Finerenone versus Steroidal Mineralocorticoid Receptor Antagonists (MRAs) in Type 2 Diabetes and Chronic Kidney Disease without Prior Heart Failure
Main finding · All-cause deathResult — go to the resultIncidence rate difference −2.41 95% CI −4.38 to −0.44Authors' conclusion
Finerenone was associated with a lower 18-month risk of all-cause death compared with steroidal MRAs in patients aged ≥18 years with T2D and CKD without prior HF, who received an SGLT2 inhibitor as first-line therapy; however, residual confounding cannot be excluded, and these findings should be considered hypothesis-generating.
Study context
- Population
- Patients aged ≥18 years with T2D and chronic kidney disease (CKD) without prior heart failure (HF) and ischemic heart disease, who initiated MRAs after receiving an SGLT2 inhibitor as first-line therapy between 2021 and 2024724 initiated finerenone and 1,542 initiated a steroidal MRA, after propensity score matching, each group included 551 patients · finerenone 724 · steroidal MRA 1,542
- Participants
- 3,680 patients
- Exposure
- Finerenone versus steroidal MRAs
- Finerenonen = 551
- Steroidal MRAn = 551
- Outcome
- All-cause death
- Follow-up
- 18-month follow-up period
Methodological detailspropensity score matching, TriNetX platform
- Propensity score matching
- TriNetX platform
Main finding
As reported in the abstract
Incidence rate difference
−2.41
95% CI −4.38 to −0.44
By group
Finerenone vs steroidal MRA
incidence rate difference −2.41 (95% CI −4.38 to −0.44)
Observational data: associations, not effects.
Secondary outcomes
Incidence rate
| Outcome | Finerenone | Steroidal MRA | Incidence rate difference (95% CI) | |
|---|---|---|---|---|
| New-onset HF (secondary outcome) · 18-month | 6.5 | 12.9 | −6.38 (−9.75 to −3.02) | |
| Renal outcome (composite of end-stage renal disease and dialysis) (secondary outcome) · 18-month | 8.3 | 9.1 | −0.81 (−3.99 to 2.37) | |
| −10−505Difference (linear scale) |
Original publication
Finerenone versus Steroidal MRAs in Type 2 Diabetes and Chronic Kidney Disease without Prior Heart Failure. ESC Heart Fail. Published 19 October 2026. doi:10.
Summarised from the published abstract; every number is checked against it