30-Second Takeaway
- Therapeutic inertia for guideline-directed nephroprotection is common even in tertiary nephrology care.
- Real-world patient populations often differ markedly from RCTs, limiting direct applicability.
Week ending May 30, 2026
Grand Rounds: recent CKD and cardiorenal evidence brief
Therapeutic inertia common in ND-CKD despite high cardiorenal risk
In 4,523 nondialysis CKD patients followed in 30 Italian nephrology clinics, most had severe cardiorenal risk and mean eGFR 34 ml/min/1.73 m2. At 6 months, home and office blood pressure remained above target in about 70% of patients with sustained hypertension in 62%. Therapeutic inertia was frequent: antialbuminuric therapy changes occurred in only 15% for RAS inhibitors and 10% for SGLT2 inhibitors. Among patients with diabetes, inertia was higher: 92% for GLP-1 RAs and 96% for finerenone, highlighting substantial underuse of guideline therapies.
iNET-CKD guidance on durable CKD cohort design
Leaders from iNET-CKD outline core design principles for prospective CKD cohorts to maximize long-term value. They recommend at least one GFR marker (preferably creatinine and cystatin C) and urine ACR for proteinuria assessment. Standard operating procedures, robust governance, and provisions for data and biosample sharing are essential for collaboration.
DIAMOND trial eligibility poorly represents real-world HF registry
Only 17.2% of CARE-HK registry patients met DIAMOND trial criteria, falling to 3.4% when excluding missing data. CARE-HK patients were older (mean 71.8 vs 67.2 years), had more comorbidity and worse renal function than DIAMOND participants. Use of ARNI and SGLT2 inhibitors was far higher in CARE-HK HFrEF patients than in DIAMOND, underscoring different background therapy.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.