{ "abstract": "Introduction\n\nThe nonsteroidal mineralocorticoid receptor antagonist finerenone reduces urine albumin-to-creatinine ratio (UACR) in people with type 1 diabetes (T1D) and chronic kidney disease (CKD). This prespecified analysis evaluated acute changes in estimated glomerular filtration rate (eGFR) with finerenone and their impact on safety.Methods\n\nAdults with T1D and CKD (n = 242; eGFR ≥ 25-< 90 ml/min per 1.73 m²; UACR ≥ 200 to < 5000 mg/g) receiving stable renin-angiotensin system (RAS) inhibition were randomized 1:1 to finerenone or placebo. The primary outcome was acute change in eGFR (from baseline to month 1), termed \"eGFR dip.\" Reversibility of eGFR change was assessed from end of the treatment (month 6) to follow-up (month 7). Change in eGFR was assessed across eGFR dip subgroups (eGFR > 0 to ≤ 10% decline, > 10% decline, and ≥ 0% increase) and prespecified characteristics (baseline eGFR, UACR, history of cardiovascular disease [CVD], and diuretic use).Results\n\nMean acute eGFR decline at month 1 was greater with finerenone (-2.78 ml/min per 1.73 m² [95% confidence interval [CI], -4.15 to -1.40]) versus placebo (-0.78 ml/min per 1.73 m²; [95% CI, -2.22 to 0.66]); treatment difference was -1.99 ml/min per 1.73 m² (95% CI, -3.97 to -0.01 [P = 0.049]). Placebo-corrected eGFR increased during the washout period across the groups. Acute eGFR changes did not differ according to prespecified characteristics. The incidence of treatment-emergent adverse events (TEAEs) was comparable across eGFR dip subgroups in both the treatment groups. Greater declines in eGFR were associated with greater reductions in UACR at month 3.Conclusion\n\nIn people with T1D and CKD, finerenone induced an acute eGFR dip that was well tolerated without unexpected safety signals.", "abstract_shown": true, "affiliations": [ "Division of Nephrology, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.", "The George Institute for Global Health, University of New South Wales, Sydney, Australia.", "Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.", "Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China.", "Division of Endocrinology, Metabolism & Lipid Research, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA.", "Steno Diabetes Center Copenhagen, Herlev, Denmark.", "Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.", "Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA.", "Nephrology Division and Kidney Research Institute, University of Washington School of Medicine, Seattle, Washington, USA.", "Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.", "University Clinic in Nephrology and Hypertension, Gødstrup Hospital, Herning, Denmark.", "Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan and Università degli Studi di Milano, Milan, Italy.", "Population Health Sciences, Bristol Medical School, University of Bristol, and Renal Unit, North Bristol NHS Trust, Bristol, UK.", "Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.", "Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, Royal Derby Hospital Campus, University of Nottingham, Derby, UK.", "Cardio-metabolic and Clinical Trials Unit, IRCCS Ospedale San Raffaele, Milan, Italy.", "Cardiology and Nephrology Clinical Development, Bayer AG, Berlin, Germany.", "Cardiology and Nephrology Clinical Development, Bayer AG, Wuppertal, Germany.", "Bayer PLC, Reading, UK.", "Clinical Statistics and Analytics, Bayer AG, Berlin, Germany.", "Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland." ], "article_type": "research article", "arxiv": null, "author_total": 20, "authors": [ { "affs": [ 0 ], "name": "David Z I Cherney" }, { "affs": [ 0 ], "name": "Tae Won Yi" }, { "affs": [ 1, 2 ], "name": "Hiddo J L Heerspink" }, { "affs": [ 3 ], "name": "Linong Ji" }, { "affs": [ 4 ], "name": "Janet B McGill" }, { "affs": [ 5, 6 ], "name": "Peter Rossing", "orcid": "0000-0002-1531-4294" }, { "affs": [ 7, 8 ], "name": "Katherine R Tuttle" }, { "affs": [ 9, 10 ], "name": "Jesper N Bech", "orcid": "0000-0002-0605-1277" }, { "affs": [ 11 ], "name": "Paolo Fiorina" }, { "affs": [ 12 ], "name": "Albert Power" }, { "affs": [ 13 ], "name": "Karoline Schousboe" }, { "affs": [ 14 ], "name": "Nicholas M Selby" }, { "affs": [ 15 ], "name": "Emanuela Setola" }, { "affs": [ 2 ], "name": "J David Smeijer" }, { "affs": [ 16 ], "name": "Robert Lawatscheck" }, { "affs": [ 17 ], "name": "Meike Brinker" }, { "affs": [ 18 ], "name": "Julie Russell" }, { "affs": [ 19 ], "name": "Patrick Schloemer" }, { "affs": [ 20 ], "name": "Per-Henrik Groop" }, { "name": "FINE-ONE Investigators23" } ], "bibtex": "https://research.draconitic.com/paper/1wsmx7p18swhg.bib", "cited_by": 0, "doi": "10.1016/j.ekir.2026.107083", "fulltext_url": "https://europepmc.org/articles/PMC13694952", "id": "1wsmx7p18swhg", "issns": [ "2468-0249" ], "landing_url": "https://europepmc.org/article/MED/42927222", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2727|Chronic Kidney Disease and Diabetes" ] ], "openalex": "W7213393978", "pdf_url": "https://europepmc.org/articles/PMC13694952?pdf=render", "pmcid": "PMC13694952", "pmid": "42927222", "published": "2026-09-16", "publisher": null, "ris": "https://research.draconitic.com/paper/1wsmx7p18swhg.ris", "sources": [ { "first_seen": "2026-10-30T12:21:18Z", "native_id": "MED:42927222", "source": "europepmc", "url": "https://europepmc.org/article/MED/42927222" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2727|Chronic Kidney Disease and Diabetes", "subfield": "general" } ], "title": "Acute eGFR Changes With Finerenone Examined in a Prespecified Analysis of FINE-ONE.", "title_text": "Acute eGFR Changes With Finerenone Examined in a Prespecified Analysis of FINE-ONE.", "type": "peer-reviewed", "updated_at": "2026-10-30T12:21:18Z", "url": "https://research.draconitic.com/paper/1wsmx7p18swhg", "venue": "Kidney international reports", "versions": [] }