2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T6e8,The renin-angiotensin-aldosterone system (RAAS) plays a central role in regulating renal hemodynamics, sodium and water balance, and cardiovascular homeostasis. Chronic RAAS activation contributes to hypertension, proteinuria, inflammation, fluid overload, and fibrosis, making RAAS blockade (RAASb) a cornerstone therapy across the kidney life cycle. Over the past decades, ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors, and mineralocorticoid receptor antagonists have demonstrated substantial benefits in slowing chronic kidney disease (CKD) progression, reducing proteinuria, and lowering cardiovascular risk. However, the efficacy and safety of RAASb vary according to the kidney life cycle. Evidence supports its use in proteinuric CKD and even in advanced stages, whereas the benefit in non-proteinuric disease remains limited. Novel non-steroidal mineralocorticoid receptor antagonists such as finerenone further enhance renal and cardiovascular protection, particularly in persons with diabetes and CKD. In dialysis populations, RAASb may preserve residual kidney function improve cardiac structure/function, although the benefit of steroidal MRAs remains uncertain. In kidney transplantation, RAASb appears safe and may improve long-term graft and patient survival, particularly when initiated early. The emergence of SGLT2 inhibitors and GLP-1 receptor agonists has reshaped therapeutic strategies, with accumulating evidence supporting complementary rather than competing roles with RAASb. This review synthesizes current evidence on RAAS modulation across the kidney life cycle from primary prevention to advanced CKD, dialysis, and transplantation, highlighting both established benefits and areas of current clinical uncertainty.31:T72c,ABSTRACT The renin–angiotensin–aldosterone system (RAAS) plays a central role in regulating renal hemodynamics, sodium and water balance, and cardiovascular homeostasis. Chronic RAAS activation contributes to hypertension, proteinuria, inflammation, fluid overload, and fibrosis, making RAAS blockade (RAASb) a cornerstone therapy across the kidney life cycle. Over the past decades, ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors, and mineralocorticoid receptor antagonists (MRAs) have demonstrated substantial benefits in slowing chronic kidney disease (CKD) progression, reducing proteinuria, and lowering cardiovascular risk. However, the efficacy and safety of RAASb vary according to the kidney life cycle. Evidence supports its use in proteinuric CKD and even in advanced stages, whereas the benefit in non-proteinuric disease remains limited. Novel non-steroidal MRAs such as finerenone further enhance renal and cardiovascular protection, particularly in persons with diabetes and CKD. In dialysis populations, RAASb may preserve residual kidney function and improve cardiac structure/function, although the benefit of steroidal MRAs remains uncertain. In kidney transplantation, RAASb appears safe and may improve long-term graft and patient survival, particularly when initiated early. The emergence of SGLT2 inhibitors and glucagon-like peptide-1 receptor agonists has reshaped therapeutic strategies, with accumulating evidence supporting complementary rather than competing roles with RAASb. This review synthesizes current evidence on RAAS modulation across the kidney life cycle from primary prevention to advanced CKD, dialysis, and transplantation, highlighting both established benefits and areas of current clinical uncertainty.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Diabetic Kidney Disease: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Diabetic Kidney Disease (condition). Clinician-written summaries and actionable practice insights. Updated daily.\",\"url\":\"https://www.reachrx.ai/hub/tag/condition/Diabetic%20Kidney%20Disease\",\"breadcrumb\":{\"@type\":\"BreadcrumbList\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https://www.reachrx.ai\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Research Hub\",\"item\":\"https://www.reachrx.ai/hub\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Conditions\",\"item\":\"https://www.reachrx.ai/hub/tag/condition\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Diabetic Kidney Disease\",\"item\":\"https://www.reachrx.ai/hub/tag/condition/Diabetic%20Kidney%20Disease\"}]}}"}}]],["$","$L2f",null,{"title":"Diabetic Kidney Disease: Research & Clinical Takeaways","description":"Discover peer-reviewed research on Diabetic Kidney Disease with concise clinician summaries and next-step guidance.","papers":[{"doi":"10.1053/j.ajkd.2026.06.008","pmid":"42726032","title":"Complement in Kidney Disease: Core Curriculum 2026","journal_title":"American Journal of Kidney Diseases","journal_issn":"0272-6386","published_at":"2026-09-11T00:00:00.000Z","url":"https://doi.org/10.1053/j.ajkd.2026.06.008","source_score":25,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-14T06:23:17.694Z","updated_at":"2026-09-14T06:23:17.694Z","tags":[{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"brand","value":"Soliris","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"condition","value":"ANCA-Associated Vasculitis","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"condition","value":"Atypical Hemolytic Uremic Syndrome","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"condition","value":"C3 Glomerulopathy","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"condition","value":"Diabetic Kidney Disease","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"condition","value":"IgA Nephropathy","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"condition","value":"Immune-Complex Membranoproliferative Glomerulonephritis","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"condition","value":"Kidney Transplantation","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"condition","value":"Lupus Nephritis","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"condition","value":"Membranous Nephropathy","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"condition","value":"Thrombotic