Results of an international clinical trial, where UHN was a Canadian site, showed that the drug finerenone may help improve kidney health in adults with type 1 diabetes and chronic kidney disease (CKD).  

Type 1 diabetes affects approximately 9.5 million people worldwide. CKD—the long-term and progressive loss of function in the kidneys—remains a common and serious complication of type 1 diabetes. Some drugs, like finerenone—which blocks the activity of certain hormones that can damage the heart and kidneys—have been shown to help people with CKD caused by type 2 diabetes. But until now, these medications haven’t been used in clinical trials in people with type 1 diabetes and kidney disease.

To address this, a team of international researchers ran a clinical trial to test finerenone on 242 adults with type 1 diabetes and CKD. Dr. David Cherney, Senior Scientist at UHN and Professor at the University of Toronto’s Temerty Faculty of Medicine, was the lead investigator at the UHN site in Toronto.

Published in The New England Journal of Medicine, results showed that participants receiving finerenone had a significantly greater decrease in the urinary albumin-to-creatinine ratio than those who received the placebo, suggesting kidney protection with finerenone. Healthy kidneys prevent albumin—a type of protein in the blood—from being excreted in the urine, resulting in a lower ratio. Therefore, a reduction in urinary albumin levels is consistent with a lower risk of developing worsening kidney disease.

These findings highlight the potential of finerenone as an additional therapeutic option for adults with type 1 diabetes and CKD. More research will be needed to understand long-term effects on diverse populations.

This study was led by the FINE-ONE Investigators, including the following authors:

  • Hiddo Heerspink, Andreas Birkenfeld, David Cherney, Helen Colhoun, Per-Henrik Groop, Linong Ji, Niels Jongs, Chantal Mathieu, Richard Pratley, Sylvia Rosas, Peter Rossing, Jay S Skyler, Katherine Tuttle, Robert Lawatscheck, Meike Brinker, Markus Scheerer, Julie Russell, Patrick Schloemer, and Janet B McGill

Dr. David Cherney is a Senior Scientist at UHN and Professor in the Department of Medicine at the University of Toronto. He is also the Gabor Zellerman Chair of Nephrology Research at the University of Toronto. He was a member of the international steering committee for the trial and the lead investigator for the UHN site of the trial.

This study was supported by Bayer.        

Research at UHN is supported by UHN Foundation, and Dr. Cherney was supported by the Canadian Institutes of Health Research.

Heerspink HJL, Birkenfeld AL, Cherney DZI, Colhoun HM, Groop PH, Ji L, Jongs N, Mathieu C, Pratley RE, Rosas SE, Rossing P, Skyler JS, Tuttle KR, Lawatscheck R, Brinker M, Scheerer MF, Russell J, Schloemer P, McGill JB; FINE-ONE Investigators. Finerenone in Type 1 Diabetes and Chronic Kidney Disease. N Engl J Med. 2026 Mar 5;394(10):947-957. doi: 10.1056/NEJMoa2512854.