People with type 1 diabetes have a high renal and cardiovascular risk, yet the current standard of care remains limited to glycaemic optimisation and renin–angiotensin system inhibition. Research into disease-modifying therapies for chronic kidney disease (CKD) has largely focused on type 2 diabetes, leaving a treatment gap. Overactivation of the mineralocorticoid receptor and excess aldosterone promotes inflammation, fibrosis and albuminuria in both diabetes populations. 

Heerspink et al. conducted a phase 3 study of finerenone in adults with type 1 diabetes, CKD and albuminuria. This drug has previously been shown to improve renal and cardiovascular outcomes in type 2 diabetes with CKD. The authors demonstrated a 25% greater reduction in urinary albumin–creatinine ratio compared with placebo over six months, while maintaining a favourable safety profile. Median urinary albumin–creatinine ratio fell from 574.6 to 373.5 in the finerenone group, while only a modest decline occurred with placebo. Benefits were consistent across multiple patient subgroups, including those at high renal risk. Hyperkalaemia occurred more frequently with finerenone but rarely required treatment discontinuation.

This well-designed randomised trial effectively targeted the underlying pathophysiology of renal complications in people with type 1 diabetes. Finerenone significantly improved albuminuria, suggesting potential kidney-protective benefits and supporting further long-term investigation.

Read the full article in New England Journal of Medicine https:// doi.org/10.1056/NEJMoa2512854