Monthly nephrology bulletin — October 8, 2026

Period covered: September 8 to October 8, 2026. The month was dominated by regulatory decisions in glomerular disease (atacicept, iptacopan in Japan, obinutuzumab in nephrotic syndrome) and by the extension of finerenone to type 1 diabetes. In dialysis and vascular access we found no verifiable randomized trials published within the window; most new data will arrive with ASN Kidney Week (October 21–25). Twelve verified items; three come from outside North America and Western Europe (Japan, Brazil, and a congress in Australia). We also searched in Chinese, Korean, Russian, Arabic, Turkish, and German without finding verifiable items dated within the month.

1. Chronic kidney disease and kidney protection

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

[Regulatory FDA] [USA]
On September 17, 2026, the FDA expanded the indication of finerenone (Kerendia, Bayer) to reduce urine albumin-to-creatinine ratio (UACR) in adults with CKD associated with type 1 diabetes. The basis is FINE-ONE, a phase 3 randomized, double-blind trial in 242 adults (finerenone 10–20 mg vs placebo on top of standard care): UACR fell 22% more than with placebo at month 3 and 28% at month 6. Hyperkalemia 10.1% vs 3.3%; discontinuation for hyperkalemia 1.7% vs 0%.
Why it matters: this is the first kidney-protective therapy approved specifically for CKD in type 1 diabetes, but approval rests on a surrogate endpoint (albuminuria) at six months, without hard kidney outcome data; potassium monitoring is required and access in the Dominican Republic will depend on cost.
https://pharmexec.com/view/fda-approves-kerendia-adults-chronic-kidney-disease-type-diabetes

2. Cost remains the main barrier to cardiorenal drugs in CKD

[Publication] [USA]
Online survey of 61 US nephrology providers (44 nephrologists and 17 advanced practice providers), published in Kidney Medicine (vol. 8, no. 10) and reported on October 8. Cost was the top barrier for GLP-1 receptor agonists (84%), SGLT2 inhibitors (74%), and nonsteroidal MRAs (57%). Among patients with stage 3 CKD and type 2 diabetes (2019–2024), only 40% used SGLT2 inhibitors, 33% GLP-1 RAs, and under 2% nonsteroidal MRAs.
Why it matters: small, self-selected sample with an incalculable response rate; still, it confirms that the evidence-to-prescription gap is largely economic, a problem that is even larger in our setting.
https://ajmc.com/view/cost-top-barrier-to-ckd-drug-access

3. Brazil: fewer than 7% of patients with diabetes or hypertension have albuminuria ordered

[Publication] [Brazil]
A multicenter Brazilian group (PUCPR, Unicamp, UFRGS, Escola Bahiana, Dante Pazzanese, and Arbor Research) published in the Brazilian Journal of Nephrology, reported on September 16. Among more than 14,000 people with diabetes or hypertension, fewer than 5% of those with a creatinine test also had UACR ordered; after a national screening campaign, the figure did not exceed 7%.
Why it matters: the design is retrospective and the press report does not detail methods, but the message applies to the Dominican Republic: without albuminuria there is no early diagnosis and no correct indication for SGLT2 inhibitors or finerenone. (source in Portuguese)
https://jornaldomedico.com.br/2026/09/16/estudo-revela-subdiagnostico-da-doenca-renal-cronica-no-brasil
https://www.scielo.br/j/jbn/a/qHH7s9xgRwkHrqNLgZswRHH/?lang=pt

2. Dialysis and vascular access

A quiet month: we found no randomized trials or device approvals in dialysis or vascular access that were verifiable and dated within the window. The VOICE trial (three-times-weekly vadadustat vs erythropoiesis-stimulating agents in hemodialysis) will be presented as a late-breaker at Kidney Week on October 23; we will cover it next month.

3. Kidney transplantation

4. Pig kidney xenotransplant as a bridge to human transplant: first published case

[Publication] [USA]
The Lancet published on September 3 the Massachusetts General Hospital case: a 66-year-old man lived 271 days off dialysis with a gene-edited pig kidney (transplanted in January 2025). Around month six, as immunosuppression was reduced during an infection, the xenograft developed microvascular injury and inflammation that progressed to failure; in January 2026 he received a deceased-donor kidney with immediate function and no detected sensitization.
Why it matters: a single case (n = 1), and at 35 days it sits at the edge of the window, but it shows for the first time that xenotransplantation can serve as a bridge without closing the door to allotransplantation; it remains experimental and distant for our region.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01295-X/abstract
https://www.eurekalert.org/news-releases/1142310