Microangiopathy","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"generic","value":"avacopan","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"generic","value":"eculizumab","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"generic","value":"iptacopan","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"generic","value":"pegcetacoplan","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"generic","value":"ravulizumab","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"modality","value":"C3 Inhibitor","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"modality","value":"C5a Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"modality","value":"C5 Inhibitor","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"modality","value":"Complement Inhibitor","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"modality","value":"Factor B Inhibitor","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"study_design","value":"Narrative Review / Core Curriculum","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"warning","value":"Avacopan's FDA approval for ANCA-associated vasculitis is under active reconsideration due to data integrity concerns in the ADVOCATE trial; clinical use should be reassessed pending regulatory decision.","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"warning","value":"Several sample sizes cited (e.g., VALIANT n=124, APPEAR-C3G n=74, APPLAUSE-IgAN n=250) are from interim analyses, not final trial results — effect sizes may change.","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"warning","value":"Study design tag reflects that this is a narrative Core Curriculum review, not a primary study; level of evidence is assigned accordingly.","value_numeric":null},{"paper_doi":"10.1053/j.ajkd.2026.06.008","tag_type":"warning","value":"The ADVOCATE trial data was retracted; the vasculitis section reflects a rapidly evolving regulatory situation as of publication date (September 2026).","value_numeric":null}],"summaries":{"what_studied":"This Core Curriculum review covers the role of complement activation in kidney disease, including the biology of the complement cascade, FDA-approved complement inhibitory drugs for 5 renal indications, complement diagnostics (plasma biomarkers, genetic testing, immunofluorescence), infection risks, and emerging therapeutic targets.","key_result":"FDA-approved complement inhibitors now cover 5 kidney diseases: aHUS (eculizumab, ravulizumab), C3 glomerulopathy (iptacopan, pegcetacoplan), IC-MPGN (pegcetacoplan), IgA nephropathy (iptacopan, accelerated approval August 2024), and ANCA-associated vasculitis (avacopan — FDA withdrawal under consideration). In aHUS, C5 inhibition reduced 5-year ESKD or death from ~60% to ~15%. In C3G, 6-month iptacopan (APPEAR-C3G, n=74) and pegcetacoplan (VALIANT interim, n=124) both significantly reduced proteinuria and stabilized kidney function.","limitations":"- Review article (Core Curriculum); not a systematic review or meta-analysis — evidence synthesis is narrative.\n- Avacopan's approval for AAV is under active FDA reconsideration due to data integrity concerns in the ADVOCATE trial.\n- Complement biomarkers (plasma/urine fragments) remain investigational and lack standardized normal ranges.","practice_takeaway":"Before starting any complement inhibitor, vaccinate patients against meningococcus (A, C, W, Y, B), *S. pneumoniae*, and *H. influenzae* type B at least 2 weeks prior; consider ongoing antibiotic prophylaxis for C5 blockers (Neisserial risk remains ~0.5%/year even after vaccination). Use kidney biopsy immunofluorescence for C3 fragments as the most accurate indicator of ongoing glomerular complement activation, and follow CH50/AH50 to confirm therapeutic suppression."}},{"doi":"10.1038/s41581-026-01120-x","pmid":"42680946","title":"Nucleic acid sensing pathways in kidney disease development","journal_title":"Nature Reviews Nephrology","journal_issn":"1759-5061","published_at":"2026-09-01T00:00:00.000Z","url":"https://doi.org/10.1038/s41581-026-01120-x","source_score":12,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-06T06:23:01.169Z","updated_at":"2026-09-06T06:23:01.169Z","tags":[{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"brand","value":"Jakafi","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"condition","value":"Acute Kidney Injury","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"condition","value":"APOL1-Associated Nephropathy","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"condition","value":"Autosomal Dominant Polycystic Kidney Disease","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"condition","value":"Crescentic Glomerulonephritis","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"condition","value":"Diabetic Kidney Disease","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"condition","value":"Lupus Nephritis","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"condition","value":"Renal Cell Carcinoma","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"generic","value":"anifrolumab","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"generic","value":"baricitinib","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"generic","value":"chloroquine","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"generic","value":"elamipretide","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"generic","value":"hydroxychloroquine","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"generic","value":"tofacitinib","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"modality","value":"cGAS–STING Inhibitor","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"modality","value":"Gene Therapy","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"modality","value":"JAK Inhibitor","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"modality","value":"Mitochondrial Protector","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"modality","value":"Precision Nanomedicine","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"modality","value":"Toll-Like Receptor Modulator","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"modality","value":"Type I Interferon Inhibitor","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"warning","value":"Brand