Nephrology Month in Review: March 2024

Building upon a strong previous 2 months to kick off 2024, March saw equal success in the field of nephrology. Characterized by updated Kidney Disease: Improving Global Outcomes (KDIGO) guidelines and new research in chronic kidney disease (CKD) as well as recent data advancing clinicians’ understanding of immunoglobulin A nephropathy (IgAN) prognosis, our March 2024 month in review spotlights some of our top nephrology content from the past few weeks.

Managing CKD

KDIGO Releases Updated 2024 CKD Clinical Practice Guideline

In an update to the previous 2012 CKD Guideline, KDIGO released its 2024 Clinical Practice Guideline for the Evaluation and Management of CKD, including 6 chapters of recommendation statements and practice guidelines reinforcing methods for accurate CKD diagnosis and prediction, incorporating novel treatment strategies and approaches to the management of CKD, and identifying future areas for research.

Clinical Decision Support System May Aid Hypertension Management, Improve Clinical Outcomes in CKD

Results from a randomized clinical trial published in JAMA Internal Medicine highlight the potential utility of a system incorporating behavioral economic principles and human-centered design methods for reducing systolic blood pressure (SBP) in patients with CKD and improving providers’ prescribing habits and other actions for improving patient outcomes.

Although there was no difference in the percentage of patients who achieved BP control in the intervention group (50.4%; 95% CI, 46.5% to 54.3%) compared with the control group (47.1%; 95% CI, 43.3% to 51.0%), more patients who received the study intervention received an action aligned with the clinical decision support recommendations (49.9%; 95% CI, 45.1% to 54.8% vs 34.6%; 95% CI, 29.8% to 39.4%; P <.001).

CKD Complications, Comorbidities

Patients with CKD Underrepresented in Cardiovascular Disease Medication Clinical Trials

Despite being at high risk for cardiovascular disease (CVD) and CVD-related mortality, patients with CKD are often underrepresented in cardiovascular clinical trials, negatively impacting providers’ understanding of the effectiveness of cardiovascular disease medications in this patient population.

“The high cardiovascular risk in patients with CKD underscores the importance of effective cardiovascular risk management for these patients,” wrote lead investigator Julia Colombijn, MD/PhD student at University Medical Center Utrecht in the Netherlands, and colleagues. “Nevertheless, even though over 90% of patients with CKD are prescribed [cardiovascular risk management] medications, evidence is limited on the safety and effectiveness of these medications in this population.”

Pegloticase, Methotrexate Co-Therapy Has Similar Safety, Efficacy for Uncontrolled Gout Regardless of CKD Status

Although tolerability and toxicity are primary concerns when using methotrexate in patients with renal impairment, a recent study highlights its safety and efficacy when co-administered with pegloticase in patients with uncontrolled gout by comparing outcomes in patients with and without CKD. Leveraging real-world data from previous studies of patients with uncontrolled gout, results showed pegloticase and methotrexate co-therapy was associated with sustained urate-lowering response, manageable adverse events, and potential improvements in renal function, regardless of patients’ CKD status.

Semaglutide 1.0 mg (Ozempic) Reduced Kidney Events 24% in FLOW Trial

Announced by Novo Nordisk, topline results of the FLOW trial showed use of semaglutide 1.0 mg (Ozempic) was associated with a 24% reduction in the risk of kidney disease-related events among people with type 2 diabetes and CKD, meeting the study’s primary endpoint for reducing risk of a composite endpoint comprised of 5 components measuring the progression of CKD and the risk of kidney and cardiovascular mortality. Based on these results, Novo Nordisk intends to file for regulatory approvals of a label expansion for Ozempic in the US and the European Union in 2024.

Understanding IgAN Prognosis

Corticosteroid Therapy Reduces Proteinuria But Does Not Delay ESKD in Patients with IgAN

Results from this retrospective cohort study showed although corticosteroid therapy reduced proteinuria in patients with IgAN, it did not affect progression to end-stage kidney disease (ESKD) with all study participants reaching ESKD after a median of 5 years, regardless of whether they received supportive therapy alone or in combination with corticosteroid therapy. Further analysis showed the time from diagnosis until ESKD was similar between the groups, but corticosteroid treatment was associated with adverse effects.

RASi Use Linked to Improved Survival, Lower Risk of ESKD in Patients with IgA Nephropathy

This retrospective analysis provides a novel overview of the long-term survival and risk factors associated with IgAN, highlighting a 20% mortality rate attributed primarily to cardiovascular diseases and linked to older age, greater comorbidity burden, decreased renal function at disease diagnosis, and the absence of renin-angiotensin-system inhibitor (RASi) use. Of note, along with improved survival, the use of RASis was also associated with a decreased risk of ESKD.

C3 Staining, Serum IgA/C3 May Aid Treatment, Prediction of Renal Outcomes in IgAN

When it comes to predicting renal outcomes and guiding treatment decisions for adult patients with IgAN, both the serum IgA/C3 ratio and glomerular C3 staining are important factors to consider, as highlighted in this study. Results showed patients with serum IgA/C3 ≥ 2.806 and C3 staining ≥ 2 had worse outcomes, further identifying hypertension, serum creatinine, CKD stage, T1/2, and C3 staining as independent predictive factors of renal survival, all of which could inform an improved prognostic model for IgAN patients and potentially allow for personalized treatment approaches.