Through the first half of 2025, nephrology has celebrated multiple noteworthy advances and this trend continued at the 62nd European Renal Association (ERA 2025) Congress. The meeting, held June 04-07, 2025 in Vienna, Austria, delivered a focused slate of data with meaningful takeaways for real-world care now and in the future. In this recap, we spotlight 5 standout studies from ERA 2025 that drew attention across the kidney care community.

Among the biggest headlines: sibeprenlimab posted phase 3 data supporting its role as a potential first-in-class anti-APRIL therapy in IgA nephropathy (IgAN), while updated 100-week results for zigakibart suggested durable immunologic suppression and proteinuria reduction in the same population. Pegcetacoplan extended its clinical profile with sustained efficacy across native and transplanted kidneys in C3G and IC-MPGN. The CONFIDENCE trial offered a compelling case for early combination therapy with finerenone and empagliflozin in CKD and type 2 diabetes. Meanwhile, results from the ACHIEVE trial sought to bring clarity on the use of spironolactone in dialysis patients.

Check out our study recaps below and use the related content links for expert perspectives direct from the conference floor!

5 Studies to Know from ERA 2025

1. CONFIDENCE: SGLT2i and Finerenone Effective, Safe to Initiate Simultaneously in CKD

In 800 patients with CKD and type 2 diabetes, combination therapy with finerenone and empagliflozin reduced UACR by 52% at 180 days compared to baseline (least-squares mean ratio, 0.48; 95% CI, 0.44–0.54), outperforming finerenone alone by 29% (LS mean ratio, 0.71; 95% CI, 0.61–0.82) and empagliflozin alone by 32% (LS mean ratio, 0.68; 95% CI, 0.59–0.79; both P < .001). Post-treatment UACR rebound confirmed the pharmacologic effect, with LS mean increases of 63% in the combo group vs. 44–45% in monotherapy arms. Serious AEs occurred in 7.1% (combination), 6.1% (finerenone), and 6.4% (empagliflozin), with <5% discontinuation across groups. These findings validate the safety and additive albuminuria-lowering effects of early dual blockade with nonsteroidal MRAs and SGLT2 inhibitors.

Related Content: Kidney Compass: CONFIDENCE Trial at ERA 2025, with Rajiv Agarwal, MD, MS

2. Sibeprenlimab Halves Proteinuria in IgAN in Phase 3 VISIONARY Trial

In the phase 3 VISIONARY trial, sibeprenlimab reduced 24-hour urine protein-to-creatinine ratio (UPCR) by 50.2% from baseline at 9 months, corresponding to a placebo-adjusted reduction of 51.2% in the interim cohort of 320 patients with biopsy-confirmed IgAN. Spot UPCR reductions emerged by week 4, suggesting early onset of efficacy. Serious treatment-emergent adverse events (TEAEs) were lower with sibeprenlimab (3.9%) versus placebo (5.4%), with overall TEAE rates of 76.3% and 84.5%, respectively. These findings, presented just ahead of the FDA’s priority review decision, support a favorable risk-benefit profile for a novel anti-APRIL monoclonal antibody in IgAN.

Related Content: Kidney Compass: Sibeprenlimab and the VISIONARY Trial, with Vlado Perkovic, MBBS, PhD, at ERA 2025 (Preview Below)

3. Pegcetacoplan Sustains Proteinuria Reductions in C3G, IC-MPGN at 52 Weeks

At 52 weeks, pegcetacoplan led to a 67.2% mean reduction in UPCR (95% CI, –75.8 to –55.4) in continuously treated patients with C3 glomerulopathy or IC-MPGN, and a 51.3% reduction (95% CI, –62.1 to –37.5) in patients who crossed over from placebo after week 26. eGFR remained stable with a mean decline of –3.7 mL/min/1.73 m² in the continuous group and –4.7 mL/min/1.73 m² in crossover patients by week 52. TEAEs occurred in 77.0% and 73.7% of patients in the continuous and crossover groups, respectively, with no deaths or allograft losses. These data reinforce pegcetacoplan’s role as a targeted complement C3 inhibitor with sustained efficacy across transplant and native kidney settings.

4. Zigakibart Maintains Efficacy Out to 100 Weeks in ADU-CL-19 Trial

In updated 100-week data from 40 patients with IgAN and persistent proteinuria, zigakibart reduced proteinuria by 60% from baseline, with 55% of patients reaching <500 mg/day and 31% reaching <300 mg/day. Serum IgA and Gd-IgA1 dropped by 74%, IgM by 78%, and IgG by 35%, reflecting targeted immunologic suppression. No serious AEs or drug discontinuations were reported despite an 85% TEAE rate, all of which were mild or moderate. These extended data suggest durable efficacy and safety of APRIL inhibition in modifying IgAN pathogenesis.

Related Content: Understanding Zigakibart's Potential in IgA Nephropathy, with Jonathan Barratt, MD, PhD (Preview Below)

5. ACHIEVE: Spironolactone Fails to Reduce Cardiovascular Risk in Dialysis Patients

In 2532 patients undergoing maintenance dialysis, spironolactone 25 mg daily did not significantly reduce the composite endpoint of cardiovascular death or heart failure hospitalization (20.5% vs 21.6% with placebo; HR, 0.92; 95% CI, 0.78–1.09; P = .35). Secondary endpoints—including cardiac death, vascular death, and all-cause mortality—were also similar across groups. Severe hyperkalemia occurred more frequently in the spironolactone arm (6.6% vs 4.5%), with a hazard ratio of 1.44 (95% CI, 1.03–2.01). These results do not support routine use of spironolactone for cardioprotection in dialysis patients and highlight the hyperkalemia risk in this population.