Published online Apr 26, 2026. doi: 10.4330/wjc.v18.i4.118879
Revised: February 14, 2026
Accepted: March 19, 2026
Published online: April 26, 2026
Processing time: 91 Days and 8.4 Hours
Chronic kidney disease (CKD) and heart failure (HF) frequently coexist, creating a complex clinical challenge. Mineralocorticoid receptor antagonists (MRAs) have shown promise in managing both conditions, primarily by mitigating the adverse effects of aldosterone. Finerenone, a novel nonsteroidal MRA, has demonstrated significant benefits in reducing cardiovascular and renal events in patients with CKD and type 2 diabetes. However, while the efficacy and safety of finerenone have been extensively evaluated in CKD popu
To investigate the efficacy and safety of finerenone in patients with HF.
Per the PRISMA guidelines, a thorough search was conducted in PubMed/MEDLINE, Science Direct, and Google Scholar, and relevant randomized control trials (RCTs) comparing finerenone to placebo or other agents on clinical outcomes in patients with HF were included.
Four RCTs involving 7457 patients with HF (mean age, 71.85 years; females, 41.0%) were included in the study. Of them, 4160 received finerenone (mean age, 71.7 years) and 3297 received a placebo (mean age, 72.04 years). The finerenone group had significantly lower odds of worsening HF [odds ratio (OR) = 0.76; 95%CI: 0.66-0.88; P = 0.0001] and improvement in the Kansas City Cardiomyopathy Questionnaire (mean differences: 1.60; 95%CI: 1.58-1.62; P < 0.0001). Furthermore, higher odds of hyperkalemia (OR = 1.32; 95%CI: 0.58-2.99; P = 0.51) and lower odds of adverse event (AE) (OR = 0.91; 95%CI: 0.72-1.15; P = 0.44) and severe AE (OR = 0.99; 95%CI: 0.88-1.10; P = 0.82).
Our meta-analysis demonstrates that finerenone significantly reduces the risk of worsening of HF and improves quality of life in HF. However, finerenone was associated with increased risks of hyperkalemia, requiring clinical vigilance. Future research should focus on long-term outcomes and the optimal dosing of finerenone in specific HF subpopulations, including those receiving other guideline-directed medical therapies.
Core Tip: Finerenone, a novel nonsteroidal mineralocorticoid receptor antagonist, has shown clear benefits in chronic kidney disease, but its specific impact on heart failure (HF) has required further synthesis. Our meta-analysis of 7457 patients reveals that finerenone significantly decreases the odds of worsening HF and enhances quality of life scores. However, potential safety signals, including hyperkalemia, suggest that while finerenone is a potent tool for managing HF, its use requires vigilant monitoring to balance clinical benefits against adverse events.