Monthly nephrology bulletin — September 29, 2026

Monthly nephrology bulletin covering verified advances from August 30 to September 29, 2026. Note for the month: it was a strong month for regulatory decisions (two FDA approvals) and glomerular disease, and a thin one for dialysis and vascular access, where no new verifiable trial was found; that section includes only what exists and is not padded. Searches were run in English, Spanish, Portuguese, Chinese, Japanese, Korean, Russian and Turkish; the yield from Asian and Russian sources was scarce this month and is flagged where relevant.

Chronic kidney disease and kidney protection

1. FDA approves finerenone for CKD associated with type 1 diabetes

[Regulatory FDA] [United States / Germany]
The approval (September 16–17) rests on FINE-ONE, a phase 3, randomized, double-blind, placebo-controlled trial of 242 adults with CKD and type 1 diabetes (NEJM 2026;394:947-957). The primary endpoint, change in urine albumin-to-creatinine ratio, was −22% at 3 months and −28% at 6 months versus placebo (ratio of means 0.72; 95% CI 0.60–0.86; P = 0.0001). Hyperkalemia occurred in 10.1% vs 3.3%, with discontinuation for hyperkalemia in 1.7% vs 0%.
Why it matters: it is the first new therapy for this population in more than 30 years, but the endpoint is a surrogate, follow-up is 6 months and the trial was funded by Bayer; in the Dominican Republic, availability and price of finerenone remain the real barrier, and potassium monitoring is mandatory.
https://doi.org/10.1056/NEJMoa2512854
https://www.businesswire.com/news/home/20260916814212/en/Bayers-KERENDIA-finerenone-Receives-FDA-Approval-as-the-First-New-Treatment-in-30-Years-for-Adults-with-Chronic-Kidney-Disease-CKD-and-Type-1-Diabetes

2. EASi-KIDNEY: vicadrostat plus empagliflozin stopped for futility

[Industry] [Germany / United Kingdom]
On September 15 Boehringer Ingelheim announced the discontinuation of the phase 3 EASi-KIDNEY trial (with the University of Oxford), which compared the aldosterone synthase inhibitor vicadrostat plus empagliflozin against empagliflozin alone in adults with CKD. The independent data monitoring committee concluded the data "did not support a meaningful clinical benefit" on the composite of kidney disease progression and cardiovascular events; there was no safety signal. The program's other three phase 3 trials continue.
Why it matters: only the headline is available, with no numbers and no peer review, but the lesson is relevant: adding a fourth pillar on top of an SGLT2 inhibitor does not guarantee benefit, and it tempers expectations for this class in CKD.
https://www.boehringer-ingelheim.com/human-health/boehringer-provides-update-easi-kidney-trial

3. Network meta-analysis: SGLT2 inhibitors, semaglutide and finerenone in diabetic kidney disease

[Meta-analysis] [China]
Bayesian network meta-analysis (Frontiers in Pharmacology, September 24) of six trial-level datasets with 20,521 participants with type 2 diabetes and CKD. Versus placebo, the composite kidney outcome was reduced by SGLT2 inhibitors (HR 0.70; 95% CrI 0.64–0.76), semaglutide (HR 0.76; 0.66–0.88) and finerenone (HR 0.84; 0.77–0.92).
Why it matters: these are indirect comparisons from few trials with heterogeneous outcome definitions, so they do not replace a head-to-head trial; publicly funded in China. It reinforces the practical hierarchy: SGLT2 inhibitor first, the other two as add-ons. (Source in English, Beijing group.)
https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2026.1882227/full

4. Semaglutide as the GLP-1 receptor agonist with the best kidney profile in a comparative study

[Publication] [United States]
In the September issue of AJKD, Neumiller and colleagues compare the effectiveness of different GLP-1 receptor agonists on kidney outcomes in type 2 diabetes using real-world data; semaglutide compares favorably with the others and may be the preferred agent to delay CKD.
Why it matters: it is observational, with possible confounding by indication, and the exact effect sizes should be checked in the paper; useful for choosing within the class when more than one agent is accessible.
https://doi.org/10.1053/j.ajkd.2026.04.007

5. Nine in ten U.S. adults with CKD do not know they have it

[Publication] [United States]
According to the CDC surveillance report "Chronic Kidney Disease in the United States, 2026," cited on September 24, about 37 million adults (14%) have CKD and 87% are unaware; in primary care, eGFR is measured annually in 89.5% of patients with diabetes, but the albumin-to-creatinine ratio in only 52.9%.
Why it matters: these are surveillance estimates and the source is an interview, but the message transfers to our setting: albuminuria screening remains the largest and cheapest gap to close.
https://www.hcplive.com/view/nearly-9-in-10-us-adults-with-ckd-don-t-know-they-have-it-with-pranav-garimella

Dialysis and vascular access

No new randomized trial or verifiable regulatory approval in hemodialysis, peritoneal dialysis or vascular access was identified within the window this month. The only item with direct implications for the dialysis population is included.

