 40 mg daily	Placebo	Composite of total worsening heart failure events and death from cardiovascular causes.	1) Total worsening heart failure events 2) Change from baseline in the total symptom score on the Kansas City Cardiomyopathy Questionnaire at months 6, 9, and 12 3) Improvement in the New York Heart Association (NYHA) functional class at month 12 4) Kidney composite outcome (a composite of a sustained decrease in the eGFR of ≥50%, a sustained decline in the eGFR to <15 ml per minute per 1.73 m2 of body-surface area, or the initiation of long-term dialysis or kidney transplantation) 5) Death from cardiovascular causes 6) Death from any cause	32 months

RCT: randomized control trial, CKD: chronic kidney disease, eGFR: estimated glomerular filtration rate.

Table 2. Baseline Characteristics

	FIDELIO-DKD		FIGARO-DKD		FINEARTS-HF
Characteristic	Finerenone (N=2833)	Placebo (N=2841)	Finerenone (N=3686)	Placebo (N=3666)	Finerenone (N=3003)	Placebo (N=2998)
Age — yr	65.4±8.9	65.7±9.2	64. 1± 9.7	64.1 ± 10.0	71.9±9.6	72.0±9.7
Male sex — no. (%)	1953 (68.9)	2030 (71.5)	2528 (68.6)	2577 (70.3)	1648 (54.9)	1621 (54.1)
Race — no. (%)
White	1777 (62.7)	1815 (63.9)	2672 (72.5)	2605 (71.1)	2366 (78.8)	2369 (79.0)
Black	140 (4.9)	124 (4.4)	113 (3.1)	145 (4.0)	49 (1.6)	39 (1.3)
Asian	717 (25.3)	723 (25.4)	715 (19.4)	739 (20.2)	497 (16.6)	499 (16.6)
Other	199 (7.0)	179 (6.3)	177 (4.8)	170 (4.6)	91 (3.0)	91 (3.0)
missing data	-	-	9 (0.2)	7 (0.2)	-	-
Duration of diabetes — yr	16.6±8.8	16.6±8.8	-	-	-	-
Glycated hemoglobin — %	7.7±1.3	7.7±1.4	7.7 ± 1.4	7.7 ± 1.4	-	-
Systolic blood pressure — mm Hg	138.1±14.3	138.0±14.4	135.8 ± 14.0	135.7 ± 14.1	129.5±15.3	129.3±15.3
History of cardiovascular disease- no. (%)	-	-	1676 (45.5)	1654 (45.1)	-	-
Left ventricular ejection fraction
Value — %	-	-	-	-	52.6 ±7.8	52.5 ± 7.8
< 50% — no. (%)	0	0	0	0	1093 (36.5)	1079 (36.0)
≥50% — no. (%)	195 (6.9)	241 (8.5)	290(7.9)	281(7.7)	1904(63.5)	1917(64)
Estimated glomerular filtration rate
Mean-ml/min/1.73m2	44.4±12.5	44.3±12.6	67.6 ± 21.7	68.0 ± 21.7	61.9±19.4	62.3±20.0
Distribution — no. (%)
≥60 ml/min/1.73 m2	318 (11.2)	338 (11.9)	2285 (62.0)	2254 (61.5)	1552 (51.7)	1561 (52.9)
45 to <60 ml/min/1.73 m2	972 (34.3)	928 (32.7)	745 (20.2)	789 (21.5)	-	-
25 to <45 ml/min/1.73 m2	1476 (52.1)	1505 (53.0)	641 (17.4)	610 (16.6)	-	-
<25 ml/min/1.73 m2	66 (2.3)	69 (2.4)	15 (0.4)	12 (0.3)	-	-
Missing data	1 (<0.1)	1 (<0.1)	0	1 (<0.1)	-	-
Urinary albumin-to-creatinine ratio
Median (IQR)	833 (441–1628)	867 (453–1645)	302 (105-749)	315 (111-731)	18 (7-67)	19 (7-66)
Distribution — no. (%)
<30	11 (0.4)	12 (0.4)	109 (3.0)	98 (2.7)	-	-
30 to <300	350 (12.4)	335 (11.8)	1726 (46.8)	1688 (46.0)	-	-
≥300	2470 (87.2)	2493 (87.8)	1851 (50.2)	1878 (51.2)	-	-
Missing data	2 (<0.1)	1 (<0.1)	0	2 (0.1)	-	-
Serum potassium — mmol/liter	4.37±0.46	4.38±0.46	4.33±0.43	4.33±0.43	4.4±0.5	4.4±0.5
Baseline medications — no. (%)
ACE inhibitor	950 (33.5)	992 (34.9)	-	-	1083 (36.1)	1072 (35.8)
Angiotensin-receptor blocker	1879 (66.3)	1846 (65.0)	-	-	1047 (34.9)	1055 (35.2)
Renin-angiotensin system inhibitor	-	-	3681 (99.9)	3662 (99.9)	-	-
Diuretic	1577 (55.7)	1637 (57.6)	1748 (47.4)	1748 (47.7)	2618 (87.2)*	2621 (87.4)*
Statin	2105 (74.3)	2110 (74.3)	2552 (69.2)	2632 (71.8)	-	-
Potassium-lowering agent	70 (2.5)	66 (2.3)	-	-	-	-
Glucose-lowering therapy	2747 (97.0)	2777 (97.7)	3607 (97.9)	3589 (97.9)	-	-
Insulin	1843 (65.1)	1794 (63.1)	2023 (54.9)	1970 (53.7)	-	-
GLP-1 receptor agonist	189 (6.7)	205 (7.2)	308 (8.4)	242 (6.6)	79 (2.6)	88 (2.9)
SGLT2 inhibitor	124 (4.4)	135 (4.8)	314 (8.5)	304 (8.3)	393 (13.1)	424 (14.1)

