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Review Article
Online Published: 30 Sep 2026
 


Finerenone and cardiorenal outcomes in diabetic kidney disease: a systematic review and meta-analysis of randomized controlled trial evidence

Hosam Hadi Awaji, Abubakr Ahmad Bajaber, Abdullah Mohammed Al Nebaihi, Lubna Mohammed Saeidalamin, Zyad Abdulrahman Algolkhof, Awatif Jubran Hazazi, Omar Ahmad Muflih Alenazi, Shahad Obaidallah Almutairi, Khadijah Reda Almubasher, Majd Hassan Alhuthayfi.


Abstract
Among patients with type 2 diabetes (T2D), diabetic kidney disease (DKD) ranks among the foremost drivers of end-stage kidney disease and cardiovascular illness. Finerenone, a selective, nonsteroidal antagonist of the mineralocorticoid receptor, has been positioned as an agent that protects both heart and kidney. This systematic review and meta-analysis was conducted to estimate how finerenone affects albuminuria and composite kidney and cardiovascular endpoints in DKD. Four databases were searched from their earliest records through August 1, 2026, to locate studies testing finerenone in T2D patients with DKD. Using a random-effects, inverse-variance approach, the geometric mean ratio were pooled for change in urinary albumin-to-creatinine ratio (UACR) together with hazard ratios (HR) for the composite kidney and cardiovascular endpoints. Of 1,573 records identified, six articles satisfied the eligibility criteria. The UACR analysis drew on four trials (n = 13,263), yielding a pooled ratio of 0.683 (95% CI 0.666-0.701; p < 0.0001), equivalent to a 32% placebo-corrected reduction, with essentially no between-study heterogeneity (I² = 0%). For the two pivotal trials, FIDELIO-DKD and FIGARO-DKD (n = 13,026), the pooled hazard ratios were 0.841 (95% CI 0.767-0.922) for the composite kidney endpoint and 0.865 (95% CI 0.788-0.950) for the composite cardiovascular endpoint. When layered onto optimized renin–angiotensin–aldosterone system blockade, finerenone meaningfully lowers albuminuria and cuts the risk of composite kidney and cardiovascular events in adults with T2D and DKD, a pattern that held consistently across the trials examined.

Key words: Finerenone, mineralocorticoid receptor antagonist, diabetic kidney disease, albuminuria, cardiovascular outcomes, meta-analysis


 
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How to Cite this Article
Pubmed Style

Awaji HH, Bajaber AA, Nebaihi AMA, Saeidalamin LM, Algolkhof ZA, Hazazi AJ, Alenazi OAM, Almutairi SO, Almubasher KR, Alhuthayfi MH. Finerenone and cardiorenal outcomes in diabetic kidney disease: a systematic review and meta-analysis of randomized controlled trial evidence. IJMDC. Online First: 30 Sep, 2026. doi:10.24911/IJMDC.51-1788434001

Web Style

Awaji HH, Bajaber AA, Nebaihi AMA, Saeidalamin LM, Algolkhof ZA, Hazazi AJ, Alenazi OAM, Almutairi SO, Almubasher KR, Alhuthayfi MH. Finerenone and cardiorenal outcomes in diabetic kidney disease: a systematic review and meta-analysis of randomized controlled trial evidence. https://www.ijmdc.com/?mno=333500 [Access: September 30, 2026]. doi:10.24911/IJMDC.51-1788434001

AMA (American Medical Association) Style

Awaji HH, Bajaber AA, Nebaihi AMA, Saeidalamin LM, Algolkhof ZA, Hazazi AJ, Alenazi OAM, Almutairi SO, Almubasher KR, Alhuthayfi MH. Finerenone and cardiorenal outcomes in diabetic kidney disease: a systematic review and meta-analysis of randomized controlled trial evidence. IJMDC. Online First: 30 Sep, 2026. doi:10.24911/IJMDC.51-1788434001