tag 'Jakafi' (ruxolitinib) was not explicitly named in the paper; it was omitted. The baricitinib brand (Olumiant) and anifrolumab brand (Saphnelo) were not listed in the paper either and were omitted accordingly.","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"warning","value":"The paper is a review article published in Nature Reviews Nephrology (2026); it synthesizes primary studies but does not present original trial data.","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"warning","value":"The Phase 3 anifrolumab lupus nephritis trial (NCT05138133) results were noted as not yet available at time of publication.","value_numeric":null},{"paper_doi":"10.1038/s41581-026-01120-x","tag_type":"warning","value":"The 'practice_changing' impact flag reflects the breadth of emerging therapeutic targets reviewed, not a single pivotal trial result — most agents remain preclinical or in early-phase trials.","value_numeric":null}],"summaries":{"what_studied":"This review evaluates the role of nucleic acid sensing pathways — chiefly cGAS–STING, AIM2, and endosomal Toll-like receptors (TLRs) — in kidney disease, covering both acute kidney injury (AKI) and chronic kidney disease (CKD) across glomerular and tubular compartments, and catalogues the therapeutic landscape targeting these pathways.","key_result":"Mislocalized self-nucleic acids (mitochondrial DNA, nuclear DNA fragments, reactivated endogenous retroelements) activate cGAS–STING, AIM2, and TLR pathways in podocytes, tubular epithelial cells, mesangial cells, and infiltrating immune cells, driving inflammation, fibrosis, and cell death across multiple kidney disease contexts. Therapeutic agents range from FDA-approved hydroxychloroquine (TLR7/9) to preclinical STING antagonists (H-151, C-176, LB244) and a Phase 2 cGAS inhibitor (VENT-03) in active cutaneous lupus.","limitations":"This is a narrative review without systematic search methodology or meta-analysis, so conclusions reflect the authors' synthesis rather than pooled quantitative data. Most mechanistic evidence comes from mouse models, with limited human clinical trial data specifically in kidney endpoints. The therapeutic table includes agents at very early preclinical stages alongside approved drugs, making direct comparison of efficacy difficult.","practice_takeaway":"Clinicians managing lupus nephritis, diabetic kidney disease, APOL1-associated nephropathy, or AKI should be aware that cGAS–STING and TLR-driven sterile inflammation are active therapeutic targets, with several agents in Phase 2 trials (baricitinib, anifrolumab, VENT-03). Mitochondrial protection strategies (e.g., elamipretide) that limit mtDNA leakage represent an upstream approach to dampening innate immune activation in the kidney."}},{"doi":"10.1016/j.ekir.2026.107037","pmid":null,"title":"Randomized Clinical Trials of Deutaleglitazar in Healthy Participants and in Patients with Diabetic Kidney Disease","journal_title":"Kidney International Reports","journal_issn":"2468-0249","published_at":"2026-08-20T00:00:00.000Z","url":"https://doi.org/10.1016/j.ekir.2026.107037","source_score":64,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-08-29T06:19:08.638Z","updated_at":"2026-08-29T06:19:08.638Z","tags":[{"paper_doi":"10.1016/j.ekir.2026.107037","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.107037","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.107037","tag_type":"condition","value":"Diabetic Kidney Disease","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.107037","tag_type":"generic","value":"deutaleglitazar","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.107037","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.107037","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.107037","tag_type":"warning","value":"Level of evidence is a best-guess based on the RCT design label in the title; actual evidence level may differ depending on trial phase and size.","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.107037","tag_type":"warning","value":"Only the publisher landing page was available — no full text, abstract, results, or methods were accessible. All structured fields requiring specific data (sample size, key results, limitations, practice takeaway) have been left null due to insufficient source content.","value_numeric":null},{"paper_doi":"10.1016/j.ekir.2026.107037","tag_type":"warning","value":"Study design tag is based on the paper title indicating 'randomized clinical trials'; further detail (e.g., phase, blinding, comparator) cannot be confirmed without full text.","value_numeric":null}],"summaries":{"what_studied":"Randomized clinical trials evaluating deutaleglitazar in healthy participants and in patients with diabetic kidney disease (DKD)."}},{"doi":"10.1111/dom.70993","pmid":"42366176","title":"Real‐World Associations of\n KidneyIntelX\n Risk Stratification With Guideline‐Directed Therapy, Kidney Outcomes, and Metabolic Trajectories in Early Diabetic Kidney Disease","journal_title":"Diabetes, Obesity and Metabolism","journal_issn":"1462-8902","published_at":"2026-06-28T00:00:00.000Z","url":"https://doi.org/10.1111/dom.70993","source_score":29,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-03T13:38:51.463Z","updated_at":"2026-07-03T13:38:51.463Z","tags":[{"paper_doi":"10.1111/dom.70993","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"brand","value":"KidneyIntelX","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"category","value":"Endocrinology & Metabolism","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"condition","value":"Diabetic Kidney Disease","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"condition","value":"Type 2 Diabetes","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"generic","value":"kidney injury molecule-1","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"modality","value":"GLP-1 Receptor Agonist","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"modality","value":"Prognostic Biomarker Test","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"modality","value":"SGLT2 