5. Tegoprubart (anti-CD40L) preserves better eGFR than tacrolimus at 24 months

[Congress] [Australia]
At the International Congress of The Transplantation Society (Sydney, September 20–23), Eledon presented the extension of the phase 2 BESTOW study: 81 patients followed to 24 months. Mean eGFR was 71 vs 58 mL/min/1.73 m² with tacrolimus (difference ≈13; 95% CI 2.6–23.3); there was no biopsy-proven acute rejection after month six with tegoprubart vs seven cases with tacrolimus. The phase 3 LEGACY trial (≈600 patients, non-inferiority) is expected to start in Q4 2026.
Why it matters: manufacturer data in a press release, open-label phase 2 with cohort attrition; it promises a calcineurin-inhibitor-free regimen but does not change practice until LEGACY confirms safety and non-inferiority.
https://www.globenewswire.com/news-release/2026/09/22/3366123/0/en/eledon-presents-updated-long-term-phase-2-bestow-extension-study-results-at-the-international-congress-of-the-transplantation-society.html

6. Deceased-donor transplant at age 75 or older: higher early mortality, longer long-term survival

[Publication] [USA]
AJKD (October issue) publishes a target trial emulation (Leeaphorn et al.) comparing deceased-donor transplantation with remaining on dialysis in patients aged 75 or older. Recipients had higher mortality in the first months, but those who survived that period lived longer; the survival advantage became evident after about three years.
Why it matters: observational design with risk of residual confounding, but it supports not excluding patients from the waitlist on age alone, provided life expectancy exceeds that three-year horizon.
https://www.ajkd.org/article/S0272-6386(26)00924-8/fulltext

4. Glomerular disease, acute kidney injury, and tropical nephrology

7. ORIGIN 3: atacicept stabilizes eGFR over two years in IgA nephropathy

[Industry] [USA / multinational]
Vera Therapeutics reported on September 15 the final efficacy analysis of ORIGIN 3 (428 patients): eGFR slope through 104 weeks of −0.6 with atacicept vs −5.6 mL/min/1.73 m²/year with placebo (difference 5.0; p < 0.0001). Kidney progression events were 11 vs 38 (HR 0.24; 76% risk reduction), and dialysis, transplant, or death 0 vs 8. Local administration reactions 30% vs 5%.
Why it matters: the first BAFF/APRIL inhibitor with two-year kidney function data, which could convert its July accelerated approval into full approval; still press-release data without peer-reviewed publication.
https://www.globenewswire.com/news-release/2026/09/15/3361855/0/en/vera-therapeutics-announces-trutakna-atacicept-vymj-stabilized-egfr-and-prevented-kidney-disease-progression-through-two-years-in-origin-3-final-efficacy-analysis-in-iga-nephropath.html

8. Japan approves iptacopan for adult IgA nephropathy

[Regulatory PMDA] [Japan]
Novartis announced in mid-September (report dated September 17) the extension in Japan of the indication of iptacopan (Fabhalta), an oral complement factor B inhibitor, to adult IgA nephropathy. Approval is based on the international phase 3 APPLAUSE-IgAN trial; according to the company, it reduced the risk of progression to kidney failure by 43% and kidney function decline by 49.3%.
Why it matters: Japan has one of the highest IgA nephropathy prevalences in the world and adds a third major regulator to this oral option; the figures are those reported by the manufacturer and should be checked against the trial's final publication. (source in Japanese)
https://iyakutsushinsha.com/2026/09/17/%E3%83%95%E3%82%A1%E3%83%93%E3%83%8F%E3%83%AB%E3%82%BF%E3%80%80iga%E8%85%8E%E7%97%87%E3%81%AB%E5%AF%BE%E3%81%99%E3%82%8B%E5%8A%B9%E8%83%BD%E3%83%BB%E5%8A%B9%E6%9E%9C%E3%81%A7%E9%81%A9%E5%BF%9C/

9. FDA approves obinutuzumab to prevent relapses in idiopathic nephrotic syndrome

[Regulatory FDA] [USA]
On September 25 the FDA approved obinutuzumab (Gazyva, Genentech/Roche) to prevent relapse in frequently relapsing or steroid-dependent childhood-onset idiopathic nephrotic syndrome in complete remission, in patients aged 2 years and older. In the INShore trial (85 patients aged 2 to 25), sustained complete remission at week 52 was 95.5% vs 73.2% with mycophenolate mofetil (adjusted difference 23.4%; p = 0.003).
Why it matters: the first new therapy approved in decades for this disease and steroid-sparing; small trial, one-year follow-up, high cost; adult nephrologists will see these patients at transition.
https://www.hcplive.com/view/fda-approves-obinutuzumab-gazyva-for-idiopathic-nephrotic-syndrome

