Comparative efficacy and safety of finerenone in diabetic kidney disease: a meta-analysis of Asian and non-Asian populations
Abstract
Background & objective: Diabetic kidney disease (DKD) is a major global burden, especially in Asia. This study aimed to evaluate the efficacy and safety of finerenone in diabetic kidney disease, comparing outcomes between Asian and non-Asian populations through a systematic review and meta-analysis.
Methods: A systematic search was conducted across PubMed, Cochrane Library, ClinicalTrials.gov, Google Scholar, and the Undermind AI platform from inception through March 2025. Studies included randomized controlled trials (RCTs) and subgroup analyses that evaluated finerenone in DKD patients. Primary outcomes included a reduction in the urinary albumin-to-creatinine ratio (UACR) and a decline in the estimated glomerular filtration rate (eGFR) of ≥40%. Secondary outcomes included cardiovascular events, mortality due to kidney failure, hyperkalemia (serum potassium >5.0 mmol/L), treatment discontinuation, hospitalization, and adverse event-related mortality. Risk ratios (RRs) and mean differences (MDs) were pooled using a random-effects model, and subgroup analyses were performed by ethnicity.
Results: Five eligible studies, comprising 8,763 participants, were included in this analysis. Finerenone significantly reduced UACR compared with placebo (MD = -0.38, 95% CI -0.42 to -0.35; p < 0.001), with consistent effects across Asian and non-Asian populations (subgroup p = 0.28). It also significantly reduced the risk of eGFR decline ≥40% (MD = -0.24 [-0.40, -0.09]; p = 0.002), with a…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 8,763 participants or records.
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