ASN Kidney Week 2026 Recap: 8 Key Updates in Kidney Disease to Know

IgA nephropathy (IgAN) dominated the late-breaking program at the American Society of Nephrology (ASN) Kidney Week 2026 in Denver, Colorado, where phase 3 data for B-cell and complement-targeted therapies arrived days after a US Food and Drug Administration (FDA) accelerated approval in the disease.

Beyond IgAN, investigators presented new evidence on aspirin for primary prevention in chronic kidney disease (CKD), vascular access for women receiving hemodialysis, pregnancy after living kidney donation, dietary potassium, and depression treatment. HCPLive's editorial team spoke with investigators on site, and has compiled 8 key updates from the meeting.

Povetacicept Cuts Proteinuria 52% in Phase 3 RAINIER Interim Analysis

In the prespecified interim analysis of RAINIER, povetacicept, a dual BAFF/APRIL inhibitor, reduced 24-hour urine protein-to-creatinine ratio (UPCR) by 52.0% at week 36 vs 4.3% with placebo (adjusted difference, −49.8 percentage points; P < .001) among 199 adults with IgAN.¹ At week 36, 42% of patients receiving povetacicept reached a UPCR < 0.5 g/g, compared with 6% receiving placebo.

Galactose-deficient IgA1 fell 77.4% with povetacicept, and hematuria resolved in 85% vs 23% of patients with baseline hematuria.¹ In an interview with HCPLive, James Tumlin, MD, of Georgia Nephrology and Emory University School of Medicine, pointed to the UPCR < 0.5 g/g finding as especially relevant as guidance shifts toward lower proteinuria targets.

The FDA target action date for accelerated approval is November 30, 2026. eGFR slope through week 104 remains the trial's final primary end point.

Read more: 42% on Povetacicept Reach KDIGO-Aligned UPCR Target in RAINIER

Telitacicept Slows eGFR Decline Through 2 Years in TELIGAN

Final 104-week results from the phase 3 TELIGAN trial showed an annualized eGFR slope of −0.6 mL/min/1.73 m² per year with telitacicept vs −5.7 mL/min/1.73 m² per year with placebo (difference, 5.1; 95% CI, 3.5–6.7; P < .001) among 318 adults with IgAN.² Confirmed eGFR decline ≥ 30% occurred in 2.5% vs 16.4% of patients (hazard ratio [HR], 0.11; 95% CI, 0.04–0.30).

Proteinuria fell 60.7% vs placebo at week 104, and no composite kidney failure events occurred with telitacicept vs 3.1% with placebo.² Serious adverse events were less frequent with telitacicept (8.2% vs 18.2%), while injection-site reactions were more common (56.0% vs 18.9%).

The trial was conducted in China, where telitacicept holds conditional approval for IgAN. No US filing plans in IgAN have been announced.

Read more: Kidney Compass: Final 2-Year TELIGAN Data for Telitacicept in IgA Nephropathy

Complement Inhibitors Ravulizumab and Sefaxersen Lower Proteinuria in IgAN

Two phase 3 interim analyses of complement-targeted therapies reported similar proteinuria reductions. In I CAN, ravulizumab (Ultomiris), a long-acting C5 inhibitor, reduced 24-hour UPCR by 43.4% vs placebo at week 34 (99% CI, 30.1–54.2; P < .001) among 352 patients.³ The FDA granted ravulizumab accelerated approval for IgAN on October 21, 2026, based on these data.

In IMAgINATION, sefaxersen, a liver-directed antisense oligonucleotide targeting complement factor B, reduced 24-hour UPCR by 43.1% vs placebo at week 37 (95% CI, 32.5–52.0; P < .0001).⁴ Differences in trial design and timepoints limit direct comparison between the 2 agents, and eGFR outcomes from both trials are still pending.

Living Kidney Donors Show Modestly Greater Hypertensive Pregnancy Risk

A matched cohort study from 3 Canadian provinces, published simultaneously in JAMA, compared 385 pregnancies in living kidney donors with 1540 matched nondonor pregnancies.⁵ Gestational hypertension, preeclampsia, or eclampsia occurred in 11.9% vs 8.3% (risk ratio, 1.51; 95% CI, 1.10–2.08), and more than 88% of donor pregnancies were unaffected.

Small for gestational age births were also more common among donors (13.8% vs 7.9%), a secondary finding investigators said could reflect chance.⁵

“If someone is interested in having a pregnancy after donation, that doesn’t preclude them from being a donor,” Amit X. Garg, MD, PhD, of Western University, said in an interview with HCPLive.

ATTACK Finds No Significant Benefit of Aspirin for Primary Prevention in CKD

In the pragmatic, open-label ATTACK trial conducted in UK primary care, 4633 adults with CKD and no history of cardiovascular disease (CVD) were randomized to aspirin 75 mg daily or no aspirin.⁶ Major cardiovascular events occurred in 2.4% vs 3.3% of participants (subdistribution hazard ratio [SHR], 0.73; 95% CI, 0.52–1.03), a difference that was not statistically significant.

There were 29 major bleeding events with aspirin vs 19 without (SHR, 1.54; 95% CI, 0.86–2.74).⁶ Enrollment fell well short of the planned 25,210 after COVID-19 disruptions, and Hugh Gallagher, MBBS, PhD, of Epsom and St Helier University Hospitals NHS Trust, told HCPLive the team is not recommending aspirin for primary prevention in CKD based on these results. Pooled analyses with prior trials are planned.