10. Mesoamerican nephropathy appears among young workers in Texas

[Publication] [USA / Mesoamerica]
Coverage dated September 16, based on Texas Monthly reporting, describes healthy men in their 20s and 30s, mostly migrant workers from Mexico and Central America in construction and roofing, arriving at Houston safety-net hospitals with kidney failure without diabetes or hypertension. A Harris County records review found that about one in six emergency dialysis cases among uninsured patients had no identifiable cause.
Why it matters: this is journalism, not a peer-reviewed study, but it reinforces the link between heat, physical labor, and CKD of nontraditional cause that we also see in Central America and the Caribbean; ask about occupation and heat exposure in every young patient with CKD of unclear cause.
https://www.fox10phoenix.com/news/mysterious-disease-sending-young-healthy-texas-workers-kidney-failure

Cross-cutting

11. An AI "virtual nephrologist" to discuss transplantation with patients with advanced CKD

[Publication] [USA]
AJKD (October) describes a tool by Reese et al. that uses AI and transplant information to simulate a video consultation with a nephrologist; patients choose among four nephrologists of different backgrounds and use it from a phone or computer. After using it, participants reported greater willingness to discuss transplantation with their doctor.
Why it matters: self-reported outcome with no control group described; a useful idea for patient education, but it has yet to show an increase in actual evaluations or transplants.
https://www.ajkd.org/article/S0272-6386(26)00994-7/fulltext

12. Kidney Week 2026 to feature VOICE results (vadadustat in hemodialysis)

[Industry] [USA]
Akebia announced on October 6 that U.S. Renal Care will present the VOICE trial on October 23 at ASN Kidney Week (Denver): safety of three-times-weekly vadadustat vs an erythropoiesis-stimulating agent in in-center hemodialysis. No results have been disclosed.
Why it matters: only an announcement, but the result will determine whether HIF-PH inhibitors gain ground in dialysis anemia; we will review it in the next issue.
https://manilatimes.net/2026/10/06/tmt-newswire/globenewswire/akebia-therapeutics-announces-late-breaking-voice-trial-presentation-and-posters-on-akebias-rare-kidney-pipeline-at-asn-kidney-week-2026/2439935

Upcoming meetings and dates

• ASN Kidney Week 2026, Denver (USA): early programs October 21; annual meeting October 22–25. VOICE presented October 23. https://www.asn-online.org/education/kidneyweek/2026/meeting-overview.aspx

Regional note: there were no verifiable items this month from China, Korea, India, Russia, the Middle East, or Turkey; nor from the Dominican Society of Nephrology, DIGEMAPS, COFEPRIS, or ANVISA within the window.

Curated by Aura Celeste Vascular · Medical Bulletins

Monthly nephrology bulletin — October 8, 2026
12 verified items from the past month (The Lancet, AJKD, Brazilian Journal of Nephrology, Kidney Medicine, FDA and Japanese regulatory decisions, and congress data).
Three worth your time:
• ORIGIN 3: atacicept in IgA nephropathy, eGFR slope −0.6 vs −5.6 mL/min/1.73 m²/year over two years and HR 0.24 for progression. Still press-release data, not peer reviewed.
• FDA approves finerenone for CKD with type 1 diabetes: UACR −28% vs placebo at 6 months (FINE-ONE, n=242). Surrogate endpoint; hyperkalemia 10% vs 3%.
• First pig kidney used as a bridge to human transplant: 271 days off dialysis, then a human graft with immediate function. A single patient.
Full bulletin, with a critical read of each study and links to primary sources:
https://boletinesmedicos.com/en/nefrologia/2026-10-08.html
#Nephrology #KidneyDisease #IgANephropathy #KidneyTransplant #Dialysis

Nephrology, October: atacicept slows eGFR loss in IgA nephropathy (−0.6 vs −5.6/yr, HR 0.24 at 2 yrs) and FDA approves finerenone for CKD with type 1 diabetes (UACR −28%). Bulletin: https://boletinesmedicos.com/en/nefrologia/2026-10-08.html