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Finerenone reduced the combined risk of cardiovascular death, heart attack, stroke, or heart failure hospitalization by 14% (HR 0.86, 95% CI 0.78-0.95). This benefit was seen consistently across multiple large studies totaling over 13,000 participants and remained significant across different patient subgroups including those with varying kidney disease severity, age groups, and concurrent medication use.

Finerenone reduced the combined risk of kidney failure, sustained decline in kidney function of 57% or more, or death from kidney disease by 23% (HR 0.77, 95% CI 0.67-0.88). The kidney protective effect was dose-dependent up to 20 mg daily and was accompanied by consistent reductions in protein in the urine and slower decline in kidney function across studies.

Finerenone reduced hospitalizations for heart failure as part of the cardiovascular composite outcome. The benefit was particularly pronounced in males (p-interaction=0.02) and in patients with left ventricular hypertrophy at baseline (p-interaction=0.0024), suggesting additional protection in these subgroups.

Finerenone consistently reduced urinary protein levels (albuminuria), a key marker of kidney damage, across all studies. The reduction was particularly notable when combined with GLP-1 receptor agonists, showing a 38% reduction compared to 31% without GLP-1RA use (p-interaction=0.03).

Elevated potassium levels (hyperkalemia) occurred in 10-26% of patients taking finerenone, depending on subgroup characteristics. However, serious hyperkalemia requiring hospitalization was rare, and fewer than 3% of patients discontinued treatment due to high potassium levels. This represents a more favorable safety profile than older mineralocorticoid receptor antagonists.

10-20 mg once daily, added to standard RAAS inhibitor therapy

These findings build on earlier evidence showing that older mineralocorticoid receptor antagonists like spironolactone can protect the kidneys, but were limited by high rates of elevated potassium (30-40% in people with moderate to severe kidney disease). Finerenone's nonsteroidal structure appears to offer a better safety profile while maintaining effectiveness. The benefits complement those seen with SGLT2 inhibitors and GLP-1 receptor agonists, which work through different mechanisms. Current clinical practice guidelines from KDIGO and diabetes organizations already recommend finerenone for people with type 2 diabetes, kidney disease, and protein in the urine despite standard treatment, a position strongly supported by these results.

Confidence is high because this review included large, well-designed studies with over 13,000 participants. The main findings came from carefully planned trials where treatments were randomly assigned and outcomes were independently verified. Results were consistent across multiple studies and different patient groups, strengthening the conclusions. The review followed strict quality standards and included only high-quality research.

Finerenone appears to reduce both heart-related events and kidney disease progression in people with type 2 diabetes and kidney disease.

The medication lowered the combined risk of heart attack, stroke, heart failure hospitalization, and cardiovascular death by 14%, with even greater protection against kidney failure.

Benefits were fairly consistent across different patient groups, though evidence is limited for elderly people over 75 and those with very advanced kidney disease.

The results suggest that adding finerenone to standard treatment may help protect both the heart and kidneys in people with type 2 diabetes and kidney disease.

Evidence is strongest for people with mild to moderate kidney disease who are already taking ACE inhibitors or ARBs.

The benefits appear to work alongside other diabetes medications like SGLT2 inhibitors and GLP-1 receptor agonists, suggesting they may complement each other.

Higher potassium levels are more common with finerenone, but most people can continue treatment with monitoring.

The primary intervention was finerenone, a nonsteroidal medication that blocks mineralocorticoid receptors, given at doses of 10-20 mg once daily. All participants were already taking optimized background therapy with ACE inhibitors or ARBs (medications that protect the kidneys). The comparison group received placebo plus the same standard background treatment. Some analyses examined whether benefits differed in people also taking SGLT2 inhibitors (medications that lower blood sugar by helping the kidneys remove glucose) or GLP-1 receptor agonists (injectable medications that help control blood sugar). Diuretic use (water pills) was also assessed as a potential modifier of treatment effects.

