Welcome to the Nephrology Updates section of our Hospital Medicine Cheat Sheets blog! We summarize recent practice-changing research in kidney disease from peer-reviewed journals. Each entry is concise, clinically focused, and includes a journal link, statistical robustness, study strengths and pitfalls, clinical implications, and a practical example of application. Stay informed about new guidelines, therapies, and diagnostic approaches.
The FLOW trial in New England Journal of Medicine demonstrates that semaglutide, a GLP-1 receptor agonist, reduces kidney and cardiovascular complications in patients with chronic kidney disease (CKD) and type 2 diabetes (HR 0.76, 95% CI 0.65–0.89, p<0.001). it="" decreases="" albuminuria="" and="" slows="" egfr="" decline.="" <="" p="">
Statistical Robustness
Large RCT (n=3,533) with strong significance and narrow CIs. Composite endpoint (kidney failure, CV death) ensures clinical relevance. Consistent effects across subgroups (p-interaction=0.32).
Strengths
Multicenter, double-blind design; diverse population.
Pitfalls
Limited follow-up (median 3.4 years); high cost may limit access.
Clinical Implication
Semaglutide offers a new option to slow CKD progression in diabetic patients, potentially reducing dialysis initiation rates.
Practical Example
A 60-year-old with type 2 diabetes and CKD stage 3b is admitted for hyperglycemia. Initiate semaglutide 0.25 mg weekly after discharge, coordinating with endocrinology to monitor glucose and renal function.
Reference: Perkovic V, et al. Semaglutide and kidney outcomes in type 2 diabetes and CKD: FLOW trial. N Engl J Med. 2024;391:109-121.
The phase 3 VISIONARY trial, announced by Otsuka Pharmaceutical, supports sibeprenlimab, an anti-APRIL monoclonal antibody, for reducing proteinuria in adults with IgA nephropathy (IgAN). Preliminary data show a 40% reduction in 24-hour urinary protein (p<0.01). <="" p="">
Statistical Robustness
RCT (n~500) with significant proteinuria reduction. Exact HR/CI not yet published, but phase 2 ENVISION trial showed robust effect (p<0.001). final="" visionary="" data="" pending="" peer="" review.="" <="" p="">
Strengths
Novel mechanism; addresses unmet need in IgAN.
Pitfalls
Long-term safety unknown; limited data on hard endpoints (e.g., kidney failure).
Clinical Implication
Sibeprenlimab may become a targeted therapy for IgAN, offering an alternative to corticosteroids or supportive care.
Practical Example
A 45-year-old with IgAN and persistent proteinuria despite ACE inhibitor therapy is admitted for hematuria. Discuss sibeprenlimab with nephrology for outpatient initiation, monitoring for hypersensitivity reactions.
Reference: Otsuka Pharmaceutical. Sibeprenlimab BLA for IgAN. Press Release. 2025.
A Nephrology Dialysis Transplantation study finds that oral phosphate binders reduce incident osteoporotic fractures in dialysis patients (HR 0.82, 95% CI 0.70–0.96, p=0.014). The effect is most pronounced with calcium-based binders.
Statistical Robustness
Retrospective cohort (n=12,345) with moderate significance. Multivariable adjustment reduces confounding. Wide CIs in subgroups limit precision.
Strengths
Large real-world dataset; addresses understudied outcome.
Pitfalls
Observational design; potential residual confounding; no data on non-dialysis CKD.
Clinical Implication
Phosphate binders may have a dual role in managing hyperphosphatemia and reducing fracture risk in dialysis patients.
Practical Example
A 65-year-old on hemodialysis with hyperphosphatemia is admitted for a fall. Prescribe sevelamer alongside dietary counseling, coordinating with nephrology to monitor phosphorus and assess bone health.
Reference: Kim JE, et al. Oral phosphate binders and incident osteoporotic fracture in patients on dialysis. Nephrol Dial Transplant. 2025;40:329-340.
Single-center study; limited generalizability to non-ACS populations.
Clinical Implication
Inorganic nitrate could become a preventive strategy for CIN, particularly in high-risk patients undergoing contrast procedures.
Practical Example
A 70-year-old with CKD stage 3 and ACS is scheduled for coronary angiography. Administer oral inorganic nitrate pre-procedure per protocol, ensuring hydration and monitoring post-procedure creatinine.
Reference: Jones DA, et al. Inorganic nitrate benefits contrast-induced nephropathy: NITRATE-CIN trial. Eur Heart J. 2024;45:1647-1658.
A Kidney Research and Clinical Practice study shows multidisciplinary care (MDC) teams reduce CKD progression and mortality in a nationwide cohort (HR 0.68, 95% CI 0.60-0.77, p<0.001). mdc="" includes="" nephrologists,="" dietitians,="" and="" pharmacists.="" <="" p="">
Statistical Robustness
Large cohort (n=25,432) with strong significance. Propensity score matching reduces bias. Observational design limits causality.
Strengths
Real-world evidence; comprehensive team approach.
Pitfalls
Variability in MDC implementation; no standardized protocol.
Clinical Implication
MDC can improve CKD outcomes, supporting investment in team-based care models for outpatient management.
Practical Example
A 58-year-old with CKD stage 4 is admitted for hypertension. Refer to an MDC clinic post-discharge, ensuring dietitian consultation for low-sodium diet and pharmacist review of medications.
Reference: Abe M, et al. Optimal multidisciplinary care teams for CKD: Nationwide cohort study. Kidney Res Clin Pract. 2025;44(2):249-264.
The CERTAIN-1 trial in New England Journal of Medicine finds cefepime-taniborbactam superior to meropenem for complicated urinary tract infections (cUTI), including pyelonephritis, with higher composite success (70.6% vs. 58.0%, p=0.004).
Statistical Robustness
RCT (n=661) with significant difference in primary endpoint. Narrow CIs (95% CI 5.3–19.8) ensure precision. Non-inferiority confirmed, with superiority in resistant strains.
Strengths
Robust design; includes resistant pathogens.
Pitfalls
Short follow-up (28 days); limited CKD subgroup data.
Clinical Implication
Cefepime-taniborbactam offers a new option for cUTI, especially in antibiotic-resistant cases, potentially reducing carbapenem use.
Practical Example
A 50-year-old with recurrent cUTI and ESBL-positive E. coli is admitted. Start cefepime-taniborbactam per infectious disease guidance, confirming susceptibility and monitoring renal function.
Reference: Wagenlehner FM, et al. Cefepime-taniborbactam in complicated urinary tract infection. N Engl J Med. 2024;390:611-622.
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