ACE: Angiotensin converting enzymes, GLP-receptor agonists: Glucagon-like-peptide-1 receptor agonists, SGLT2 inhibitor: sodium-glucose cotransporter 2 inhibitors, *: loop diuretic

Table 3: Primary outcomes

Study	Intervention		Death from cardiovascular causes	Hospitalization for heart failure	Kidney failure	Death from any cause
FIDELIO-DKD	Finerenone (N=2833)	no. of patients with event (%)	128 (4.5)	139 (4.9)	208 (7.3)	219 (7.7)
	Placebo (N=2841)	no. of patients with event (%)	150 (5.3)	162 (5.7)	235 (8.3)	244 (8.6)
	Hazard Ratio (95% CI)		0.86 (0.68-1.08)	0.86 (0.68-1.08)	0.87 (0.72-1.05)	0.90 (0.75-1.07)
FIGARO-DKD	Finerenone (N=3686)	no. of patients with event (%)	194 (5.3)	117 (3.2)	46 (1.2)	333 (9.0)
	Placebo (N=3666)	no. of patients with event (%)	214 (5.8)	163 (4.4)	62 (1.7)	370 (10.1)
	Hazard Ratio (95% CI)		0.90 (0.74-1.09)	0.71 (0.56-0.90)	0.72 (0.49-1.05)	0.89 (0.77-1.04)
FINEARTS-HF	Finerenone (N=3003)	no. of patients with event (%)	242 (8.1)	842*	54 (1.8)	70 (2.3)
	Placebo (N=2998)	no. of patients with event (%)	260 (8.7)	1024*	28 (0.9)	97 (3.2)
	Hazard Ratio (95% CI)		0.93 (0.71-0.94)	0.82 (0.71-0.94)	-	-

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

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Abstract

Purpose

Methods

Results

Conclusion

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Introduction

Materials and Methods

Results

Discussion

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Conclusion

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Supplementary Files

Status:

Version 1