Kidney Week 2025 Annual Meeting-Hemodialysis: Novel Interventions

Video Transcription

Video Summary

This session on hemodialysis and novel interventions featured multiple studies spanning symptom management, anemia therapy analytics, diabetes medications, SGLT2/GLP-1 use in dialysis, hemodiafiltration outcomes, and incremental dialysis strategies.<br /><br />A Thai multicenter open-label RCT tested intradialytic quadriceps strengthening exercise plus gabapentin versus gabapentin alone for restless legs syndrome (RLS) in hemodialysis patients. Over 12 weeks, both groups improved, but combination therapy produced a substantially larger reduction in International RLS severity scores with similar minor adverse events, supporting supervised intradialytic exercise as an effective add-on.<br /><br />A post hoc analysis of the global INNOVATE phase 3 trials of vadadustat (HIF-PHI) versus darbepoetin in dialysis patients applied hierarchical “win odds” methods to prioritize more serious outcomes. While primary time-to-first-event analyses showed non-inferior cardiovascular safety, the win-odds approach suggested fewer deaths and hospitalizations with vadadustat (about 7% lower ITT; 14% lower on-treatment).<br /><br />A Taiwanese national database study examined antidiabetic drug classes in ~50,000 dialysis patients using marginal structural models. DPP-4 inhibitors and thiazolidinediones were associated with lower mortality, while insulin (and possibly metformin, though rare) was linked to higher mortality; insulin, sulfonylureas, and meglitinides increased hypoglycemia risk.<br /><br />A double-blind RCT (HALD-HF) evaluated low-dose henagliflozin in dialysis patients with HFpEF. Over 24 weeks, LV mass index improved versus placebo, especially in less overhydrated patients, with similar adverse events.<br /><br />Real-world analyses suggested off-label SGLT2 inhibitor use in ESKD may reduce mortality and sepsis versus DPP-4 inhibitors, and GLP-1 use in incident U.S. dialysis patients (DaVita cohort) was associated with ~9% lower hospitalization rates after matching.<br /><br />A large EMEA cohort study (Fresenius) found hemodiafiltration versus high-flux HD was associated with fewer cardiovascular- and fluid-related hospital admissions and fewer hospital days.<br /><br />Finally, one center reported incremental HD (less than thrice weekly) was not associated with worse survival when carefully monitored; diabetics transitioned faster. Another group developed a machine-learning decision tool to emulate expert decisions on when to intensify incremental HD, with strong internal and moderate external validation.

Asset Subtitle

Moderator(s): Rupali Avasare, Vimal Derebail

Presentation(s):

TRPC6 Inhibition for the Treatment of FSGS: Phase 2 Randomized Controlled Trial of BI 764198 - Nicholas Cross
Duration of Absolute Proteinuria Response with Nefecon in Patients with Primary IgAN: Results from the Two-Year NefIgArd Trial - Brad Rovin
Pegcetacoplan for 52 Weeks Results in Sustained Proteinuria Reduction to Remission (≤0.5 g/g) and Normalization (≤0.2 g/g): Phase 3 VALIANT Trial - Carla Nester
Ravulizumab in Atypical Hemolytic Uremic Syndrome: Time-to-Treatment Analysis from a Phase 3 Trial - Katherine Garlo
Prospective Randomized Controlled 96-week Study to Evaluate the Efficacy and Safety of Tacrolimus and Glucocorticoid as Continuous Induction-Maintenance Treatment for Class III/IV±V Lupus Nephritis - Tak Mao Chan
Zanubrutinib (zanu) in Anti-Phospholipase A2 Receptor (PLA2R)-Associated Primary Membranous Nephropathy (PMN): Preliminary Results of a Phase 2/3, Multicenter, Randomized, Open-Label Study - Richard Lafayette
Targeting Podocytopathy: Liraglutide Restores Podocyte Adhesion Homeostasis via GLP1R-CD151-Dependent Integrin Signaling in FSGS - Ying Fan
FB-7013: A Novel, Long-Duration siRNA Targeting Mannan-Binding Lectin Serine Protease 2 (MASP2) Exhibits Therapeutic Potential for Treatment of IgAN - Michael Wang
Spatially Controlled Immunosuppression with SynNotch T Cells for the Treatment of Kidney Autoimmunity - Tobias Eckey

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

Meta Tag

Date 11/6/2025

Pathway 1 Dialysis

Session ID 519836

Keywords

hemodialysis

end-stage kidney disease (ESKD)

restless legs syndrome (RLS)

intradialytic exercise

gabapentin

vadadustat

darbepoetin

HIF-prolyl hydroxylase inhibitor (HIF-PHI)

win odds analysis

antidiabetic medications in dialysis

SGLT2 inhibitors

GLP-1 receptor agonists

hemodiafiltration (HDF)

incremental hemodialysis