Kidney Week 2025 Annual Meeting-Best of the Journal of the American Medical Association and the New England Journal of Medicine

Video Transcription

Video Summary

This Kidney Week session launched an inaugural “Best of JAMA and NEJM” program to bring high-impact cardiovascular and general-medicine studies to a nephrology audience. It featured multiple recent papers.<br /><br />Two phase 3 trials evaluated novel aldosterone synthase inhibitors for uncontrolled/resistant hypertension. LAUNCH-HTN (JAMA) tested lorundrostat in a large, diverse global cohort on 2–5 background drugs (eGFR ≥45; MRAs excluded). Lorundrostat lowered automated office systolic BP rapidly and sustainably, with a placebo-adjusted reduction of ~9 mmHg at week 6 and significant reductions at week 12; 44% achieved <130 mmHg. Hyperkalemia and hyponatremia were generally mild; clinically significant potassium >6 mmol/L was <1%, and no glucocorticoid deficiency occurred. The BaxHTN trial (NEJM) tested baxdrostat 1–2 mg in mostly resistant hypertension and showed placebo-adjusted systolic BP reductions ~9–10 mmHg at 12 weeks, consistent effects across subgroups, notable ambulatory BP lowering, and a partly persistent effect after withdrawal. Hyperkalemia increased with dose but severe confirmed events were uncommon.<br /><br />A JAMA health-services study examined dialysis staffing and transplant access for adolescents/young adults. Using USRDS data (2005–2019), higher patient-to-nurse and patient-to-social-worker ratios were associated with reduced waitlisting/transplantation, especially for patients <22 years.<br /><br />The CONFIDENCE trial (NEJM) in type 2 diabetes with CKD showed that starting finerenone plus empagliflozin together produced larger albuminuria reductions (~52% at 180 days) than either alone, with relatively low discontinuation for hyperkalemia; BP and eGFR changes were largely hemodynamic and reversible.<br /><br />A CKDPC meta-analysis (JAMA) found frequent discordance between creatinine- and cystatin C–based eGFR (common in older, comorbid, and hospitalized patients). An eGFRcys ≥30% lower than eGFRcr predicted higher mortality, cardiovascular events, heart failure, and kidney failure, supporting broader cystatin C use and combined reporting.<br /><br />Finally, the REGENCY lupus nephritis trial (NEJM) showed obinutuzumab plus standard therapy improved complete renal response at week 76 versus placebo, enabled steroid tapering, achieved deep B-cell depletion, and had higher infection events largely influenced by the COVID era.

Asset Subtitle

Moderator(s): Julie Ingelfinger, Wolfgang Winkelmayer

Presentation(s):

JAMA: Lorundrostat in Participants with Uncontrolled Hypertension and Treatment-Resistant Hypertension - The Launch-HTN Randomized Clinical Trial - Manish Saxena
NEJM: Efficacy and Safety of Baxdrostat in Uncontrolled and Resistant Hypertension - John M. Flack
JAMA: Dialysis Facility Staffing Ratios and Kidney Transplant Access Among Adolescents and Young Adults - Elaine Ku
NEJM: Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes - Rajiv Agarwal
JAMA: Discordance in Creatinine Based eGFR and Cystatin C Based eGFR and Clinical Outcomes - A Meta-Analysis - Michelle M. Estrella
NEJM: Efficacy and Safety of Obinutuzumab in Active Lupus Nephritis - Brad Rovin

Note: Continuing education credits are not being offered for this session.

Meta Tag

Date 11/7/2025

Pathway 1 Other

Session ID 507653

Keywords

Kidney Week

Best of JAMA and NEJM

aldosterone synthase inhibitor

lorundrostat

LAUNCH-HTN trial

baxdrostat

BaxHTN trial

resistant hypertension

hyperkalemia

dialysis staffing ratios

transplant waitlisting access

finerenone plus empagliflozin

CONFIDENCE trial

cystatin C versus creatinine eGFR discordance

obinutuzumab lupus nephritis REGENCY trial