Finerenone in type 1 diabetes and chronic kidney disease

This randomised, double-blind, placebo-controlled trial evaluated the efficacy and safety of finerenone, a non-steroidal mineralocorticoid receptor antagonist, in patients with type 1 diabetes and chronic kidney disease (CKD). While finerenone has previously demonstrated renal and cardiovascular benefits in type 2 diabetes, evidence in type 1 diabetes has been lacking.

Participants receiving standard therapy, including renin–angiotensin system inhibitors, were randomly assigned to finerenone or placebo. The primary endpoint was change in urinary albumin-to-creatinine ratio from baseline over a period of 6 months.

Finerenone treatment resulted in a statistically significant reduction in albuminuria compared with placebo. An initial, modest decline in estimated glomerular filtration rate (eGFR) was observed followed by stabilisation over time. The incidence of adverse events was similar between groups, although hyperkalaemia occurred more frequently in the finerenone group and this was generally manageable with appropriate monitoring.

The findings suggest that finerenone may offer renal benefits in patients with type 1 diabetes and CKD. Further study is required to look at long-term clinical outcomes such as progression to kidney failure or cardiovascular events as the duration of follow-up was limited.

The investigators conclude that finerenone reduced albuminuria in this population and demonstrated an acceptable safety profile, supporting its potential role as an adjunctive therapy. 

The full article can be read here.