6. Deceased-donor kidney transplant versus remaining on dialysis in adults over 75

[Publication] [United States]
Target trial emulation using national registry data (AJKD, September) in patients aged 75 or older with kidney failure. Transplantation is associated with higher early mortality, but survival surpasses that of patients who remain on dialysis after approximately 3 years.
Why it matters: it is observational and not randomized, with evident selection of candidates; even so, it supports not excluding well-selected older patients by age alone, a debate rarely addressed in Latin American transplant programs.
https://doi.org/10.1053/j.ajkd.2026.02.647

Kidney transplantation and immunology

7. Gene-edited pig kidney as a bridge to human transplantation

[Publication] [United States]
Mass General Brigham published in The Lancet (press release September 3) the first documented case of porcine kidney xenotransplantation as a bridge to allotransplantation. A 66-year-old man received the pig kidney (eGenesis) in January 2025, remained dialysis-free for 271 days, overcame early T-cell-mediated rejection and, after immunosuppression was reduced because of an infection, the graft developed microvascular injury and failed; in January 2026 he received a deceased-donor kidney with immediate function and no sensitization.
Why it matters: it is a single case under FDA expanded access, funded by the company, but it shows that a xenograft can buy time without compromising the subsequent transplant, particularly relevant where waiting lists are long and donation is scarce.
https://doi.org/10.1016/S0140-6736(26)01295-X
https://news.massgeneralbrigham.org/en/pig-kidney-xenotransplant-bridge-to-human-transplant

8. Atacicept in IgA nephropathy: final 104-week data from ORIGIN 3

[Industry] [United States, multicenter]
On September 15 Vera Therapeutics reported the final results of the phase 3 ORIGIN 3 trial (n = 428, randomized 1:1, double-blind, atacicept 150 mg subcutaneous weekly versus placebo). eGFR slope over 104 weeks −0.6 vs −5.6 mL/min/1.73 m² per year (P < 0.0001); eGFR change at 52 weeks −0.1 vs −5.7 (difference 5.6; 95% CI 3.7–7.5); composite kidney progression 11 vs 38 events (HR 0.24; 95% CI 0.12–0.48).
Why it matters: it is a manufacturer-funded press release without peer review; if confirmed, the effect on eGFR slope is the largest reported so far in IgA nephropathy, and the application for full approval is planned for the fourth quarter of 2026.
https://www.hcplive.com/view/atacicept-cuts-igan-progression-risk-76-in-origin-3-final-data

Acute kidney injury and critical care, pediatric nephrology and genetics

9. MERCURI-2: perioperative dapagliflozin prevents AKI after cardiac surgery

[Clinical trial] [Netherlands]
Multicenter, double-blind, placebo-controlled trial (JAMA, September 1 issue; online since July 30) of 784 patients undergoing cardiac surgery, randomized to dapagliflozin 10 mg in four perioperative doses or placebo. AKI within 7 days: 28% vs 52% (RR 0.54; 95% CI 0.45–0.65; P < 0.001).
Why it matters: the endpoint is the KDIGO definition of AKI rather than dialysis or mortality, but a 46% relative reduction with an inexpensive four-dose intervention is among the largest seen in AKI prevention, and it is immediately applicable in Dominican centers performing cardiac surgery.
https://jamanetwork.com/journals/jama/article-abstract/2852324

10. FDA approves obinutuzumab for childhood-onset idiopathic nephrotic syndrome

[Regulatory FDA] [United States / Switzerland]
Approved September 25 for patients aged 2 and older with frequently relapsing or steroid-dependent idiopathic nephrotic syndrome in complete remission. In INShore (phase 3, open-label, n = 85, ages 2–25) sustained complete remission at week 52 was 95.5% with obinutuzumab vs 73.2% with mycophenolate mofetil (adjusted difference 23.4%; P = 0.0031).
Why it matters: an open-label, small trial funded by Roche/Genentech, but it is the first therapy approved for this indication in about 70 years and offers an option with less steroid exposure; the cost of the biologic will limit its use in our setting.
https://www.gene.com/media/statements/ps_092526

11. Inaxaplin in APOL1-mediated kidney disease: phase 2b AMPLIFIED

[Industry] [United States]
Vertex reported (September 22–23) results of the single-arm phase 2b study of inaxaplin 45 mg daily for 13 weeks in 41 patients. In the cohort without diabetes (albuminuria 0.1–0.42 g/g) UACR fell 42.7% (95% CI −58.3 to −21.1); in the cohort with type 2 diabetes it fell 17.3% (95% CI −36.3 to +7.2), not significant. No related serious adverse events.
Why it matters: no control group, very few patients, 13 weeks and a surrogate endpoint; still, it is the first gene-specific target in a disease that mostly affects people of African ancestry, with potentially high prevalence in the Caribbean. Phase 3 (AMPLITUDE) data are expected in early 2027.
https://news.vrtx.com/news-releases/news-release-details/vertex-announces-positive-results-phase-2b-amplified-study