Inhibitor","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"sample_size","value":"n=2470","value_numeric":2470},{"paper_doi":"10.1111/dom.70993","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"warning","value":"KIM-1 is listed as a component biomarker of KidneyIntelX, not as a standalone generic drug; tagged under generic for searchability.","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously: findings are promising but randomized evidence is lacking.","value_numeric":null},{"paper_doi":"10.1111/dom.70993","tag_type":"warning","value":"This is a real-world observational study; causal relationships between KidneyIntelX risk strata and clinical outcomes cannot be established — residual confounding is likely.","value_numeric":null}],"summaries":{"what_studied":"This real-world study evaluated KidneyIntelX (a blood-based prognostic test) in 2,470 adults with type 2 diabetes and CKD (stages G1–G3b) across two medical centres, assessing its association with guideline-directed therapy (GDMT) use, kidney and metabolic trajectories, DKD progression risk, and risk reclassification at 12 months with repeat testing.","key_result":"High-risk patients had 10.4x greater hazard of DKD progression vs. low-risk (HR 10.4 [95% CI 4.4–24.8]); post-test SGLT2i use reached 56% in high-risk vs. 34% in low-risk groups. The high-risk group showed the greatest improvements: eGFR slope improved from −4.6 to −2.6 mL/min/1.73 m²/year, UACR decreased 23%, and HbA1c decreased 7.6%. With repeat testing (n=1,143), 29% transitioned to lower risk, and starting an SGLT2i or GLP-1 agonist doubled the odds of risk reduction.","limitations":"Observational real-world design limits causal inference; GDMT initiation was not randomized, so confounding by indication is possible. The study was conducted at only two medical centres, which may limit generalizability.","practice_takeaway":"KidneyIntelX risk stratification appears to drive targeted SGLT2i and GLP-1 agonist use in patients with early DKD, and higher-risk patients show the greatest measurable clinical benefit. Clinicians should consider repeat testing at 12 months, as risk downgrading—linked to GDMT initiation and KIM-1 reduction—may help monitor treatment response."}},{"doi":"10.1093/ndt/gfag140","pmid":"42294943","title":"FINE-ONE, more to come: moving beyond ACEis and ARBs in type 1 diabetes with kidney disease?","journal_title":"Nephrology Dialysis Transplantation","journal_issn":"0931-0509","published_at":"2026-06-15T00:00:00.000Z","url":"https://doi.org/10.1093/ndt/gfag140","source_score":9,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-20T13:24:56.864Z","updated_at":"2026-06-20T13:24:56.864Z","tags":[{"paper_doi":"10.1093/ndt/gfag140","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"condition","value":"Diabetic Kidney Disease","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"condition","value":"Type 1 Diabetes","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"modality","value":"ACE Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"modality","value":"Angiotensin Receptor Blocker","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"study_design","value":"Editorial","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"warning","value":"No sample size, outcomes, or drug-specific data could be extracted.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"warning","value":"Only bibliographic metadata was provided — no abstract, results, or methods text. All structured content is inferred from the title alone and may be incomplete or inaccurate.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag140","tag_type":"warning","value":"Study design classified as 'Editorial' based on the commentary-style title, but this cannot be confirmed without full text.","value_numeric":null}],"summaries":{"what_studied":"This appears to be an editorial or commentary evaluating the FINE-ONE trial and the potential role of therapies beyond ACE inhibitors (ACEis) and angiotensin receptor blockers (ARBs) for kidney protection in type 1 diabetes with kidney disease.","limitations":"The source text provides only the title, DOI, journal, and publication date — no abstract, methods, results, or conclusions are available for extraction."}},{"doi":"10.1016/j.diabres.2026.113377","pmid":"42297213","title":"B-type natriuretic peptide level reduction and its predictors following sodium-glucose cotransporter 2 inhibitor treatment in patients with diabetic kidney disease: a Japan Chronic Kidney Disease Database Extension analysis","journal_title":"Diabetes Research and Clinical Practice","journal_issn":"0168-8227","published_at":"2026-06-15T00:00:00.000Z","url":"https://doi.org/10.1016/j.diabres.2026.113377","source_score":37,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-02T13:33:10.421Z","updated_at":"2026-07-02T13:33:10.421Z","tags":[{"paper_doi":"10.1016/j.diabres.2026.113377","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113377","tag_type":"category","value":"Endocrinology & Metabolism","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113377","tag_type":"condition","value":"Diabetic Kidney Disease","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113377","tag_type":"condition","value":"Heart Failure","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113377","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113377","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113377","tag_type":"modality","value":"SGLT2 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113377","tag_type":"sample_size","value":"n=1818","value_numeric":1818},{"paper_doi":"10.1016/j.diabres.2026.113377","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113377","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113377","tag_type":"warning","value":"Mean age was 71 ± 12 years and 68% were men, limiting generalizability to younger or predominantly female populations.","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113377","tag_type":"warning","value":"No specific SGLT2 inhibitor agents are named; results reflect a class effect across all SGLT2i used in the registry. Individual drug differences cannot be determined.","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113377","tag_type":"warning","value":"The BNP reduction threshold of >10% is