Kidney Week 2025 Annual Meeting-Late-Breaking Research Orals

Video Transcription

Video Summary

The session featured several late-breaking nephrology studies. First, investigators from the CKD-EPI-CT consortium presented an updated individual patient–data meta-analysis of 48 randomized trials (over 85,000 participants) evaluating whether early change in albuminuria can serve as a surrogate endpoint for kidney failure. Average treatment effects reduced albuminuria by ~30% and kidney outcomes by ~25%. Trial-level effects were strongly correlated (overall R² ~0.66), with similar patterns across diabetes, CKD, and IgA nephropathy, though uncertainty remained due to wide credible intervals. Modeling suggested that a ≥25% UACR reduction predicts a high probability of later kidney benefit; however, the proportion of benefit explained by albuminuria differed by drug class (e.g., most RAS inhibitor benefit was mediated through albuminuria, while SGLT2 inhibitors had substantial benefit beyond albuminuria reduction).<br /><br />Next, a VA pilot cluster-randomized study tested a personalized clinical decision support tool (incorporating NLP to extract discontinuation reasons from notes) to encourage ACEi/ARB reinitiation in CKD patients. Reinitiation within 30 days was modestly higher with the tool (18% vs 13% control), and higher eGFR increased reinitiation likelihood.<br /><br />A learning health system “pseudo-randomized” VA trial used the last digit of Social Security numbers to phase a pharmacist-led SGLT2i initiation program. It nearly doubled initiation rates versus usual care and improved 1-year persistence (33.6% vs 15.5% filling SGLT2i).<br /><br />The NIGHTLIFE trial compared thrice-weekly in-center nocturnal extended hemodialysis (6–8 hours) vs conventional daytime dialysis for 6 months. It was underpowered for the primary quality-of-life endpoint but showed signals of improved kidney-disease–specific QOL, cognition, and reduced binder/ESA medication burden without major safety differences.<br /><br />A Phase 2 kidney transplant trial (BISTO) compared the anti-CD40L antibody tegoprubart with tacrolimus. Overall 12-month eGFR was similar, with potentially better function in certain subgroups, fewer tacrolimus-associated metabolic/neurologic effects, but more leukopenia/proteinuria and a trend toward more cellular rejection.<br /><br />Finally, an early pediatric study reported BCMA/CD70-targeted CAR-T therapy in six children with multidrug-resistant steroid-resistant nephrotic syndrome: all achieved partial or complete remission with mild, manageable CRS and no ICANS reported.

Asset Subtitle

Moderator(s): Eugene Rhee, Jodi Smith

Presentation(s):

Albuminuria Change as a Surrogate End Point for Kidney Failure: An Updated Meta-Analysis of Randomised Controlled Trials - Hiddo Heerspink
Clinical Decision Support Tool to Enhance Angiotensin-Converting Enzyme Inhibitor (ACEI)/Angiotensin Receptor Blocker (ARB) Use in Patients with CKD - Sankar Navaneethan
Learning Health System Intervention to Increase SGLT2 Inhibitor Use - Areef Ishani
Extended In-Center Nocturnal vs. Conventional Daytime Dialysis: The NightLife Trial - James Burton
Efficacy and Safety of Tegoprubart for the Prevention of Rejection in Kidney Transplantation: Results from the Phase 2 BESTOW Trial - Andrew Adams
Safety and Efficacy of B Cell Maturation Antigen (BCMA)/CD70-Targeted Chimeric Antigen Receptor T Cell (CAR-T) Therapy in Pediatric Patients with Multidrug-Resistant, Steroid-Resistant Nephrotic Syndrome - Hanyan Meng

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

Meta Tag

Date 11/6/2025

Pathway 1 Other

Session ID 527925

Keywords

albuminuria surrogate endpoint

UACR reduction

CKD-EPI individual patient data meta-analysis

kidney failure outcomes

RAS inhibitors mediation

SGLT2 inhibitors beyond albuminuria

VA clinical decision support NLP

ACEi/ARB reinitiation in CKD

pharmacist-led SGLT2i initiation program

nocturnal extended hemodialysis NIGHTLIFE trial

CAR-T therapy steroid-resistant nephrotic syndrome