Finerenone Significantly Reduces Albuminuria in Type 1 Diabetes CKD, suggests study

Chronic kidney disease is a major cause of morbidity and mortality in diabetic patients, and finerenone has been shown to improve kidney and cardiovascular outcomes in type 2 diabetic patients with chronic kidney diseases, although its effect in type 1 diabetic patients with chronic kidney diseases is unknown, and albuminuria, as measured by the albumin-to-creatinine ratio, is an important marker of kidney diseases and is considered an important therapeutic goal for the treatment of diabetic kidney diseases, as reducing albuminuria is believed to be a key therapeutic goal for the treatment of diabetic kidney diseases.

The study design of this research is a randomized controlled trial, with the study population being composed of adult patients with type 1 diabetes and chronic kidney disease. The study participants who qualified for the research had an estimated glomerular filtration rate (eGFR) of 25 or higher and less than 90 ml per minute per 1.73 m² of body-surface area, as well as albuminuria, with the albumin-to-creatinine ratio ranging from 200 and higher and less than 5000.

The study participants who qualified for the research were those who were undergoing standard of care with either an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin-receptor blocker (ARB), as both medications are commonly used for the treatment of kidney disease in diabetic patients. A total of 242 study participants were randomized to a finerenone or placebo treatment, with finerenone administered at a dose of either 10 or 20 mg/day based on the baseline eGFR level of the study participant.

Key findings:

• In all, 242 adults with type 1 diabetes and chronic kidney disease were randomly assigned to receive finerenone or placebo, together with background therapy with an ACE inhibitor or an angiotensin receptor blocker.

• Patients had an eGFR between 25 and less than 90 ml/min per 1.73 m² and albuminuria with a urinary albumin to creatinine ratio between 200 and less than 5000.

• The median reduction in the urinary albumin to creatinine ratio over six months was from 574.6 to 373.5 with finerenone and from 506.4 to 475.6 with placebo.

• Finerenone reduced albuminuria by 34%, whereas placebo reduced it by 12%, which is 25% greater than placebo (geometric mean ratio 0.75; 95% CI, 0.65 to 0.87; P < 0.001). In all, 12 patients (10.1%) had hyperkalemia with finerenone, and 4 patients (3.3%) had hyperkalemia with placebo, but only 2 patients (1.7%) stopped their medication because of hyperkalemia.

• The mean reduction in eGFR at six months was -5.6 ml/min per 1.73 m² with finerenone and -2.7 ml/min per 1.73 m² with placebo, with eGFR approaching baseline levels during the washout period.

The results of the study showed that in adults with type 1 diabetes and chronic kidney disease, the treatment with finerenone led to a significant difference in the reduction of the urinary albumin-to-creatinine ratio when compared with the placebo, and this effect was observed over a period of six months. Therefore, it is possible to conclude that finerenone may offer an effective treatment approach for reducing albuminuria and slowing the progression of chronic kidney disease in this population of patients with type 1 diabetes-related chronic kidney disease, despite the higher risk of hyperkalemia with finerenone treatment, as it was observed in the study.

Reference:

Heerspink, H. J. L., Birkenfeld, A. L., Cherney, D. Z. I., Colhoun, H. M., Groop, P.-H., Ji, L., Jongs, N., Mathieu, C., Pratley, R. E., Rosas, S. E., Rossing, P., Skyler, J. S., Tuttle, K. R., Lawatscheck, R., Brinker, M., Scheerer, M. F., Russell, J., Schloemer, P., & McGill, J. B. (2026). Finerenone in type 1 diabetes and chronic kidney disease. The New England Journal of Medicine, 394(10), 947–957.https://doi.org/10.1056/nejmoa2512854