Bioengineered Vessel Adds Catheter-Free Days for Women on Hemodialysis

In the phase 3 V012 trial, women with end-stage kidney disease (ESKD) receiving hemodialysis via catheter were randomized to an acellular tissue engineered vessel (ATEV) or arteriovenous fistula (AVF).⁷ In a prespecified interim analysis of 80 patients, the ATEV group had a mean of 220 catheter-free days over 12 months vs 129 with AVF (difference, 91 days; P < .001), and mean time to maturation was 1.7 vs 5.3 months.

Dialysis access-related infections occurred in 5.1% of the ATEV group vs 15% of the AVF group.⁷ Thrombosis and stenosis events were more frequent with the ATEV, though its usage-adjusted stenosis rate was lower. Prabir Roy-Chaudhury, MD, PhD, of the University of North Carolina Kidney Center, said the event rates need to be examined in more detail.

The ATEV remains investigational for hemodialysis access.

Read more: Bioengineered Vessel for Dialysis Access Integrates With Patient Cells

Liberalized Produce Diet Did Not Raise Serum Potassium in CKD

In a randomized crossover trial of 30 adults with an eGFR of 15–45 mL/min/1.73 m², a diet targeting 2000 mg/day of potassium from fruits and vegetables did not significantly change serum potassium compared with a restricted 500 mg/day diet (mean difference, −0.014 mEq/L; P = .875), while urinary potassium excretion rose.⁸

Navdeep Tangri, MD, of the University of Manitoba, told HCPLive the findings suggest restricting potassium-rich produce may be unnecessary for many patients with CKD. The trial was small and short, however, and cannot establish the long-term safety of dietary liberalization.⁸

CONCORD: Bupropion and Behavioral Activation Do Not Outperform Control for Depression in CKD

CONCORD randomized 202 patients with CKD stages G3b to G5D and major depressive disorder (MDD) to behavioral activation therapy (BAT), bupropion, or attention control, with combination therapy for nonresponders at 8 weeks.⁹ At 16 weeks, depressive symptom scores fell by similar amounts in all 3 arms (5.9, 5.7, and 5.9 points, respectively).

BAT showed an advantage over control at 8 weeks that did not persist, and bupropion was associated with more insomnia and confusion than BAT.⁹ Susan Hedayati, MD, MHSc, of Stony Brook University Renaissance School of Medicine, told HCPLive she recommends shared decision making and a 4 to 6 week treatment trial, stopping therapy if patients do not respond.

Read more: Treating Depression in CKD After CONCORD, With Susan Hedayati, MD, MHSc

References

1. Barratt J, Zhang H, Han SH, et al. Interim analysis of a phase 3 trial of povetacicept in IgA nephropathy. N Engl J Med. Published online October 23, 2026. doi:10.1056/NEJMoa2608682

2. Lv J, Perkovic V, Zhang H, et al. Telitacicept for IgA nephropathy: final two-year results of the phase 3 TELIGAN trial. Presented at: ASN Kidney Week 2026; October 21-25, 2026; Denver, CO. Abstract TH-OR111. doi:10.1681/ASN.20265trr83ac

3. Barratt J, Farag YMK, Rice K, et al. Ravulizumab in IgA nephropathy: interim analysis of a phase 3 trial. N Engl J Med. Published online October 23, 2026. doi:10.1056/NEJMoa2607544

4. Barratt J, Cheng J, Duggal V, et al. Sefaxersen, a novel mRNA-targeted therapy for IgA nephropathy: interim analysis of the phase 3 IMAgINATION trial. Presented at: ASN Kidney Week 2026; October 21-25, 2026; Denver, CO. Abstract FR-OR104. doi:10.1681/ASN.2026n6sbk0tt

5. Wang C, Naylor KL, McArthur E, et al. Pregnancy outcomes after living kidney donation. JAMA. Published online October 22, 2026. doi:10.1001/jama.2026.21737

6. Gallagher H, Dumbleton JS, Daunt W, et al. ATTACK (Aspirin To Target Arterial events in Chronic Kidney Disease): a multicentre randomised trial of aspirin vs. usual care for the primary prevention of cardiovascular events in patients with CKD. Presented at: ASN Kidney Week 2026; October 21-25, 2026; Denver, CO. Abstract FR-OR100. doi:10.1681/ASN.2026pd5vw8fa

7. Hussain MA, Roy-Chaudhury P, Bou-Ghannam S, et al. Randomized controlled trial of an acellular tissue engineered vessel vs. arteriovenous fistula for hemodialysis access in female patients with ESKD: a phase 3 CLN-PRO-V012 interim analysis. Presented at: ASN Kidney Week 2026; October 21-25, 2026; Denver, CO. Abstract TH-OR113. doi:10.1681/ASN.2026q87550d8

8. Tangri N, Seniuk B, Hager D, et al. Dietary potassium liberalization with fruits and vegetables in people with CKD: a randomized crossover clinical trial. Presented at: ASN Kidney Week 2026; October 21-25, 2026; Denver, CO. Abstract TH-PO1247. doi:10.1681/ASN.2026t1yq1btf

9. Hedayati S, Zhang X, Tuttle KR, et al. CONCORD: a randomized controlled trial of novel therapies for depression in patients with CKD. Presented at: ASN Kidney Week 2026; October 21-25, 2026; Denver, CO. Abstract FR-OR110.