OBJECTIVE To study the efficacy and safety of finerenone in the treatment of diabetic nephropathy.

METHODS The published literatures of CNKI, Wanfang, VIP, Sinomed, Pubmed, Cochrane Library and Embase up to May 9, 2023 were retrieved, and the certainty of evidence was evaluated by suggested grading, evaluation, development and evaluation methods. A meta-analysis of random effects was conducted to summarize the effects between studies. Literature screening, data extraction and quality evaluation were carried out according to the methods provided by Cochrane system evaluation manual. Review Manager 5.3 and Stata 12.0 were used to make a meta-analysis of the data included in the literature.

RESULTS Eight articles were finally included. A total of 32 075 patients with diabetic nephropathy with or without heart failure. Meta-analysis showed that compared with placebo, fenelidone reduced the risk of complex cardiovascular events (P<0.000 01), and fenelidone was effective in reducing urine protein/creatinine(P=0.003), but there was no significant difference in reducing NT-ProBNP between fenelidone and eplerenone(P=0.37). In terms of safety, the incidence of serious adverse reactions of fenelidone was lower than that of placebo/eplerenone group(P<0.000 01).

CONCLUSION Compared with placebo, fenelidone has obvious advantages in improving the prognosis of heart and kidney, but compared with eplerenone, the advantages of fenelidone still need to be studied. In terms of safety, fenelidone is superior to placebo group and eplerenone group.