study-defined and not a validated surrogate for hard cardiovascular outcomes. Clinical significance should be interpreted cautiously.","value_numeric":null}],"summaries":{"what_studied":"This study examined whether SGLT2 inhibitors (SGLT2i) reduce B-type natriuretic peptide (BNP) levels more than other antidiabetic drugs in 1,818 patients with diabetic kidney disease (DKD), and identified predictors of BNP reduction within 30–365 days of treatment initiation.","key_result":"BNP reduction >10% occurred in 50.5% (474/939) of SGLT2i-treated patients vs. 38.6% (339/879) on other antidiabetic drugs; SGLT2i was independently associated with BNP reduction (OR 1.497, 95% CI 1.206–1.859, p<0.001). Concomitant loop diuretic use was linked to a lower rate of BNP reduction with SGLT2i.","limitations":"Observational registry design limits causal inference. BNP was only measured at a single follow-up window (30–365 days), so longer-term trajectories are unknown. The 10% BNP reduction threshold is a study-defined surrogate, not a validated clinical endpoint.","practice_takeaway":"In patients with DKD, initiating an SGLT2 inhibitor is associated with meaningful BNP reduction across a broad range of eGFR and proteinuria levels. Clinicians should be aware that patients already on loop diuretics may show less BNP response to SGLT2i, which may reflect more advanced cardiac disease."}},{"doi":"10.1111/dom.70934","pmid":"42219273","title":"Adding Finerenone to\n SGLT2\n Inhibitors and Long‐Term Kidney Outcomes in Diabetic Kidney Disease","journal_title":"Diabetes, Obesity and Metabolism","journal_issn":"1462-8902","published_at":"2026-05-31T00:00:00.000Z","url":"https://doi.org/10.1111/dom.70934","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-07T13:26:42.698Z","updated_at":"2026-06-07T13:26:42.698Z","tags":[{"paper_doi":"10.1111/dom.70934","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"brand","value":"Kerendia","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"category","value":"Endocrinology & Metabolism","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"condition","value":"Diabetic Kidney Disease","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"generic","value":"finerenone","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"modality","value":"Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"modality","value":"Renin-Angiotensin System Inhibitor","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"modality","value":"SGLT2 Inhibitor","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"sample_size","value":"n=255","value_numeric":255},{"paper_doi":"10.1111/dom.70934","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"study_design","value":"Observational Cohort Study with Propensity Score Matching","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"warning","value":"Sex distribution of the study population is not explicitly reported in the abstract; 'mixed' is inferred from typical DKD trial populations.","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"warning","value":"The brand name 'Kerendia' is assumed for finerenone; the paper does not explicitly state the brand.","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"warning","value":"The 'impact_flag' of practice_changing is applied cautiously — this is an observational study and not an RCT; findings are hypothesis-generating and supportive, not definitive.","value_numeric":null},{"paper_doi":"10.1111/dom.70934","tag_type":"warning","value":"The study does not report hard clinical endpoints (e.g., ESKD, cardiovascular mortality), limiting direct clinical impact assessment.","value_numeric":null}],"summaries":{"what_studied":"In 255 patients with diabetic kidney disease (DKD) already on combined RASi + SGLT2i therapy, this study evaluated whether adding finerenone (triple combination therapy, TCT) improved proteinuria, eGFR slope, and serum potassium over 24 months compared to dual therapy (DCT) alone, using intention-to-treat analysis with propensity score matching.","key_result":"TCT reduced proteinuria by 47% at 24 months (p=0.028). The post-initial dip eGFR slope was significantly better with TCT vs. DCT: ~1.31 mL/min/1.73 m²/year less annual decline (95% CI: 0.25–2.36; p=0.015), persisting after PS matching (difference 1.45 mL/min/1.73 m²/year; 95% CI: 0.32–2.58; p=0.012). Total eGFR slope did not differ significantly. Serum potassium rose modestly early but equalized by 24 months.","limitations":"- Observational, single-arm propensity score–matched design limits causal inference and may not fully control for confounding.\n- Relatively small sample (n=255) with only 24-month follow-up; longer-term hard outcomes (ESKD, doubling of creatinine, cardiovascular events) not reported.\n- Real-world adherence and dose titration of finerenone not described, which could affect generalizability.","practice_takeaway":"For patients with DKD already on RASi + SGLT2i, adding finerenone may further slow kidney function decline and meaningfully reduce proteinuria — consider triple therapy as part of a comprehensive kidney-protective strategy. Monitor potassium closely in the early weeks after starting finerenone, though levels appear to stabilize by 24 months."}},{"doi":"10.1016/j.diabet.2026.101772","pmid":"42177980","title":"Impact of high intensity physical activity compared to routine counseling on renal function decline in patients with type 2 diabetes at high risk for kidney disease - the ACTIDIANE randomized controlled trial","journal_title":"Diabetes & Metabolism","journal_issn":"1262-3636","published_at":"2026-05-23T00:00:00.000Z","url":"https://doi.org/10.1016/j.diabet.2026.101772","source_score":10,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-31T13:35:36.457Z","updated_at":"2026-05-31T13:35:36.457Z","tags":[{"paper_doi":"10.1016/j.diabet.2026.101772","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1016/j.diabet.2026.101772","tag_type":"category","value":"Endocrinology & Metabolism","value_numeric":null},{"paper_doi":"10.1016/j.diabet.2026.101772","tag_type":"condition","value":"Diabetic Kidney Disease","value_numeric":null},{"paper_doi":"10.1016/j.diabet.2026.101772","tag_type":"condition","value":"Type 