Comparing CKD populations with T1D and T2D: a perspective based on the FINE-ONE and FIDELITY populations

Chronic kidney disease (CKD) is a common comorbidity of both type 1 diabetes (T1D) and type 2 diabetes (T2D) and is associated with increased mortality, end-stage kidney disease and cardiovascular disease risk. Despite standard-of-care treatment with renin-angiotensin system inhibitors added to blood pressure and glycaemic control, people with CKD and T1D have a residual risk of CKD progression. Advances in therapeutic management have been limited over the past 3 decades, especially compared with CKD in T2D, for which new treatment options have emerged in the last 5 years. In this review article we discuss the similarities and differences between T1D and T2D populations with CKD, including epidemiology, pathophysiology and clinical findings. Additionally, we explore the use of albuminuria as a potential bridging biomarker to extrapolate clinical evidence from one population to the other. This concept could offer a promising strategy to narrow the gap in treatment availability between these populations and address the unmet therapeutic need in people with CKD and T1D. The FINE-ONE trial is investigating the non-steroidal mineralocorticoid receptor antagonist finerenone in a population with CKD and T1D using the change in urine albumin:creatinine ratio from baseline over 6 months as its primary endpoint and bridging biomarker. Similarities between the populations from FINE-ONE trial and FIDELITY (a pooled dataset of individuals with CKD and T2D included in two large phase 3 clinical trials of finerenone) may inform the translation of clinical evidence on finerenone from people with CKD and T2D to those with CKD and T1D.

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Publication Details

Journal
Nephrology Dialysis Transplantation
Published
2025-09-09
DOI
https://doi.org/10.1093/ndt/gfaf183
Citations
1
Primary Topic
Hormonal Regulation and Hypertension
Type
article
Field-Weighted Citation Impact
1.29

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article

Comparing CKD populations with T1D and T2D: a perspective based on the FINE-ONE and FIDELITY populations

Stefan D. Anker, Jesper Nørgaard Bech, John M. Russell, Gerasimos S Filippatos et al.
1 citations
Nephrology Dialysis Transplantation
Hormonal Regulation and Hypertension
1.29
article

Comparing CKD populations with T1D and T2D: a perspective based on the FINE-ONE and FIDELITY populations

Stefan D. Anker, Jesper Nørgaard Bech, John M. Russell, Gerasimos S Filippatos, Paolo Fiorina, David Z.I. Cherney, Hiddo J.L. Heerspink, Karoline Schousboe, Luís M. Ruilope, Bertram Pitt, Patrick Schloemer, Janet B. McGill, Rajiv Agarwal, Meike Brinker, Robert Lawatscheck, Nicholas M. Selby, Antonio Jesús Amor, Peter R Rossing
article en
1 citations

Abstract

Chronic kidney disease (CKD) is a common comorbidity of both type 1 diabetes (T1D) and type 2 diabetes (T2D) and is associated with increased mortality, end-stage kidney disease and cardiovascular disease risk. Despite standard-of-care treatment with renin-angiotensin system inhibitors added to blood pressure and glycaemic control, people with CKD and T1D have a residual risk of CKD progression. Advances in therapeutic management have been limited over the past 3 decades, especially compared with CKD in T2D, for which new treatment options have emerged in the last 5 years. In this review article we discuss the similarities and differences between T1D and T2D populations with CKD, including epidemiology, pathophysiology and clinical findings. Additionally, we explore the use of albuminuria as a potential bridging biomarker to extrapolate clinical evidence from one population to the other. This concept could offer a promising strategy to narrow the gap in treatment availability between these populations and address the unmet therapeutic need in people with CKD and T1D. The FINE-ONE trial is investigating the non-steroidal mineralocorticoid receptor antagonist finerenone in a population with CKD and T1D using the change in urine albumin:creatinine ratio from baseline over 6 months as its primary endpoint and bridging biomarker. Similarities between the populations from FINE-ONE trial and FIDELITY (a pooled dataset of individuals with CKD and T2D included in two large phase 3 clinical trials of finerenone) may inform the translation of clinical evidence on finerenone from people with CKD and T2D to those with CKD and T1D.

Nephrology Dialysis TransplantationVol. 41(3)
University Health Network (CA), University Medical Center Groningen (NL), Steno Diabetes Centers (DK), University of Nottingham (GB), National and Kapodistrian University of Athens (GR), Washington University in St. Louis (US), University of Michigan (US), Royal Derby Hospital (GB), Odense University Hospital (DK), Research Institute Hospital 12 de Octubre (ES), Hospital Universitario 12 De Octubre (ES), Richard L. Roudebush VA Medical Center (US), Michigan Medicine (US), Hospital Clínic de Barcelona (ES), German Centre for Cardiovascular Research (DE), Hypertension Institute (US), ASST Fatebenefratelli Sacco (IT), Bayer (United Kingdom) (GB), Indiana University – Purdue University Indianapolis (US), Bayer (Germany) (DE), Universidad Europea de Madrid (ES)
Bayer
Openalex Percentile: Top 15%
Hormonal Regulation and Hypertension
1.29
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