Our meta-analyses (Table 2) show that in individuals with CKD and/or T2D and compared to placebo, MRAs reduce the risk of developing a composite kidney outcome (RR 0.85; 0.82 to 0.88; high certainty), reduce the odds of estimated glomerular filtration rate (eGFR) worsening or kidney failure (OR 0.84; 0.74 to 0.96; moderate certainty), reduce the risk of a > 40% eGFR worsening (RR 0.85; 0.82 to 0.88; high certainty), reduce urinary albumin-to-creatinine ratio (UACR) (SMD − 1.31; − 1.84 to − 0.77; high certainty), and reduce eGFR (SMD − 0.40; − 0.69 to − 0.11; high certainty). This evidence concerns the gene ALB and chronic kidney disease.