Finerenone Shows Promise in Reducing Kidney Damage in Type 1 Diabetes
Use of finerenone was associated with a statistically meaningful 25% relative reduction in urine albumin-to-creatinine ratio compared with placebo over 6 months in patients with type 1 diabetes.
The findings,presented at the National Kidney Foundation 2024 Spring Clinical meetings,suggest finerenone may offer a new therapeutic avenue for preventing kidney disease progression in this population. Currently, there are limited treatment options specifically targeting kidney protection in individuals with type 1 diabetes.
“These are very encouraging results,” said Hiddo Heerspink, PharmD, PhD, led investigator of the study and researcher at The George Institute for Global Health. “We’ve shown that finerenone can substantially reduce albuminuria, a key marker of kidney damage, in people with type 1 diabetes.”
The study involved patients with type 1 diabetes and elevated urine albumin-to-creatinine ratio, indicating early signs of kidney disease. Participants were randomly assigned to receive either finerenone or placebo in addition to standard diabetes management.
researchers observed not only a reduction in albuminuria but also improvements in estimated glomerular filtration rate (eGFR), a measure of kidney function, although this was not statistically significant. the safety profile of finerenone was consistent with previous trials, with no new safety signals identified.
Heerspink emphasized the importance of these findings, stating, “Kidney disease is a common and serious complication of type 1 diabetes. Finerenone could potentially delay the need for dialysis or kidney transplantation in these patients.”
American Society of Nephrology (ASN) Kidney Week 2025
The new data, which come less than 4 months after the agent received approval for heart failure with preserved ejection fraction from the US Food and Drug Governance (FDA), offer evidence supporting the use of Bayer’s nonsteroidal mineralocorticoid receptor agonist (nsMRA) in additional populations with kidney disease.1,2
“Patients living with type 1 diabetes and chronic kidney disease face an increased risk of kidney failure and cardiovascular disease, impacting quality of life and life expectancy,” said Hiddo Lambers Heerspink, professor of Clinical Trials and Personalized Medicine at the University Medical Center Groningen, Netherlands, and chair of the study’s Steering Committee.2 “UACR reduction is highly correlated with a reduction in kidney and cardiovascular events. The positive results of the FINE-ONE study represent a landmark moment and give hope to patients with chronic kidney disease associated with type 1 diabetes who currently have very limited treatment options.”
Over the last decade,finerenone has established a significant role in the landscape of cardiometabolic health. First, in people with type 2 diabetes and chronic kidney disease based on the FIGARGO-DKD and FIDELIO-DKD trials, which were used in support of the agent’s 2021 approval from the FDA for chronic kidney disease associated with type 2 diabetes. Next,the FINEARTS-HF trial set the stage for the agent’s July 2025 approval for HFpEF.2
now, FINE-ONE offers evidence of finerenone’s benefit in chronic kidney disease in people with type 1 diabetes.
FINE-ONE was a randomized, double-blind, placebo-controlled, multicenter trial and enrolled 242 participants across more than 80 sites in 9 countries. participants were randomly assigned in a 1:1 ratio to receive finerenone (10 mg or 20 mg once daily) or placebo, in addition to standard-of-care therapies for chronic kidney disease and comorbidities.1,2
The starting dose of finerenone was based on estimated glomerular filtration rate (eGFR):
* 10 mg once daily for participants with eGFR ≥25 – <60 mL/min/1.73 m * 20 mg once daily for participants with eGFR ≥60 mL/min/1.73 m After 30 days, uptitration to the 20 mg target dose was permitted if serum/plasma potassium was ≤4.8 mmol/L and eGFR decline was <30% compared with the prior visit.1,2
The primary endpoint was the relative change in UA
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