Kidney Week 2025 Annual Meeting-Cardiovascular-Kidney-Metabolic Syndrome Case Discussions: From Trials to Patient Management, Including the Garabed Eknoyan, MD, Endowed Lectureship

Video Transcription

Video Summary

The session opens by honoring Dr. Garabed Eknoyan, recognized as a major figure in nephrology and a key architect of evidence-based clinical practice guidelines, including CKD staging and NKF/KDOQI initiatives. Dr. Ian DeBoer then delivers the endowed lecture, explaining why guidelines matter: they synthesize diverse evidence, support equity, guide shared decision-making, and evolve as “living documents.” He “decodes” KDIGO’s evidence grading (recommend vs suggest; evidence A–D) and summarizes 2022 and 2024 KDIGO guidance for CKD management.<br /><br />DeBoer reviews core therapies and supporting trial/meta-analysis evidence: statins for cardiovascular risk reduction in non-dialysis CKD; SGLT2 inhibitors as foundational for kidney and heart protection; growing evidence for GLP-1–based therapies (including FLOW); continued importance of ACEi/ARB; and finerenone for type 2 diabetes with albuminuria despite RAS blockade. He emphasizes combination therapy, but questions rigid “four pillars” frameworks, noting not all patients meet indications for all drugs. Key implementation gaps include slow uptake, disparities, and inadequate albuminuria testing.<br /><br />A debate follows on sequential versus simultaneous initiation. Dr. Viktor Rotbain-Kurvink argues for sequential/personalized treatment considering cost, side effects, and variable albuminuria response, proposing rapid monitoring (potentially at-home UACR) to identify responders. Dr. Meg Jardine argues for faster, multi-drug initiation to counter poor real-world persistence, drawing lessons from heart failure “pillars” and emphasizing early follow-up to maintain adherence while monitoring potassium and eGFR.<br /><br />Dr. Madalena Madero closes with real cases highlighting CKM (cardiovascular-kidney-metabolic) overlap, use of potassium binders to maintain RAS/MRA therapy, and the value of multidisciplinary cardiorenal clinics to optimize guideline-directed therapy and avoid premature dialysis labeling.

Asset Subtitle

Moderator(s): Christoph Wanner, Kevin Yau

Presentation(s):

KDIGO Guidelines Decoded: What They Mean for CKD Management in Practice: The Garabed Eknoyan, MD, Endowed Lectureship - Ian de Boer
Step-by-Step: The Case for Sequential Treatment in CKD Management - Viktor Rotbain Curovic
All In at Once: Evidence for Simultaneous Treatment Initiation in CKD - Meg Jardine
From Evidence to Action: Case-Based Discussions on CKD Management - Magdalena Madero

ASN gratefully acknowledges Wadi N. Suki, MD, for support of the Eknoyan Endowed Lectureship.

Meta Tag

Date 11/8/2025

Pathway 1 Diabetic Kidney Disease

Pathway 2 Hypertension and Cardiorenal Disorders

Session ID 507084

Keywords

Dr. Garabed Eknoyan

nephrology

evidence-based clinical practice guidelines

CKD staging

NKF KDOQI

KDIGO guidelines

KDIGO evidence grading

CKD management 2022 2024

statins in CKD

SGLT2 inhibitors

GLP-1 receptor agonists FLOW trial

ACE inhibitors ARB RAS blockade

finerenone

albuminuria testing UACR

cardiovascular-kidney-metabolic CKM and cardiorenal clinics