Finerenone, Mineralocorticoid receptor antagonist, ACE inhibitor, Angiotensin receptor blocker, SGLT2 inhibitor, GLP-1 receptor agonist, Diuretic

Bachar Al Sumodi W, Sajjad M, Rana SU, Ahmed G, Hans A, Mirani W. Effects of Contemporary Therapies on Cardiovascular and Renal Outcomes in Diabetic Kidney Disease: A Systematic Review of Randomized Controlled Trials (RCTs). Cureus. 2025;17(10):e95400. doi:10.7759/cureus.95400

Across the pooled analysis of 13,026 participants, finerenone reduced the combined risk of cardiovascular death, heart attack, stroke, or heart failure hospitalization by 14% compared to placebo. The absolute risk reduction translates to preventing about 14 cardiovascular events per 1,000 people treated over 3 years. Kidney benefits were even more pronounced, with a 23% reduction in the combined risk of kidney failure, major sustained decline in kidney function, or death from kidney disease. Finerenone also consistently reduced protein in the urine (a marker of kidney damage) and slowed the decline in kidney function. These benefits were generally consistent across different patient subgroups, though people over 75 showed less clear kidney protection. The dose-response analysis showed that benefits plateaued at the 20 mg dose. The main safety concern was higher potassium levels, which occurred in 10-26% of patients depending on subgroup, but led to treatment discontinuation in fewer than 3% of cases.

Finerenone reduces heart and kidney disease risk in type 2 diabetes with kidney disease.

The studies had important gaps in who was included. Women made up less than 30% of participants, and people over 75 or with very advanced kidney disease were underrepresented. The follow-up period of 2-3 years may not be long enough to see the full long-term effects on kidney health. Many of the subgroup findings came from secondary analyses that weren't originally planned, which increases the chance of misleading results. The highly selected study participants with optimized background treatment may not represent typical patients seen in everyday practice.

Cardiovascular events → ↓ (moderate reduction, 14%)

Kidney failure/function decline → ↓ (strong reduction, 23%)

Potassium levels → ↑ (increased, but rarely leading to stopping treatment)

Aldosterone Antagonists for Preventing the Progression of Chronic Kidney Disease

This systematic review followed rigorous PRISMA guidelines to identify and analyze randomized controlled trials. Researchers searched major medical databases through May 2025 for studies testing contemporary therapies in adults with type 2 diabetes and chronic kidney disease. The review focused primarily on finerenone, a newer medication, added to standard kidney-protective treatment. Eight high-quality studies were included, involving more than 13,000 participants followed for median durations of 2.6 to 3 years. The main pooled analysis (FIDELITY) combined data from two large trials. Multiple subgroup analyses examined whether benefits differed by age, sex, kidney disease severity, or use of other medications. Study quality was assessed using standard tools, and outcomes were independently verified in the original trials.

Finerenone reduces cardiovascular and kidney disease risk in type 2 diabetes

This systematic review analyzed 8 studies involving over 13,000 adults with type 2 diabetes and chronic kidney disease. The studies tested finerenone, a newer medication that blocks certain hormone receptors, added to standard care. Participants already taking medications to protect their kidneys were followed for about 3 years. Results showed finerenone reduced the risk of heart attacks, strokes, heart failure hospitalization, and cardiovascular death by 14%, and lowered the risk of kidney failure or major kidney function decline by 23%. Benefits were seen across different patient groups, though elderly patients over 75 showed less kidney protection. The main side effect was higher potassium levels, but few people stopped treatment because of it.

Most study participants were male and under 75 years old, so results may not fully apply to women or elderly patients.

People with very advanced kidney disease made up only 7% of participants, so benefits in this group are less certain.

Follow-up lasted about 3 years, which may not be long enough to see all long-term effects on kidney health.

Study participants received careful monitoring and optimized background treatment, which may not reflect typical care settings.

8 studies with over 13,000 adults with type 2 diabetes and kidney disease over 3 years

Adults with type 2 diabetes and chronic kidney disease who are already taking medications to protect their kidneys (ACE inhibitors or ARBs). Benefits were seen across different stages of kidney disease, though evidence is strongest for people with mild to moderate kidney impairment. Results may apply less directly to women, people over 75, or those with very advanced kidney disease, as these groups were underrepresented in the studies.

Finerenone reduces cardiovascular and kidney disease risk in type 2 diabetes

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