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Daily Medical Update
Strategies to prevent progression of chronic kidney disease
Friday, September 25, 2026
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🔬 Practice-Changing Findings
Evidence from RCTs and meta-analyses published in the
last 12 months.
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Lancet (London, England) (2026) - Individual participant data pooled analysis
Key Findings
- Finerenone reduced the composite kidney outcome by 24% versus placebo (22.3 vs 28.8 events per 1000 patient-years; HR 0.76, 95% CI 0.68-0.86).
- Kidney failure alone was reduced (HR 0.85, 95% CI 0.74-0.99), with consistent treatment effects across CKD etiology, baseline eGFR, albuminuria, glycemic status, and SGLT2 inhibitor use.
- Hyperkalemia increased with finerenone, but the absolute incidence leading to hospitalization was low.
📋 Practice Implication: Finerenone is a reasonable foundational option for appropriately selected patients at risk of CKD progression, with serum potassium and kidney function monitored during treatment.
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American journal of nephrology (2025) - Systematic review and meta-analysis of clinical trials
Key Findings
- Intensive blood-pressure control did not significantly reduce all-cause mortality (6.4% vs 6.9%; RR 0.91, 95% CI 0.73-1.13).
- It did not significantly reduce decline in kidney function (RR 0.86, 95% CI 0.59-1.25) or progression to end-stage kidney disease (RR 1.00, 95% CI 0.81-1.23).
📋 Practice Implication: Use individualized blood-pressure targets in CKD rather than assuming that more intensive lowering improves renal outcomes; avoid treatment escalation that is poorly tolerated or unsupported by the patient’s risk profile.
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Clinical nutrition ESPEN (2025) - Systematic review and meta-analysis
Key Findings
- High DASH adherence was associated with a mean eGFR improvement of 3.34 mL/min/1.73 m² (6.8%), although the result was not statistically significant (p=0.08).
- The single study reporting UACR found a lower median with high versus low adherence (33.6 vs 55.6 mg/g).
- Low DASH adherence corresponded to a smaller mean eGFR improvement of 0.54 mL/min/1.73 m² (1.2%; p=0.57).
📋 Practice Implication: DASH-style dietary counseling can be offered as an adjunct to CKD care, with emphasis on sustained adherence while communicating that renal benefits remain suggestive rather than definitive.
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Journal of nephrology (2025) - Systematic review and meta-analysis
Key Findings
- Among patients with pre-existing CKD, a history of acute kidney injury was associated with higher risk of CKD progression (HR 2.36, 95% CI 1.96-2.85).
- Acute kidney injury was also associated with higher all-cause mortality (HR 1.58, 95% CI 1.38-1.81).
- For both CKD progression and mortality, risk increased with greater acute kidney injury stage.
📋 Practice Implication: Treat an acute kidney injury episode as a major risk-reclassification event in CKD, prompting recovery assessment, medication review, and closer surveillance for recurrent decline.
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Clinical journal of the American Society of Nephrology : CJASN (2026) - Systematic review and meta-analysis
Key Findings
- Compared with control, multicomponent interventions improved eGFR by 1.18 mL/min/1.73 m² (95% CI 0.09-2.27) and eGFR slope by 0.61 mL/min/1.73 m²/year (95% CI 0.16-1.06).
- Multicomponent interventions reduced HbA1c by 0.26 percentage points (95% CI -0.49 to -0.02).
- Multicomponent interventions did not significantly improve albuminuria or blood pressure and did not increase adverse events.
📋 Practice Implication: For CKD G3-G4, multidisciplinary programs that combine behavioral, medical, technology, and team-based elements may provide modest slowing of decline, with expectations calibrated to the low-certainty evidence.
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Summary
Recent evidence supports finerenone and multicomponent CKD care as approaches associated with slower decline, while DASH adherence may improve eGFR and albuminuria but remains statistically uncertain. Intensive blood-pressure lowering did not improve pooled renal or mortality outcomes, and acute kidney injury in patients with pre-existing CKD was associated with substantially higher subsequent progression and mortality, underscoring individualized targets and post-AKI surveillance.
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