Comparative Cardiorenal Efficacy and Safety of Finerenone, SGLT2 Inhibitors, Semaglutide and Their Combination in Diabetic Kidney Disease.

In 30 seconds

This frequentist network meta-analysis compared cardiorenal efficacy and safety of finerenone, SGLT2 inhibitors, semaglutide and their combination in adults with type 2 diabetes and diabetic kidney disease. It included 10 randomized datasets involving 37 923 participants. SGLT2 inhibitors showed the broadest overall pattern of benefit across cardiorenal outcomes. Dapagliflozin was associated with a lower risk of the composite kidney outcome than semaglutide (RR 0.71, 95% CI: 0.53-0.94), while most other active-monotherapy comparisons were not statistically significant. Finerenone increased hyperkalaemia and discontinuation due to adverse events.

Key findings

• Compared with control, dapagliflozin, canagliflozin, finerenone and semaglutide reduced cardiovascular composite events and composite kidney outcomes.
• Dapagliflozin had a lower risk of the composite kidney outcome than semaglutide (RR 0.71, 95% CI: 0.53-0.94).
• Finerenone increased hyperkalaemia (RR 2.03, 95% CI: 1.82-2.26) and discontinuation due to adverse events (RR 1.18, 95% CI: 1.02-1.35).
• Finerenone plus empagliflozin was associated with more hyperkalaemia than empagliflozin alone (RR 2.48, 95% CI: 1.22-5.06).

Why it matters

The analysis compares several therapies across cardiovascular, kidney and safety outcomes in diabetic kidney disease, helping clarify the breadth of evidence for each option. Its findings highlight that apparent cardiorenal benefits must be considered alongside adverse effects, particularly hyperkalaemia with finerenone. The limited evidence for combination therapy also leaves uncertainty about its comparative efficacy and safety.

What to keep in mind

The findings are based on a network meta-analysis, so many comparisons between active treatments are indirect; most active-monotherapy efficacy comparisons were not statistically significant.