Cardiovascular and Renal Outcomes of the New Kid on the Block: FiFi analysis

Abstract Finerenone is a selective nonsteroidal mineralocorticoid receptor antagonist that has been shown to reduce the urinary albumin-to-creatinine ratio in patients with CKD treated with a renin angiotensin system blocker, improving cardiovascular injury while having smaller effects on serum potassium levels than spironolactone. We aim to assess whether nonsteroidal mineralocorticoid receptor antagonists are effective in the treatment of patients with type 2 diabetes and chronic kidney disease using a systematic review approach. We searched PubMed and screened the resulting records on 10 September 2021. A total of 13026 participants were included in this analysis. Overall cardiovascular outcomes were significantly lower in the finerenone group (RR 0.88 (95% CI 0.81 to 0.96; I² = 0%; p = 0.004). Cardiovascular death had an RR of 0.88 (95% CI 0.76 to 1.02; I² = 0%), nonfatal myocardial infarction had an RR of 0.91 (95% CI 0.74 to 1.13; I² = 8%), and heart failure hospitalizations had an RR of 0.79 (95% CI 0.66 to 0.64; I² = 23%; p = 0.001). Overall renal outcomes were significantly lower in the finerenone group (RR 0.84 (95% CI 0.79 to 0.90; I² = 0%; p ≤ 0.00001). Death from renal causes had an RR of 0.86 (95% CI 0.73 to 1.01; I² = 0%). End-stage kidney disease was lower in the intervention arm (p = 0.05) (RR 0.79 (95% CI 0.63 to 1.00; I² = 10%). These results suggest that finerenone might have an additional protective effect on the cardiovascular and renal systems that is nonexistent with the use of spironolactone and eplerenone.