Comparative Cardiorenal Efficacy and Safety of Finerenone, SGLT2 Inhibitors, Semaglutide and Their Combination in Diabetic Kidney Disease
Abstract
Aim: To compare the cardiorenal efficacy and safety of finerenone, sodium-glucose cotransporter 2 inhibitors (SGLT2i), semaglutide and finerenone-SGLT2i combination therapy in diabetic kidney disease (DKD).
Materials and methods: PubMed, Embase and CENTRAL were searched through July 9, 2026 for randomized trials involving adults with Type 2 diabetes and DKD. A frequentist network meta-analysis estimated risk ratios (RRs) with 95% confidence intervals (CIs) for cardiorenal and safety outcomes.
Results: Ten randomized datasets involving 37 923 participants were included. Compared with control, dapagliflozin, canagliflozin, finerenone and semaglutide reduced both cardiovascular composite events and composite kidney outcomes; sotagliflozin reduced cardiovascular composite events, and empagliflozin reduced composite kidney outcomes. SGLT2i showed the broadest overall pattern of benefit across cardiorenal outcomes. Dapagliflozin was associated with a lower risk of the composite kidney outcome than semaglutide (RR 0.71, 95% CI: 0.53-0.94), while most other efficacy comparisons between active monotherapies were not statistically significant. Finerenone increased hyperkalaemia (RR 2.03, 95% CI: 1.82-2.26) and treatment discontinuation due to adverse events (RR 1.18, 95% CI: 1.02-1.35). Finerenone plus empagliflozin was associated with a higher risk of hyperkalaemia than empagliflozin alone (RR 2.48, 95% CI: 1.22-5.06).
Conclusions: SGLT2i showed the broadest cardiorenal benefits,…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 37 participants or records.
Read the paper
Related studies
- Strategy for Mitigating DKA Risk in Patients with Type 1 Diabetes on Adjunctive Treatment with SGLT Inhibitors: A STICH Protocol
- Glucoraphanin: a broccoli sprout extract that ameliorates obesity-induced inflammation and insulin resistance
- SGLT2 Inhibitors in Heart Failure: Targeted Metabolomics and Energetic Metabolism
- Mechanisms of blood pressure reduction with sodium-glucose co-transporter 2 (SGLT2) inhibitors
- Sodium-glucose cotransporter inhibitors: beyond glycaemic control
- Decoding the effects of SGLT2 inhibitors on cardiac arrhythmias in heart failure
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.