{"id":"b2d94c955db0","type":"article","url":"https://hartvaat.nl/2026/11/01/finerenone-veroorzaakt-reversibele-egfr-daling-bij-diabetes-type-1-met-chronisch/","title":"Finerenone veroorzaakt reversibele eGFR-daling bij diabetes type 1 met chronische nierziekte — FINE-ONE","title_en":"Acute eGFR Changes With Finerenone Examined in a Prespecified Analysis of FINE-ONE.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Kidney international reports","doi":"10.1016/j.ekir.2026.107083","source_url":"https://doi.org/10.1016/j.ekir.2026.107083","authors":["David Z I Cherney","Tae Won Yi","Hiddo J L Heerspink","Linong Ji","Janet B McGill","Peter Rossing","Katherine R Tuttle","Jesper N Bech","Paolo Fiorina","Albert Power","Karoline Schousboe","Nicholas M Selby","Emanuela Setola","J David Smeijer","Robert Lawatscheck","Meike Brinker","Julie Russell","Patrick Schloemer","Per-Henrik Groop"],"significance":5,"published":"2026-11-01","source_date":"2026-11-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/wat-is-chronische-nierziekte/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"In a randomized analysis of 242 adults with type 1 diabetes and chronic kidney disease on stable renin-angiotensin system inhibition, finerenone caused a mild, reversible eGFR decline of 2.8 ml/min/1.73 m² at one month versus 0.8 ml/min/1.73 m² with placebo. The dip was well tolerated, lacked unexpected safety signals, and correlated with greater reductions in urine albumin-to-creatinine ratio. Clinically, this confirms that a transient eGFR drop is an expected pharmacodynamic effect of finerenone and does not warrant discontinuation of therapy.","created":"2026-10-26T01:51:56Z","updated":"2026-10-26T01:51:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een gerandomiseerde analyse bij 242 volwassenen met diabetes type 1 en chronische nierziekte op stabiele RAS-remming, veroorzaakte finerenone een acute, reversibele eGFR-daling van gemiddeld 2,8 ml/min/1,73 m² na één maand, tegenover 0,8 ml/min/1,73 m² bij placebo. Deze tijdelijke daling was goed verdraagbaar, vertoonde geen onverwachte veiligheidsignalen en correleerde sterker met een afname van de urine-albumine-creatinineratio. Voor de klinische praktijk bevestigt dit dat een lichte, reversibele eGFR-daling onder finerenone een verwacht farmacodynamisch effect is dat geen aanleiding hoeft te zijn tot stoppen van de therapie.","abstract_original":"INTRODUCTION: The 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: Adults 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: Mean 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: In people with T1D and CKD, finerenone induced an acute eGFR dip that was well tolerated without unexpected safety signals."}