Kidney Week 2025 Annual Meeting-CKD: Identifying Risks and Optimizing Outcomes

Video Transcription

Video Summary

This CKD session focused on identifying risk and optimizing outcomes across several emerging therapies and biomarkers.<br /><br />Sydney Hartzell presented an emulated trial using U.S. Veterans Health Administration data (2018–2021) comparing new users of SGLT2 inhibitors versus GLP-1 receptor agonists, stratified by baseline Kidney Failure Risk Equation (KFRE). Overall, kidney failure and mortality outcomes were similar between drug classes, but GLP-1RAs showed a modest advantage for MACE and a CKM composite. Importantly, baseline kidney failure risk modified comparative benefit: GLP-1RAs appeared more favorable in moderate KFRE risk, whereas SGLT2 inhibitors appeared more favorable in high KFRE risk—suggesting KFRE could help prioritize therapy when both cannot be started.<br /><br />Victor Warhaus summarized the ZODIAC randomized double-blind crossover trial (n=27) testing low-dose endothelin receptor antagonist zibotentan (reported as “cipotentin”) with dapagliflozin. Combination therapy reduced albuminuria more than either agent alone (about 49% UACR reduction), and dapagliflozin mitigated ERA-related fluid retention (weight and bioimpedance measures), with tolerability similar to dapagliflozin.<br /><br />Geeta Yamlani examined primary aldosteronism (PA) testing and outcomes in advanced CKD veterans transitioning to dialysis. Only ~2% underwent PA evaluation, yet ~10.5% of those tested met PA criteria. PA status was not associated with faster eGFR decline; unexpectedly, lower aldosterone correlated with greater decline.<br /><br />Shun Watanabe reported a phase 2 trial of lubiprostone in CKD (eGFR 25–45) showing slower eGFR decline and lower BUN without reducing indoxyl sulfate; multi-omics implicated a gut polyamine–mitochondrial pathway.<br /><br />Other talks highlighted: FLOW trial analyses linking low cystatin-C/creatinine eGFR ratio (<0.7) to higher MACE/mortality and greater semaglutide benefit; real-world data suggesting finerenone outperformed spironolactone for kidney outcomes and hyperkalemia; FDA-cleared transdermal GFR measurement using relmapirazin; and HUNT study findings that urinary α1- and β2-microglobulin predicted adverse kidney events beyond eGFR/albuminuria.

Asset Subtitle

Moderator(s): Sankar Navaneethan, Panduranga Rao

Presentation(s):

Kidney Failure Risk Modifies Comparative Effectiveness of SGLT2 Inhibitors and GLP-1 Receptor Agonists on Cardiovascular-Kidney-Metabolic (CKM) Events - Sydney Hartsell
Effects of Zibotentan and Dapagliflozin Combination Therapy on Albuminuria and Fluid Parameters in CKD: Results from the ZODIAC Trial - Victor Wasehuus
Association of Primary Aldosteronism with Kidney Outcomes in Patients with Advanced CKD - Geeta Gyamlani
Lubiprostone in CKD: Insights into Mitochondrial Function and Polyamines from a Randomized Phase 2 Clinical Trial - Shun Watanabe
Discordance Between Cystatin C-Based eGFR and Creatinine-Based eGFR and Cardiovascular Risk in the FLOW Trial - Inga Soveri
Comparative Kidney Outcomes of Spironolactone vs. Finerenone in Patients with CKD - Connor O'Neill-Dee
Clinical Study Evaluating Accuracy of the Transdermal (GFR) Methodology in Patients with CKD - Stuart Goldstein
Proximal Tubule Reabsorption Markers and CKD Progression: Case-Cohort Analysis from the Population-Based HUNT3 Study - Marius Øvrehus

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

Meta Tag

Date 11/7/2025

Pathway 1 CKD Non-Dialysis

Session ID 519916

Keywords

chronic kidney disease

SGLT2 inhibitors

GLP-1 receptor agonists

Kidney Failure Risk Equation (KFRE)

major adverse cardiovascular events (MACE)

zibotentan endothelin receptor antagonist

dapagliflozin combination therapy

primary aldosteronism screening in CKD

lubiprostone phase 2 trial

cystatin-C/creatinine eGFR ratio

finerenone vs spironolactone

urinary alpha-1 and beta-2 microglobulin biomarkers