2 Diabetes","value_numeric":null},{"paper_doi":"10.1016/j.diabet.2026.101772","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1016/j.diabet.2026.101772","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/j.diabet.2026.101772","tag_type":"modality","value":"Physical Activity Intervention","value_numeric":null},{"paper_doi":"10.1016/j.diabet.2026.101772","tag_type":"sample_size","value":"n=103","value_numeric":103},{"paper_doi":"10.1016/j.diabet.2026.101772","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.diabet.2026.101772","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/j.diabet.2026.101772","tag_type":"warning","value":"Adherence to the high-intensity protocol is not described in the available text — it is unclear whether dose targets were met, which limits interpretation of a null result.","value_numeric":null},{"paper_doi":"10.1016/j.diabet.2026.101772","tag_type":"warning","value":"The analyzed sample (n=103) is smaller than the randomized cohort (n=122); reasons for exclusion are not detailed in the abstract, which may introduce attrition bias.","value_numeric":null},{"paper_doi":"10.1016/j.diabet.2026.101772","tag_type":"warning","value":"The study is open-label, so blinding limitations apply to both participants and outcome assessors.","value_numeric":null}],"summaries":{"what_studied":"This RCT (ACTIDIANE) compared 2 years of high-intensity physical activity (HIPA) vs. standard PA counseling (STPA) in 103 adults with type 2 diabetes and rapid renal function decline (eGFR slope < −5 ml/min/year), across 21 centers. The primary endpoint was the slope of cystatin C-derived eGFR (cys-eGFR) decline.","key_result":"HIPA did not significantly slow renal function decline vs. STPA: cys-eGFR slope −2.05 ml/min/year (95% CI −3.46 to −0.64) vs. −2.77 ml/min/year (95% CI −4.40 to −1.14), P = 0.512. Cardiovascular events/deaths (17% vs. 14%, P = 0.646) and hypoglycemia rates were also similar between groups.","limitations":"- Relatively small analyzed sample (n=103 of 122 randomized), limiting statistical power to detect modest differences.\n- Open-label design introduces risk of performance and detection bias.\n- Adherence to the HIPA protocol is not reported in the abstract, making it unclear whether the intervention was truly delivered at intended intensity.","practice_takeaway":"High-intensity PA does not appear to slow kidney function decline more than standard counseling in T2D patients already on a rapid decline trajectory. Clinicians should not rely on structured high-intensity exercise as a kidney-protective strategy in this high-risk group, but standard PA counseling remains appropriate given its broader cardiometabolic benefits."}},{"doi":"10.1093/ndt/gfag090","pmid":"42008148","title":"RAAS blockade in the kidney life-cycle–treatment standard","journal_title":"Nephrology Dialysis Transplantation","journal_issn":"0931-0509","published_at":"2026-04-21T00:00:00.000Z","url":"https://doi.org/10.1093/ndt/gfag090","source_score":43,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-04-22","doi":"10.1093/ndt/gfag090","days":"30","issn":"0931-0509","rank":"3","field":"Clinical Medicine","score":"43","category":"Urology & Nephrology","categories":["Urology & Nephrology"],"_categories":["Urology & Nephrology"]},"pubmed":{"doi":"10.1093/ndt/gfag090","title":"RAAS blockade in the kidney Life-Cycle - Treatment Standard.","journal":"Nephrology, dialysis, transplantation : official 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,"}]},{"given":"Katherine","family":"Tuttle","sequence":"additional","affiliation":[{"name":"Division of Nephrology, University of Washington School of Medicine , Seattle, WA ,"},{"name":"Providence Medical Research Center , Providence Inland Northwest Health, Spokane, WA ,"}]},{"given":"María José","family":"Soler","sequence":"additional","affiliation":[{"name":"Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus Nephrology and Transplantation Research Group, Vall d’Hebron Institut de Recerca (VHIR), Nephrology Department, , Barcelona ,"},{"name":"Redes de Investigación Cooperativa Orientadas a Resultados en Salud 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Pharmacologic approaches to glycemic treatment: standards of care in diabetes-2025","journal-title":"Diabetes Care","doi-asserted-by":"publisher"}],"short-title":[],"article-number":"gfag090","content-domain":{"domain":[],"crossmark-restriction":false},"original-title":[],"container-title":["Nephrology Dialysis Transplantation"],"reference-count":64,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,4,20]]},"references-count":64,"short-container-title":[],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1093/ndt/gfag090","is_oa":false,"title":"RAAS blockade in the kidney life-cycle–treatment standard","updated":"2026-05-10T08:57:56+00:00","published_date":"2026-04-17","best_oa_location":null}},"created_at":"2026-05-07T22:50:42.636Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1093/ndt/gfag090","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"condition","value":"Diabetic Kidney Disease","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"condition","value":"End-Stage Kidney Disease","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"condition","value":"Hypertension","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"condition","value":"Kidney Transplantation","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"condition","value":"Proteinuria","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"generic","value":"finerenone","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"modality","value":"ACE Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"modality","value":"Angiotensin Receptor Blocker","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"modality","value":"Direct Renin Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"modality","value":"GLP-1 Receptor Agonist","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"modality","value":"Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"modality","value":"SGLT2 Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"warning","value":"No sample size is applicable as this is a review article; the sample_size tag has been omitted.