Nephrology

SGLT2 inhibitors beat GLP-1RAs for CKD and AKI prevention in routine T2D care

In >55,000 metformin-treated adults with type 2 diabetes, SGLT2 inhibitor initiation lowered 5-year CKD risk versus GLP-1RA (6.7% vs 8.2%; RR 0.81). SGLT2 inhibitors also reduced AKI event burden compared with GLP-1RAs (mean cumulative AKI counts RR 0.88). GLP-1RAs slightly favored albuminuria and mortality, suggesting partially distinct kidney and survival effects. Benefits of SGLT2 inhibitors on CKD and AKI were greatest in individuals without baseline kidney disease, supporting earlier initiation for renal protection. 1

Creatinine-based eGFR overestimates kidney function in South Asians

Across 35 South Asian cohorts (n=4725), creatinine-based eGFR equations consistently overestimated measured GFR, especially CKD-EPI-2009Cr (SMD 0.66). Cystatin C–based equations had minimal bias but accuracy (P30) for both creatinine- and cystatin C–based equations remained below 75%. Combined creatinine–cystatin C equations achieved the highest P30 (79%–82%) but still fell short of ideal performance. Age, sex, ethnicity, and cohort type significantly modified bias, underscoring limited generalizability of uncalibrated equations. Clinicians caring for South Asian patients should interpret creatinine-only eGFR cautiously and consider combined or cystatin C–based estimates when decisions are high stakes. 2

pKDIGO improves pediatric AKI risk stratification for in-hospital mortality

In >65,000 hospitalized children from two Chinese cohorts, the new pediatric KDIGO (pKDIGO) criteria refined AKI thresholds for age and sex. pKDIGO achieved higher AUCs for predicting in-hospital death than KDIGO, mKDIGO, pROCK, or pRIFLE in both general ward and ICU cohorts. Mortality rose stepwise across pKDIGO AKI stages, supporting its use for staging severity and risk communication. These data suggest current pediatric AKI definitions underperform for prognostication, and pKDIGO may be preferable for research endpoints and clinical risk stratification. 3

Individualized steroid benefit model for IgA nephropathy from TESTING trial

This secondary TESTING analysis modeled individual 4-year absolute risk reduction (ARR) from methylprednisolone in IgA nephropathy. Key modifiers included eGFR, age, proteinuria, RAAS blockade dose, ethnicity, biopsy timing, blood pressure, sex, BMI, and MEST-C T and C scores. Predicted individual ARR ranged from -10% (net harm) to 40%, despite an average trial ARR of 16.1%. Patients with predicted ARR >10% had observed ARR 24%, whereas those ≤10% had no benefit (observed ARR -5%). 4