Several significant clinical trials presented at ASN Kidney Week 2024 have shed light on potential advancements in the treatment and management of various kidney-related conditions. These studies explored the efficacy of novel therapeutic interventions and diagnostic approaches, offering insights into improving patient outcomes in chronic kidney disease (CKD), acute kidney injury (AKI), and nephrotic syndrome.
Finerenone in Heart Failure Patients
The FINEARTS-HF trial investigated the effects of finerenone, a selective non-steroidal mineralocorticoid receptor antagonist, on kidney outcomes in heart failure patients with mildly reduced or preserved ejection fraction. Analyzing data from 6,001 participants, researchers observed that while finerenone led to an initial decline in kidney function measurements, longer-term kidney function patterns were similar to those receiving placebo. However, finerenone did reduce the amount of protein leaked by the kidneys, suggesting a potential benefit in preventing further kidney damage. According to Finnian R. Mc Causland, MBBCh, of Brigham and Women’s Hospital, this reduction in protein leakage could be predictive of better patient outcomes.
Personalized Recommendations for AKI
A multi-center randomized clinical trial involving 4,003 hospitalized patients with AKI assessed whether rapid and remote diagnostic and therapeutic recommendations, delivered via electronic health records, could prevent adverse outcomes. While the intervention significantly improved clinician behaviors in managing AKI, it did not reduce the primary outcome of worsening kidney injury, the need for dialysis, or death. Abinet M. Aklilu, MD, MPH, of Yale University School of Medicine, noted that future studies will focus on individuals at high risk for severe kidney injury and specific phenotypes to improve outcomes.
Semaglutide for CKD in Overweight/Obese Patients
Researchers assessed the effects of semaglutide in patients with overweight/obesity and albuminuric CKD without diabetes. In a trial of 101 patients, semaglutide, compared to placebo, significantly reduced the urine albumin-to-creatinine ratio by -52.1% at week 24. Additionally, semaglutide led to a body weight change of -9.1 kg and a systolic blood pressure change of -6.3 mmHg. Hiddo J.L. Heerspink, PhD, PharmD, of University Medical Center Groningen, highlighted the potential of semaglutide to protect the kidney in patients with CKD and obesity, while also improving blood pressure control and reducing body weight. Further studies are needed to assess the long-term efficacy and safety of semaglutide in reducing the risk of kidney failure in these patients.
Tacrolimus vs. Mycophenolate Mofetil for Nephrotic Syndrome
A 243-patient multicenter, randomized, open-label, controlled trial compared the efficacy and safety of tacrolimus and mycophenolate mofetil in children with frequently relapsing nephrotic syndrome and steroid-dependent nephrotic syndrome. Tacrolimus reduced the risk of relapse by 65% compared to mycophenolate mofetil. The median time to first relapse was 225.5 days in the tacrolimus group and 165.5 days in the mycophenolate mofetil group. Fei Liu, associate chief physician at The Children's Hospital, Zhejiang University School of Medicine, noted that tacrolimus significantly extended the period of relapse-free survival compared to mycophenolate mofetil treatment.
