Nephrology

Febuxostat provides no kidney or survival benefit in asymptomatic hyperuricemic stage 3–4 CKD

In 3,232 adults with newly diagnosed stage 3–4 CKD and asymptomatic hyperuricemia, 20% initiated febuxostat within one year of hyperuricemia detection. Over five years, febuxostat initiation did not reduce the composite of ≥40% eGFR decline, ESKD, or kidney replacement therapy (HR 1.07; 95% CI 0.91–1.20). All-cause mortality (HR 1.00; 95% CI 0.66–1.35) and MACE (HR 1.03; 95% CI 0.95–1.11) were also unaffected. These findings argue against initiating febuxostat solely for kidney protection in asymptomatic hyperuricemic stage 3–4 CKD patients. 1

SOUL: oral semaglutide slows eGFR decline without reducing kidney event composites

In SOUL, 9,650 people with type 2 diabetes and ASCVD and/or CKD were randomized to oral semaglutide or placebo for 47.5 months. Semaglutide did not significantly reduce the five-point kidney composite versus placebo (8.4% vs. 9.0%; HR 0.91; 95% CI 0.80–1.05). The four-point composite excluding cardiovascular death was also nonsignificant (HR 0.86; 95% CI 0.66–1.10). However, annual eGFR decline was slower with semaglutide (−1.67 vs. −2.06 mL/min/1.73 m²; difference 0.40; 95% CI 0.27–0.53). 2

FIVE-STAR: finerenone cuts albuminuria but not arterial stiffness in diabetic CKD

FIVE-STAR randomized 101 Japanese patients with type 2 diabetes, eGFR 25–<90, and UACR 30–<3500 mg/g to finerenone or placebo. At 24 weeks, changes in cardio-ankle vascular index were similar (group difference −0.057; 95% CI −0.428 to 0.314; P = 0.760), indicating no arterial stiffness effect. Finerenone reduced UACR by ~29% at weeks 12 and 24 versus placebo, demonstrating sustained antiproteinuric action. An early, persistent eGFR drop occurred without increases in urinary tubular injury markers, suggesting hemodynamic rather than nephrotoxic effects. 3