Finerenone, a nonsteroidal mineralocorticoid antagonist, is a novel therapeutic agent for renal protection in patients with diabetic kidney disease, joining the ranks of angiotensin-converting enzyme inhibitors and sodium-glucose cotransporter 2 inhibitors in providing renal protection for such patients. Recently, two meta-analyses focusing on patients with chronic kidney disease have yielded conflicting conclusions regarding the impact of finerenone on the decline of estimated glomerular filtration rate (eGFR) . In light of this, the present meta-analysis specifically targets the population with type 2 diabetes, aiming to thoroughly investigate the efficacy and safety of finerenone.

To systematically evaluate the efficacy and safety of finerenone in patients with type 2 diabetes and kidney disease.

A computerized search was conducted in the Cochrane Library, Web of Science, Embase, and PubMed databases, covering the period from their inception to April 2024. Literature was screened and data extracted according to the inclusion and exclusion criteria. Meta-analysis was performed using Revman 5.3, comparing indicators such as the urine albumin-to-creatinine ratio and estimated glomerular filtration rate in type 2 diabetes patients treated with finerenone.

A total of 7 articles were ultimately included, involving 15 528 patients. The results showed that compared with the control group, intervention group (using finerenone) had statistically significant differences in the urine albumin-to-creatinine ratio (SMD=-0.46, 95%CI=-0.48 to -0.39, P<0.05) , estimated glomerular filtration rate (SMD=-0.15, 95%CI=-0.19 to -0.10, P<0.05) , renal composite endpoint (OR=0.83, 95%CI=0.75 to 0.92, P<0.05) , all-cause mortality (OR=0.88, 95%CI=0.78 to 0.99, P<0.05) , and end-stage renal disease (OR=0.88, 95%CI=0.78 to 0.99, P<0.05) . Compared with the control group, intervention group significantly increased the risk of hyperkalemia (OR=2.13, 95%CI=1.89 to 2.39, P<0.05) .

Finerenone can significantly improve renal composite endpoint events in patients with type 2 diabetes and kidney disease, reduce the urine albumin-to-creatinine ratio, and slow down the decline of estimated glomerular filtration rate; however, attention should be paid to the risk of hyperkalemia during treatment.