1) NEJM — A Phase 3 Trial of Atacicept in IgA Nephropathy
Study design: Multicenter, randomized, double-blind phase-3 trial of atacicept (BAFF/APRIL pathway inhibitor) vs placebo in biopsy-proven IgA nephropathy with persistent proteinuria despite optimized supportive care.
https://www.nejm.org/doi/full/10.1056/NEJMoa2510198
Population: Adults with proteinuria above protocol threshold and preserved/declining eGFR per inclusion rules.
Key results: Atacicept produced a statistically significant reduction in proteinuria vs placebo and a signal for slower eGFR decline in a prespecified subgroup. Safety signals included higher rates of neutropenia and infections in treated patients.
Limitations: Follow-up relatively short for definitive kidney outcomes; subgroup signals need confirmation; immunosuppression risks require careful monitoring.
Clinical relevance: High — promising immune-targeted option for selected IgAN patients; requires risk-benefit assessment and safety monitoring.
2) NEJM — Fish-Oil Supplementation and Cardiovascular Events in Hemodialysis Patients
Study design: Large randomized, placebo-controlled trial of long-chain omega-3 supplementation vs placebo to reduce major cardiovascular events in maintenance HD patients.
https://www.nejm.org/doi/full/10.1056/NEJMoa2513032
Population: Adult maintenance HD patients with cardiovascular risk factors.
Key results: No statistically significant reduction in the primary composite MACE outcome over median follow-up; secondary analyses suggested fewer arrhythmic deaths in the fish-oil arm but event numbers were small. Safety profile acceptable.
Limitations: Lower-than-expected event rate reduced power for some endpoints; background CV therapies varied.
Clinical relevance: Moderate — does not support routine fish-oil for primary CV prevention in HD patients; hypothesis-generating signals (arrhythmia) deserve targeted study.
3) The Lancet — Global, Regional, and National Burden of Chronic Kidney Disease, 1990–2023 (GBD analysis)
Study design: Global Burden of Disease modeling across 204 countries estimating prevalence, mortality, and DALYs for CKD through 2023.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2825%2901853-7/fulltext
Key findings: CKD prevalence and DALYs have increased globally with marked regional differences; top attributable risks include hypertension, diabetes, and environmental factors. The work highlights undercounting in low-resource settings and calls for better surveillance.
Limitations: Model estimates depend on input data quality; data paucity in some regions increases uncertainty.
Clinical relevance: High — informs public health priorities, resource allocation, and global nephrology policy and planning.
6) Nephrology Dialysis Transplantation (NDT) — PAPP-A Monoclonal Antibody in ADPKD Models
Study design: Preclinical study testing monoclonal antibody against pregnancy-associated plasma protein-A (PAPP-A) in multiple murine ADPKD models (supplement/Oct issue). Kidney International+1
Key findings: Treated mice showed reduced cyst growth, less fibrosis, and preserved renal function versus controls. No prohibitive preclinical toxicities reported. Authors suggest PAPP-A inhibition as a novel ADPKD strategy.
Limitations: Animal models may not recapitulate human ADPKD complexity; dosing, delivery, and safety need human phase-1 work.
Clinical relevance: Moderate — identifies a promising translational target warranting early-phase clinical development. Kidney International
7) NEJM / Policy Perspective — Race-Neutral eGFR and Transplant Access
Content: Analysis and commentary on how race-adjusted eGFR equations historically affected Black patients’ transplant access and how removing race coefficients changes referral and listing dynamics. New England Journal of Medicine
Key points: Race-neutral reporting improves earlier nephrology referral and can increase transplant listing eligibility for historically disadvantaged groups; operational changes (lab reporting, clinician education) required for safe implementation.
Limitations: Policy modeling and observational analyses rather than randomized interventions.
Clinical relevance: High — immediate operational implications for labs, nephrology clinics, and transplant centers wanting to improve equity. New England Journal of Medicine
8) CJASN — Safety of SGLT2 Inhibitors During Ramadan Fasting (Prospective Cohort)
Study design: Prospective observational cohort of CKD patients on SGLT2 inhibitors who chose to fast for Ramadan, with structured monitoring for renal and volume adverse events. jasn.asnjournals.org
Key results: With hydration guidance and monitoring, most patients tolerated SGLT2 inhibitors; some had transient creatinine rises that resolved. No major dehydration-related hospitalizations reported in carefully selected patients.
Limitations: Non-randomized, selection bias (healthier or motivated patients may have been included), and limited sample size.
Clinical relevance: Moderate–High — practical guidance for clinicians in Muslim-majority populations: individualized management, counseling, and monitoring can allow continued SGLT2 use when needed. jasn.asnjournals.org
9) BMC Nephrology — Incident Dialysis Modality and Early Survival: Systematic Review & Meta-analysis
Study design: Systematic review/meta-analysis pooling observational cohorts comparing incident PD vs HD outcomes.
Key findings: A modest survival advantage for PD in the first 1–2 years after dialysis initiation was observed—most pronounced in younger, less comorbid patients. Authors emphasize residual confounding and selection bias in observational data.
Limitations: Observational data dominate; randomized evidence lacking; heterogeneity across cohorts.
Clinical relevance: Moderate — useful for shared decision-making about initial modality, especially in younger/low-comorbidity patients; not definitive to mandate modality choice.
10) Clinical Kidney Journal (CKJ) — Urinary Extracellular Vesicle RNAs as Biomarkers in Lupus Nephritis
Study design: Translational case-control and longitudinal study assessing urinary EV RNA signatures in active vs inactive lupus nephritis and correlation with biopsy activity indices. Kidney International+1
Key findings: Specific urinary EV RNA panels correlated with active histologic features and predicted flares with promising sensitivity/specificity in internal validation; potential as a noninvasive monitoring tool.
Limitations: Relatively small cohorts, single-center biases, and need for external validation and assay standardization before clinical use.
Clinical relevance: Moderate — promising noninvasive disease-monitoring biomarkers pending larger validation studies. Kidney International