# Finerenone verlaagt cardiorenale uitkomsten bij diabetische nierziekte — FIDELITY-samenvoeging

*geplaatst 2026-09-17 · Nierziekte · Acta clinica Belgica · doi 10.1080/17843286.2026.2731613 · https://hartvaat.nl/2026/09/09/finerenone-verlaagt-cardiorenale-uitkomsten-bij-diabetische-nierziekte-fidelity-/*

Een systematische review van analyses uit het FIDELITY-programma toont aan dat finerenone bij patiënten met diabetische nierziekte de kans op een samengestelde nier- en cardiovasculaire uitkomst significant verlaagt (HR respectievelijk 0,77 en 0,86). De absolute risicoreductie bedraagt ongeveer 1,6% tot 1,7% over drie jaar, gepaard met minder albuminurie en een langzamere daling van de eGFR. Hoewel hyperkaliëmie vaker voorkomt, leidt dit zelden tot stoppen met de behandeling. De bevindingen ondersteunen het gebruik van finerenone als cardiorenale bescherming bij diabetische nierziekte, zij het dat het bewijs momenteel beperkt blijft tot dit specifieke preparaat.

## English: Impact of nonsteroidal mineralocorticoid receptor antagonism on cardiorenal outcomes in diabetic kidney disease: a systematic review.

A systematic review of pooled analyses from the FIDELITY programme demonstrates that finerenone significantly reduces composite renal and cardiovascular outcomes in patients with diabetic kidney disease (HR 0.77 and 0.86, respectively). Over three years, absolute risk reductions were approximately 1.6% to 1.7%, accompanied by reduced albuminuria and a slower decline in eGFR. Although hyperkalaemia occurred more frequently, it rarely led to treatment discontinuation. These findings support finerenone as a cardiorenal protective agent in diabetic kidney disease, though evidence currently remains specific to this nonsteroidal MRA.

## Abstract (original, from the publication)

PURPOSE: Diabetic kidney disease (DKD) is a major complication of type 2 diabetes and a leading cause of kidney failure and cardiovascular death. This review evaluated the cardiorenal effects and safety of nonsteroidal mineralocorticoid receptor antagonists (MRAs), particularly finerenone, in DKD. METHODS: PubMed, Scopus, Embase, Web of Science, and ClinicalTrials.gov were searched through October 2024 for randomized controlled trials and prospective studies in adults with DKD. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Because eligible analyses were derived predominantly from the same two parent trials, quantitative pooling was avoided to prevent double-counting of participants. RESULTS: Seven analyses from the FIDELITY programme (FIDELIO-DKD and FIGARO-DKD), representing 13,026 unique participants, were included. Finerenone reduced composite renal outcomes by 23% (HR 0.77, 95% CI 0.67-0.88) and cardiovascular outcomes by 14% (HR 0.86, 95% CI 0.78-0.95). Over approximately three years, absolute risk reductions were 1.6% for the kidney composite (5.5% vs 7.1%; NNT ≈60) and 1.7% for the cardiovascular composite (12.7% vs 14.4%). Benefits were generally consistent across subgroups and accompanied by reduced albuminuria and slower eGFR decline. Hyperkalemia was more frequent with finerenone (14.0% vs 6.9%) but rarely resulted in discontinuation (1.7% vs 0.6%). CONCLUSION: Finerenone provides meaningful cardiorenal protection in DKD with a manageable safety profile. However, evidence is largely limited to finerenone within a single trial programme; therefore, these findings should not be generalized to the entire nonsteroidal MRA class.

Auteurs: Maram Rabih Musa Rabih, Sara Elsayed Saeed Gharbawi, Samih Abdelmutalab Mohamed Abdalla, Amal Abdallah Suliman Said, Amel Babekir Abdelmajed Ahmed, Elkhansaa Ali Elsheikh Mohamed Elsamani, Alaa Abuagla Mahmoud Hussein

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Bron: Acta clinica Belgica, https://doi.org/10.1080/17843286.2026.2731613. Bijgewerkt 2026-09-10T01:17:09Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.