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Background <p>​ Immunoglobulin A nephropathy (IgAN) is a leading cause of chronic kidney disease worldwide, creating a significant need for novel, effective therapies. Finerenone has demonstrated renal protective benefits in diabetic kidney disease, but its efficacy and safety profile specifically in IgAN require comprehensive evaluation.</p> Objective <p>​ This study aimed to systematically assess the therapeutic potential and safety of finerenone in patients with IgAN.</p> Methods <p>​ A systematic literature search of PubMed, Embase, and the Cochrane Library was conducted up to November 25, 2025. Cohort studies involving adults with biopsy-proven IgAN, comparing finerenone plus standard care against standard care alone with at least 6 months of follow-up, were included. Data on urine protein-to-creatinine ratio (UPCR), estimated glomerular filtration rate (eGFR), and adverse events (hyperkalemia) were extracted.</p> Results <p>​ The meta-analysis revealed that finerenone treatment significantly reduced proteinuria compared to control (MD -12.98, 95% CI: -16.04 to -9.93; <i>P</i> &lt; 0.00001) and significantly improved renal function, indicated by an increase in eGFR (MD 4.41, 95% CI: 2.94 to 5.89; <i>P</i> &lt; 0.00001). Statistical heterogeneity was negligible (I² = 0%) for both efficacy outcomes. Regarding safety, finerenone was associated with a non-significant increase in the risk of hyperkalemia (OR 2.12, 95% CI: 0.27 to 16.80; <i>P</i> = 0.48), though the confidence interval was wide, indicating uncertainty due to a low event rate.</p> Conclusion <p>​ In this meta-analysis, finerenone demonstrated significant benefits on short-term surrogate endpoints in patients with IgAN.</p>

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Finerenone in IgA nephropathy: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月14日

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  • Jidi Wu,
  • Yanqun Li,
  • Li Luo,
  • Qianshi Wu,
  • Yulin Mou,
  • Yong Xu,
  • Qifu Li,
  • Qian Ren,
  • Yan Qiao,
  • Wei Huang

摘要

Background

​ Immunoglobulin A nephropathy (IgAN) is a leading cause of chronic kidney disease worldwide, creating a significant need for novel, effective therapies. Finerenone has demonstrated renal protective benefits in diabetic kidney disease, but its efficacy and safety profile specifically in IgAN require comprehensive evaluation.

Objective

​ This study aimed to systematically assess the therapeutic potential and safety of finerenone in patients with IgAN.

Methods

​ A systematic literature search of PubMed, Embase, and the Cochrane Library was conducted up to November 25, 2025. Cohort studies involving adults with biopsy-proven IgAN, comparing finerenone plus standard care against standard care alone with at least 6 months of follow-up, were included. Data on urine protein-to-creatinine ratio (UPCR), estimated glomerular filtration rate (eGFR), and adverse events (hyperkalemia) were extracted.

Results

​ The meta-analysis revealed that finerenone treatment significantly reduced proteinuria compared to control (MD -12.98, 95% CI: -16.04 to -9.93; P < 0.00001) and significantly improved renal function, indicated by an increase in eGFR (MD 4.41, 95% CI: 2.94 to 5.89; P < 0.00001). Statistical heterogeneity was negligible (I² = 0%) for both efficacy outcomes. Regarding safety, finerenone was associated with a non-significant increase in the risk of hyperkalemia (OR 2.12, 95% CI: 0.27 to 16.80; P = 0.48), though the confidence interval was wide, indicating uncertainty due to a low event rate.

Conclusion

​ In this meta-analysis, finerenone demonstrated significant benefits on short-term surrogate endpoints in patients with IgAN.