Finerenone reduces cardiovascular and kidney disease risk in type 2 diabetes
Cureus
Summary
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.
Study Design
Interventions
Study Type
Outcomes
Duration and Size
Study Population
Age Range
Sex
Geography
Other Criteria
Methodology
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.
Interventions
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.
Key Findings
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.
Comparison with other Studies
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.
Journal Reference
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
© 2026 deDiabetes. Licensed under CC BY (Attribution)
Related and Discussions
Stay informed. Stay ahead.
Subscribe now for the latest breakthroughs, expert insights, and cutting-edge updates in diabetes care—delivered straight to your inbox.