12. Contrast-enhanced CT after recovery from dialysis-requiring AKI

[Publication] [Taiwan]
Target trial emulation with nationwide data from Taiwan (AJKD, September; Lin and colleagues) in adults who recovered from dialysis-requiring AKI. Contrast-enhanced CT within 30 days of dialysis cessation was associated with a higher rate of re-dialysis and persistent kidney dysfunction.
Why it matters: it is observational and residual confounding is possible, but it suggests deferring non-urgent contrast studies during that recovery window, a no-cost measure. (Source in English, data from Taiwan.)
https://doi.org/10.1053/j.ajkd.2026.03.045

Cross-cutting

13. ESC/ERA guideline on cardiovascular disease in CKD and the ASN glomerular disease compendium

[Guideline] [Europe / United States]
The European Society of Cardiology and the European Renal Association published on August 29 (European Heart Journal, ESC Congress) the first joint guideline on cardiovascular disease in CKD, with the "STAMP" framework. Separately, the American Society of Nephrology launched the compendium of its Glomerular Diseases Collaborative (GD-C), a platform on ANCA vasculitis, IgA nephropathy, lupus nephritis, C3 glomerulopathy and membranous nephropathy, with referral pathways, landmark trials and newer therapies.
Why it matters: both are consensus documents rather than new evidence; the European guideline finally sets a shared cardio-kidney standard and the compendium is a useful reference for residents.
https://www.hcplive.com/view/faq-understanding-new-esc-era-guideline-on-cardiovascular-disease-and-chronic-kidney-disease
https://www.hcplive.com/view/how-the-asn-s-gd-c-compendium-aims-to-unify-glomerular-disease-care

14. Latin America and Asia: Brazilian congress and China's essential medicines list

[Congress] [Brazil / China]
The Brazilian Society of Nephrology held the XXXIII Brazilian Congress of Nephrology on September 16–19 in Belo Horizonte (Minascentro), with the SBN 2026 census of dialysis units under way since August. In China, the 2026 National Essential Medicines List (794 drugs, 109 more than in 2018), which adds finerenone, roxadustat and sevelamer, took effect on September 1. No verifiable trials or approvals were found within the window from Japan, Korea, India, Russia or the Middle East.
Why it matters: the congress has not yet released new census data; the Chinese list is health policy, not evidence, but it shows how large systems bring the pillars of kidney protection into public access, still pending in several countries of the region. (Sources in Portuguese and Chinese.)
https://sbn.org.br/category/congresso-brasileiro-de-nefrologia-2026/
https://www.nephro-online.com/index/article/detail?id=11374

Upcoming meetings and dates

ASN Kidney Week 2026: October 22–25 (early programs October 21), Denver, USA. https://www.asn-online.org/education/kidneyweek/2026/important-dates.aspx

56th National Congress of the Spanish Society of Nephrology (SEN): November 5–7, Murcia, Spain. https://www.congresosen.com/2026

SLANH: webinar "Current challenges in CKD and its complications," September 30, 8:00 pm (Panama time). No SLANH congress in 2026; the next is in 2027. https://slanh.net/

Monthly nephrology bulletin — September 29, 2026
14 verified items from the past month, sourced from NEJM, The Lancet, JAMA, AJKD, Frontiers in Pharmacology, and FDA and society releases.

Three worth your time:
• FDA approved finerenone for CKD with type 1 diabetes (FINE-ONE, n=242): UACR −28% at 6 months; hyperkalemia 10% vs 3%. Surrogate endpoint, short trial, manufacturer-funded.
• MERCURI-2 (JAMA, n=784): four perioperative doses of dapagliflozin cut AKI after cardiac surgery from 52% to 28% (RR 0.54). Endpoint is lab-defined AKI, not dialysis or death.
• First pig kidney used as a bridge to human transplant (Lancet): 271 dialysis-free days, then an allograft with immediate function. A single case under expanded access.

Full bulletin, with a critical reading of each study and links to primary sources:
https://boletinesmedicos.com/en/nefrologia/2026-09-29.html
#Nephrology #KidneyDisease #Dialysis #KidneyTransplant #IgAN

Nephrology, September 2026: FDA approves finerenone for CKD with type 1 diabetes (UACR −28%, n=242). MERCURI-2 (JAMA, n=784): perioperative dapagliflozin cuts AKI after cardiac surgery from 52% to 28%. Bulletin: https://boletinesmedicos.com/en/nefrologia/2026-09-29.html