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

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.