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"warning","value":"The benefit of steroidal MRAs in dialysis patients is explicitly noted as uncertain; clinicians should interpret those recommendations cautiously.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag090","tag_type":"warning","value":"This is a narrative review ('Treatment Standard' article); no pooled statistics or original data are reported — all numerical conclusions reflect cited trial-level evidence.","value_numeric":null}],"summaries":{"what_studied":"This review evaluates RAAS blockade (RAASb) — including ACE inhibitors, ARBs, direct renin inhibitors, and mineralocorticoid receptor antagonists — across the full kidney care continuum: primary prevention, proteinuric and non-proteinuric CKD, dialysis, and kidney transplantation, including interactions with SGLT2 inhibitors and GLP-1 receptor agonists.","key_result":"RAASb reduces proteinuria, slows CKD progression, and lowers cardiovascular risk, with strongest evidence in proteinuric CKD; novel non-steroidal MRAs (e.g., finerenone) add renal and cardiovascular protection in diabetic CKD; benefit in non-proteinuric disease is limited; in dialysis, RAASb may preserve residual kidney function and improve cardiac structure; in transplantation, early RAASb appears safe and may improve graft and patient survival.","limitations":"- Review article (not a meta-analysis or RCT); conclusions are synthesis-level and inherit the limitations of underlying studies.\n- Efficacy and safety data in dialysis populations and transplant recipients remain uncertain, particularly for steroidal MRAs in dialysis.\n- Evidence on optimal timing, agent selection, and combination with newer agents (SGLT2i, GLP-1 RA) across all lifecycle stages is still evolving.","practice_takeaway":"Use RAASb as first-line therapy in proteinuric CKD and consider adding finerenone in patients with diabetes and CKD for added renal and cardiovascular protection. In transplant recipients, early initiation of RAASb appears safe and may improve long-term outcomes; SGLT2 inhibitors and GLP-1 receptor agonists play a complementary — not competing — role alongside RAASb."}},{"doi":"10.1016/j.kint.2025.10.004","pmid":"41205673","title":"From progression to remission: a new paradigm for success in chronic kidney disease","journal_title":"Kidney International","journal_issn":"0085-2538","published_at":"2025-11-09T00:00:00.000Z","url":"https://doi.org/10.1016/j.kint.2025.10.004","source_score":182,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2025-12-04","doi":"10.1016/j.kint.2025.10.004","days":"30","issn":"0085-2538","rank":"1","field":"Clinical Medicine","score":"182","category":"Urology & Nephrology","categories":["Urology & Nephrology"],"_categories":["Urology & Nephrology"]},"pubmed":{"doi":"10.1016/j.kint.2025.10.004","title":"From progression to remission: a new paradigm for success in chronic kidney disease.","journal":"Kidney international","methods":"","results":"","abstract":"Recent advances in treatment of chronic kidney disease have changed the clinical paradigm from slowing inevitable progression to achievable remission. Landmark trials involving sodium-glucose cotransporter 2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists, glucagon-like peptide 1 receptor agonists, and targeted immunotherapies for IgA nephropathy demonstrate that sustained estimated glomerular filtration rate preservation and normalization of albuminuria are now realistic goals in both diabetic and glomerular kidney diseases. Remission, defined by estimated glomerular filtration rate slopes of <1 ml/min per 1.73 m","keywords":["albuminuria","chronic kidney disease","glomerular filtration rate"],"pubmed_id":"41205673","conclusions":"","publication_date":"2025-11-09T00:00:00"},"crossref":{"DOI":"10.1016/j.kint.2025.10.004","URL":"https://doi.org/10.1016/j.kint.2025.10.004","ISSN":["0085-2538"],"link":[{"URL":"https://api.elsevier.com/content/article/PII:S0085253825008476?httpAccept=text/xml","content-type":"text/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://api.elsevier.com/content/article/PII:S0085253825008476?httpAccept=text/plain","content-type":"text/plain","content-version":"vor","intended-application":"text-mining"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["From progression to remission: a new paradigm for success in chronic kidney disease"],"author":[{"given":"Navdeep","family":"Tangri","sequence":"first","affiliation":[]},{"given":"Brendon L.","family":"Neuen","sequence":"additional","affiliation":[]},{"given":"David Z.","family":"Cherney","sequence":"additional","affiliation":[]},{"given":"Katherine R.","family":"Tuttle","sequence":"additional","affiliation":[]},{"given":"Vlado","family":"Perkovic","sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2025,11]]},"member":"78","prefix":"10.1016","source":"Crossref","volume":null,"created":{"date-time":"2025-11-06T14:34:11Z","timestamp":1762439651000,"date-parts":[[2025,11,6]]},"indexed":{"date-time":"2025-11-28T01:56:41Z","timestamp":1764295001832,"date-parts":[[2025,11,28]]},"license":[{"URL":"https://www.elsevier.com/tdm/userlicense/1.0/","start":{"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000,"date-parts":[[2025,11,1]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://www.elsevier.com/legal/tdmrep-license","start":{"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000,"date-parts":[[2025,11,1]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"http://creativecommons.org/licenses/by/4.0/","start":{"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000,"date-parts":[[2025,10,28]]},"delay-in-days":0,"content-version":"vor"}],"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"https://linkinghub.elsevier.com/retrieve/pii/S0085253825008476"}},"subtitle":[],"assertion":[{"name":"publisher","label":"This article is maintained by","value":"Elsevier"},{"name":"articletitle","label":"Article Title","value":"From progression to remission: a new paradigm for success in chronic kidney disease"},{"name":"journaltitle","label":"Journal Title","value":"Kidney International"},{"name":"articlelink","label":"CrossRef DOI link to publisher maintained version","value":"https://doi.org/10.1016/j.kint.2025.10.004"},{"name":"content_type","label":"Content Type","value":"article"},{"name":"copyright","label":"Copyright","value":"© 2025 International Society of Nephrology. Published by Elsevier Inc."