Vancouver/ICMJE Style

Awaji HH, Bajaber AA, Nebaihi AMA, Saeidalamin LM, Algolkhof ZA, Hazazi AJ, Alenazi OAM, Almutairi SO, Almubasher KR, Alhuthayfi MH. Finerenone and cardiorenal outcomes in diabetic kidney disease: a systematic review and meta-analysis of randomized controlled trial evidence. IJMDC, [cited September 30, 2026]; Online First: 30 Sep, 2026. doi:10.24911/IJMDC.51-1788434001


Harvard Style

Awaji, H. H., Bajaber, . A. A., Nebaihi, . A. M. A., Saeidalamin, . L. M., Algolkhof, . Z. A., Hazazi, . A. J., Alenazi, . O. A. M., Almutairi, . S. O., Almubasher, . K. R. & Alhuthayfi, . M. H. (2026) Finerenone and cardiorenal outcomes in diabetic kidney disease: a systematic review and meta-analysis of randomized controlled trial evidence. IJMDC, Online First: 30 Sep, 2026. doi:10.24911/IJMDC.51-1788434001


Turabian Style

Awaji, Hosam Hadi, Abubakr Ahmad Bajaber, Abdullah Mohammed Al Nebaihi, Lubna Mohammed Saeidalamin, Zyad Abdulrahman Algolkhof, Awatif Jubran Hazazi, Omar Ahmad Muflih Alenazi, Shahad Obaidallah Almutairi, Khadijah Reda Almubasher, and Majd Hassan Alhuthayfi. 2026. Finerenone and cardiorenal outcomes in diabetic kidney disease: a systematic review and meta-analysis of randomized controlled trial evidence. International Journal of Medicine in Developing Countries, Online First: 30 Sep, 2026. doi:10.24911/IJMDC.51-1788434001


Chicago Style

Awaji, Hosam Hadi, Abubakr Ahmad Bajaber, Abdullah Mohammed Al Nebaihi, Lubna Mohammed Saeidalamin, Zyad Abdulrahman Algolkhof, Awatif Jubran Hazazi, Omar Ahmad Muflih Alenazi, Shahad Obaidallah Almutairi, Khadijah Reda Almubasher, and Majd Hassan Alhuthayfi. "Finerenone and cardiorenal outcomes in diabetic kidney disease: a systematic review and meta-analysis of randomized controlled trial evidence." International Journal of Medicine in Developing Countries Online First: 30 Sep, 2026. doi:10.24911/IJMDC.51-1788434001


MLA (The Modern Language Association) Style

Awaji, Hosam Hadi, Abubakr Ahmad Bajaber, Abdullah Mohammed Al Nebaihi, Lubna Mohammed Saeidalamin, Zyad Abdulrahman Algolkhof, Awatif Jubran Hazazi, Omar Ahmad Muflih Alenazi, Shahad Obaidallah Almutairi, Khadijah Reda Almubasher, and Majd Hassan Alhuthayfi. "Finerenone and cardiorenal outcomes in diabetic kidney disease: a systematic review and meta-analysis of randomized controlled trial evidence." International Journal of Medicine in Developing Countries Online First: 30 Sep, 2026. Web. 30 Sep 2026 doi:10.24911/IJMDC.51-1788434001


APA (American Psychological Association) Style

Awaji, H. H., Bajaber, . A. A., Nebaihi, . A. M. A., Saeidalamin, . L. M., Algolkhof, . Z. A., Hazazi, . A. J., Alenazi, . O. A. M., Almutairi, . S. O., Almubasher, . K. R. & Alhuthayfi, . M. H. (2026) Finerenone and cardiorenal outcomes in diabetic kidney disease: a systematic review and meta-analysis of randomized controlled trial evidence. International Journal of Medicine in Developing Countries, Online First: 30 Sep, 2026. doi:10.24911/IJMDC.51-1788434001




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