Nephrology Month in Review: September 2024

As 2024 nears its end, the field of nephrology finds itself continuing to experience more and more historic news and breakthroughs in renal care and research. While the year may be winding down, nephrologists and other kidney care professionals show no signs of slowing as we enter the final months of 2024.

This nephrology month in review spotlights HCPLive’s coverage of the field’s top news and research from the past few weeks, including the release of new obesity management guidelines, an FDA approval, studies exploring potential ways to expand the donor kidney pool, different lifestyle interventions for kidney disease, and new research about cardiorenal health.

New Renal Guidelines, Pipeline Updates

ASN Releases New Guidance on Obesity Management in Kidney Disease

On September 18, 2024, the American Society of Nephrology (ASN) released its inaugural Kidney Health Guidance on the Management of Obesity in Persons Living with Kidney Diseases, providing nephrologists and other kidney health professionals with an overview of the existing tools for obesity management and guidance on their implementation in clinical practice. Specifically, the guidance focused on adults ≥ 18 years of age living with obesity and kidney disease and emphasized the importance of individualized health and weight loss goals; the need for a multidisciplinary kidney care team to optimize outcomes; and the use of a combination of multiple interventions to achieve and sustain safe weight loss.

FDA Approves Travere Therapeutics’ Sparsentan to Slow Kidney Function Decline in Adult Primary IgAN

September also saw the full approval of Travere Therapeutics’ sparsentan (Filspari) for slowing kidney function decline in adults with primary IgA nephropathy (IgAN) at risk of disease progression, making it the second IgAN therapeutic to receive full FDA approval after last year’s approval of Calliditas Therapeutics’ budesonide (Tarpeyo) delayed-release capsules.

Related: Jonathan Barratt, PhD, FRCP: Sparsentan Full FDA Approval, Future IgAN Developments

Expanding the Kidney Donor Pool

Organ Donation After Euthanasia Can Safely Expand Kidney Donor Pool, Study Finds

Organ donation after euthanasia (donation after circulatory death type V [DCD-V]) kidney grafts may be a viable tool for safely expanding the donor kidney pool, according to findings from a recent study conducted in the Netherlands. Leveraging deceased donor kidney transplantation data from the start of a national organ donation euthanasia program in 2012 through 2023, the study found DCD-V kidney transplantation yielded similar short- and long-term outcomes compared with donation after circulatory death after withdrawal of life-sustaining therapies (DCD-III) and donation after brain death (DBD) kidney transplantation.

HCV Viremic Donor Kidney Exposure Not Linked to Opportunistic Viral Infection

A single-center study conducted at Duke University Hospital found no significant difference in viral reactivation of BK polyomavirus (BKPyV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) in the first year following kidney transplantation based on donor kidney hepatitis C virus (HCV) nucleic acid test (NAT) status, suggesting the safety of HCV NAT-positive donor kidneys.

Lifestyle Interventions for Kidney Disease

Cannabis Cream Safely Reduces Itch in Patients with CKD-Associated Pruritus

A recent study found topical cream containing cannabis significantly reduced the severity of itching symptoms compared with placebo in patients with chronic kidney disease (CKD)-associated pruritus, suggesting the potential benefit of cannabinoid-containing products in this patient population.

Certain Foods May Help Reduce Risk of IgA Nephropathy, Study Finds

Citing limitations to and shortcomings of current pharmacologic treatments for IgAN, a recent study explored the potential of various dietary exposures for protecting against the leading cause of glomerulonephritis and renal failure. Results showed alcohol intake frequency was associated with a significantly increased risk of IgAN, suggesting that reducing alcohol intake may be an important protective strategy against IgAN. Additionally, cheese, cereal, and sushi intake were all associated with a decreased risk of IgAN.

Cardiovascular, Kidney Health

EMPACT-MI Kidney: SGLT2 Initiation Can Preserve Kidney Function in Post-MI Population

This analysis of the EMPACT-MI study highlights the safety of initiating SGLT2 inhibitor therapy in patients with a history of acute myocardial infarction, demonstrating use of empagliflozin (Jardiance) provided meaningful reductions in heart failure events among patients in the trial regardless of baseline kidney function.

“Our study will help to fill a key gap in the understanding of the clinical use of SGLT2 inhibitors in people who have suffered a heart attack,” said study investigator Deepak Bhatt, MD, MPH, MBA, director of the Mount Sinai Fuster Heart Hospital and the Dr. Valentin Fuster Professor of Cardiovascular Medicine at the Icahn School of Medicine at Mount Sinai. “By reassuring physicians of the safety and efficacy of empagliflozin early after a heart attack, EMPACT-MI has enormous implications for treating a very vulnerable population of patients with cardiovascular disease worldwide.”

Brendon Neuen, MBBS, PhD: Expanding Evidence of Combination Therapy with GLP-1 RAs and SGLT2 Inhibitors

Findings from this systematic review and meta-analysis of placebo-controlled outcome trials of GLP-1 receptor agonists in type 2 diabetes are shedding further light on the effects of combination therapy with the class and SGLT2 inhibitors. Leveraging data from around 17,000 patients, including more than 1700 using both GLP-1 receptor agonists and SGLT1 inhibitors, results of the study suggest both classes provide distinct cardiovascular and kidney benefits while also offering evidence of the consistency of GLP-1 receptor agonists’ benefit across different patient populations in type 2 diabetes.