}],"deposited":{"date-time":"2025-11-28T01:51:59Z","timestamp":1764294719000,"date-parts":[[2025,11,28]]},"issn-type":[{"type":"print","value":"0085-2538"}],"published":{"date-parts":[[2025,11]]},"publisher":"Elsevier BV","reference":[{"DOI":"10.1056/NEJMoa2410659","key":"10.1016/j.kint.2025.10.004_bib1","year":"2025","issue":null,"author":"Agarwal","volume":"393","first-page":"533","unstructured":null,"article-title":"Finerenone with empagliflozin in chronic kidney disease and type 2 diabetes","journal-title":"N Engl J Med","doi-asserted-by":"crossref"},{"DOI":"10.1001/jamanetworkopen.2021.12828","key":"10.1016/j.kint.2025.10.004_bib2","year":"2021","issue":null,"author":"Liu","volume":"4","first-page":null,"unstructured":null,"article-title":"Progression and regression of chronic kidney disease by age among adults in a population-based cohort in Alberta, Canada","journal-title":"JAMA Netw Open","doi-asserted-by":"crossref"},{"DOI":"10.1016/S0140-6736(22)02074-8","key":"10.1016/j.kint.2025.10.004_bib3","year":"2022","issue":null,"author":null,"volume":"400","first-page":"1788","unstructured":null,"article-title":"Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials","journal-title":"Lancet","doi-asserted-by":"crossref"},{"DOI":"10.1016/S2213-8587(24)00271-7","key":"10.1016/j.kint.2025.10.004_bib4","year":"2025","issue":null,"author":"Badve","volume":"13","first-page":"15","unstructured":null,"article-title":"Effects of GLP-1 receptor agonists on kidney and cardiovascular disease outcomes: a meta-analysis of randomised controlled trials","journal-title":"Lancet Diabetes Endocrinol","doi-asserted-by":"crossref"},{"DOI":"10.1681/ASN.0000000541","key":"10.1016/j.kint.2025.10.004_bib5","year":"2025","issue":null,"author":"Barratt","volume":"36","first-page":"679","unstructured":null,"article-title":"Long-term results from an open-label extension study of atacicept for the treatment of IgA nephropathy","journal-title":"J Am Soc Nephrol","doi-asserted-by":"crossref"}],"short-title":[],"update-policy":"https://doi.org/10.1016/elsevier_cm_policy","alternative-id":["S0085253825008476"],"content-domain":{"domain":["kidney-international.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"original-title":[],"container-title":["Kidney International"],"published-print":{"date-parts":[[2025,11]]},"reference-count":5,"published-online":null,"references-count":5,"short-container-title":["Kidney International"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1016/j.kint.2025.10.004","is_oa":true,"title":"From progression to remission: a new paradigm for success in chronic kidney disease","updated":"2025-11-08T00:30:58+00:00","published_date":"2025-11-01","best_oa_location":{"url":"https://www.kidney-international.org/article/S0085-2538(25)00847-6/pdf","pmh_id":null,"url_for_pdf":"https://www.kidney-international.org/article/S0085-2538(25)00847-6/pdf","url_for_landing_page":"https://doi.org/10.1016/j.kint.2025.10.004"}}},"created_at":"2025-12-05T07:03:31.304Z","updated_at":"2025-12-05T07:03:31.304Z","tags":[{"paper_doi":"10.1016/j.kint.2025.10.004","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1016/j.kint.2025.10.004","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1016/j.kint.2025.10.004","tag_type":"condition","value":"Diabetic Kidney Disease","value_numeric":null},{"paper_doi":"10.1016/j.kint.2025.10.004","tag_type":"condition","value":"IgA Nephropathy","value_numeric":null},{"paper_doi":"10.1016/j.kint.2025.10.004","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.kint.2025.10.004","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1016/j.kint.2025.10.004","tag_type":"modality","value":"GLP-1 Receptor Agonist","value_numeric":null},{"paper_doi":"10.1016/j.kint.2025.10.004","tag_type":"modality","value":"Nonsteroidal Mineralocorticoid Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1016/j.kint.2025.10.004","tag_type":"modality","value":"SGLT2 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.kint.2025.10.004","tag_type":"modality","value":"Targeted Immunotherapy","value_numeric":null},{"paper_doi":"10.1016/j.kint.2025.10.004","tag_type":"study_design","value":"Editorial","value_numeric":null},{"paper_doi":"10.1016/j.kint.2025.10.004","tag_type":"warning","value":"Abstract text is truncated; the remission definition is incomplete.","value_numeric":null},{"paper_doi":"10.1016/j.kint.2025.10.004","tag_type":"warning","value":"Design appears to be editorial/narrative rather than a primary study.","value_numeric":null},{"paper_doi":"10.1016/j.kint.2025.10.004","tag_type":"warning","value":"No numerical outcomes, sample sizes, or timeframes are provided in the abstract.","value_numeric":null}],"summaries":{"what_studied":"A perspective argues for redefining success in chronic kidney disease from slowing decline to achieving remission, citing landmark trials of SGLT2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists, GLP-1 receptor agonists, and targeted immunotherapies for IgA nephropathy; remission is defined by eGFR slope <1 ml/min per 1.73 m and normalization of albuminuria.","limitations":"This is a narrative/editorial drawing on unspecified landmark trials without quantitative effect sizes, sample sizes, or timeframes in the abstract; the remission definition is truncated ('<1 ml/min per 1.73 m…').","practice_takeaway":"Set treatment goals beyond slowing CKD: aim for sustained eGFR preservation and albuminuria normalization, using SGLT2 inhibitors, nonsteroidal MRAs, GLP-1 receptor agonists, and targeted IgA nephropathy therapies where indicated."}}],"initialOffset":10,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Diabetic Kidney Disease"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Diabetic Kidney Disease"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Diabetic Kidney Disease"}}}]]

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