N Engl J Med

Finerenone reduces albuminuria in adults with type 1 diabetes and chronic kidney disease

March 11, 2026

Finerenone reduced urinary albumin‑to‑creatinine ratio by 34% over 6 months compared with 12% on placebo—a 25% greater relative reduction (geometric mean ratio, 0.75; 95% confidence interval, 0.65–0.87; P<0.001)—in the phase 3 FINE‑ONE trial (NCT05901831) of adults with type 1 diabetes, chronic kidney disease, and albuminuria despite ACE‑inhibitor or ARB therapy. Hyperkalemia occurred more often with finerenone (10.1% vs. 3.3%; 1.7% discontinued), and a modest early eGFR dip (–5.6 vs. –2.7 mL/min/1.73 m²) returned toward baseline during washout.

Clinical takeaway: For adults with type 1 diabetes and CKD already receiving ACE-inhibitor or ARB therapy, finerenone may offer an additional option to reduce albuminuria, though clinicians should continue to monitor for hyperkalemia and await longer‑term outcome data.

Source:

Heerspink H, et al. (2026, March 4). N Engl J Med. Finerenone in Type 1 Diabetes and Chronic Kidney Disease. https://pubmed.ncbi.nlm.nih.gov/41780000/