Kidney Week

Abstract: FR-PO0563

Finerenone Plus SGLT2 Inhibitor Therapy in CKD and Type 2 Diabetes: A Systematic Review and Meta-Analysis

Session Information

• Top Trainee Posters - 2
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 01:24 PM - 01:30 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Rivera, Oscar R., Universidad Peruana de Ciencias Aplicadas, Lima District, Lima Region, Peru

Oscar R. Rivera, MD

• Hadji, Amir, University of Health Sciences, Algiers, Algeria

Amir Hadji, MD

• Diaz-Gutierrez, Maria Jose, The George Washington University, Washington, District of Columbia, United States

Maria Jose Diaz-Gutierrez, MD

• Chiong, Erik E., Universidad Peruana de Ciencias Aplicadas, Lima District, Lima Region, Peru

Erik E. Chiong

• Rivera Maquera, Alisson Marisol, Universidad Peruana de Ciencias Aplicadas, Lima District, Lima Region, Peru

Alisson Marisol Rivera Maquera

• Batista, Emanuele, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

Emanuele Batista

• Muca, Loreta, Socio Center Health No. 4, Elbasan, Elbasan County, Albania

Loreta Muca, MD

• Arslan, Felemez, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey

Felemez Arslan, MD

Background

Finerenone and SGLT2 inhibitors improve outcomes in CKD with type 2 diabetes (T2D), but the incremental clinical effect of combination therapy over active monotherapy remains uncertain.

Methods

PubMed, Embase, and Cochrane were searched for randomized trials, trial secondary/subgroup analyses, and adjusted observational cohorts evaluating finerenone plus an SGLT2 inhibitor versus SGLT2i or finerenone monotherapy in adults with CKD, primarily or exclusively with T2D. Study-defined cardiovascular composite/MACE, all-cause mortality, kidney composite/MAKE, hyperkalemia adverse events (AEs), and UACR change were extracted. Random-effects inverse-variance models pooled HRs for time-to-event outcomes; Mantel-Haenszel models pooled RRs for binary safety outcomes. Sensitivity analyses assessed potentially overlapping TriNetX cohorts.

Results

Five unique studies were eligible; four contributed quantitative clinical-outcome data. Primary HR-based analyses prioritized the TriNetX estimate most consistent with the primary comparison, with alternative TriNetX estimates assessed in sensitivity analyses. Combination therapy was associated with significantly lower all-cause mortality versus SGLT2i monotherapy (HR 0.43, 95% CI 0.29–0.65; p<0.0001; I2=24%), with consistent sensitivity findings. Cardiovascular composite/MACE favored combination therapy without reaching significance (HR 0.84, 95% CI 0.67–1.06; p=0.14; I2=19%). Kidney composite/MAKE estimates were directionally favorable but varied by TriNetX cohort selection. Hyperkalemia AEs were imprecise and heterogeneous (RR 2.12, 95% CI 0.94–4.77; p=0.07; I2=87%). CONFIDENCE showed greater UACR reduction with combination therapy versus empagliflozin at 180 days (p<0.001).

Conclusion

Combination therapy is associated with lower mortality and better albuminuria reduction, but certainty is limited by few studies, endpoint heterogeneity, and possible real-world dataset overlap. Dedicated outcome trials are needed to define long-term efficacy and safety.