Hyperkalemia (Figure 7)
The following outcomes were used to assess hyperkalemia: The investigator reported hyperkalemia, hyperkalemia related to the trial regimen, and the trial regimen’s permanent discontinuation due to hyperkalemia. Four out of five studies[5,10,14,15] reported investigator-reported hyperkalemia, and the pooled analysis revealed that treatment with Finerenone was associated with a significantly increased risk of hyperkalemia (RR = 2.20 [1.90, 2.55] p 0.00001; I2= 77%). Due to the high heterogeneity, a leave one out analysis was performed, which revealed that excluding Betram 2021 [10] reduced heterogeneity (RR = 2.03 [1.89, 2.18] p < 0. 00001; I2= 0%).
On the other hand, five out of seven studies[5,10,13-17] reported hyperkalemia related to the trial regimen, and the pooled analysis revealed that Finerenone was associated with a significantly increased risk of hyperkalemia related to the treatment regimen. Similarly, six of seven studies[5,10,13-16] reported permanent discontinuation of treatment regimen due to hyperkalemia, and the pooled analysis revealed that treatment with Finerenone was associated with a significantly higher risk of treatment discontinuation due to hyperkalemia compared to placebo (RR = 2.59 [1.92, 3.50] p 0.00001; I2= 40%).