Cardiovascular-kidney-metabolic syndrome is an emerging entity that connects cardiovascular diseases, chronic kidney disease, and diabetes. The non-steroidal mineralocorticoid receptor antagonist, finerenone, has been studied in three prospective randomized clinical trials of patients with cardio-kidney-metabolic syndrome: FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF. In light of the strong epidemiological overlap and shared mechanistic drivers of clinical outcomes across cardio-kidney-metabolic syndrome, we summarize the efficacy and safety of finerenone on cardiovascular, kidney, and mortality outcomes in this prespecified participant-level pooled analysis. The three trials included 18,991 participants (mean age 67 ± 10 years; 35% women). During 2.9 years median follow-up, the primary outcome of cardiovascular death occurred in 421 (4.4%) assigned to finerenone and 471 (5.0%) assigned to placebo (HR 0.89; 95% CI 0.78-1.01; P = 0.076). Death from any cause occurred in 1,042 (11.0%) participants in the finerenone arm and 1,136 (12.0%) in the placebo arm (HR 0.91; 95% CI 0.84-0.99; P = 0.027). Finerenone further reduced the risk of HF hospitalization (HR 0.83; 95% CI 0.75-0.92; P < 0.001) and the composite kidney outcome (HR 0.80; 95% CI 0.72-0.90; P < 0.001). While this pooled analysis failed to demonstrate significant reductions in cardiovascular death, finerenone was associated with significantly lower deaths of any cause, cardiovascular events, and kidney outcomes. PROSPERO identifier: CRD42024570467

心血管-肾脏-代谢综合征是一种连接心血管疾病、慢性肾病和糖尿病的新兴实体。非甾体盐皮质激素受体拮抗剂 finerenone 已在心肾代谢综合征患者的三项前瞻性随机临床试验中进行了研究：FIDELIO-DKD、FIGARO-DKD 和 FINEARTS-HF。鉴于心肾代谢综合征临床结果的强烈流行病学重叠和共同的机制驱动因素，我们在这个预先指定的参与者水平汇总分析中总结了 finerenone 对心血管、肾脏和死亡率结果的有效性和安全性。这三项试验包括 18,991 名参与者 （平均年龄 67 ± 10 岁;35% 为女性）。在 2.9 年的中位随访中，心血管死亡的主要结局发生在 421 例 （4.4%） 非奈利酮组和 471 例 （5.0%） 安慰剂组 （HR 0.89;95% CI 0.78-1.01;P = 0.076）。finerenone 组有 1,042 名 （11.0%） 参与者发生任何原因死亡，安慰剂组有 1,136 名 （12.0%） 参与者发生 （HR 0.91;95% CI 0.84-0.99;P = 0.027）。Finerenone 进一步降低了 HF 住院风险 （HR 0.83;95% CI 0.75-0.92;P < 0.001） 和复合肾脏结局 （HR 0.80;95% CI 0.72-0.90;P < 0.001）。虽然这项汇总分析未能证明心血管死亡的显着减少，但 finerenone 与任何原因导致的死亡、心血管事件和肾脏结局的显着降低相关。PROSPERO 标识符： CRD42024570467