Nephrology

“Stage 1” nocturnal hypertension predicts CKD progression under 2025 thresholds

Among 2418 Chinese CKD stage 1–4 adults, nocturnal BP was categorized by 2025 ACC/AHA criteria using ambulatory monitoring. Compared with nocturnal nonhypertension, stage 1 nocturnal hypertension (110–120/65–70 mm Hg) increased composite kidney outcome risk (HR 2.49; 95% CI 1.31–4.72). Stage 1 nocturnal hypertension also raised KFRT (HR 2.37; 95% CI 1.17–4.82) and worsening kidney function risk (HR 3.79; 95% CI 1.04–13.84). In patients aged ≥65 years, nocturnal BP <110/65 mm Hg was associated with higher worsening kidney function and composite outcome risk. 1

SGLT2 inhibitor use lowers ischaemic and haemorrhagic stroke in T2D with CKD

This population-based retrospective cohort compared 107,819 SGLT2 inhibitor users with 107,819 nonusers with T2D and CKD after 1:1 propensity matching. SGLT2 inhibitor therapy was associated with fewer ischaemic strokes (HR 0.86; 95% CI 0.81–0.90) than nonuse. Haemorrhagic stroke risk was also lower with SGLT2 inhibitors (HR 0.80; 95% CI 0.74–0.87). Sensitivity analyses using 1:2 sex and age matching showed even stronger stroke risk reductions. 2

SZC approval associated with reduced RRT and ICU use for acute hyperkalaemia

A nationwide Japanese EMR and claims database identified 38,540 adult hospitalisations with serum potassium ≥5.5 mmol/L between 2015 and 2024. Following SZC approval in April 2020, RRT use for acute hyperkalaemia showed a significant monthly decline (slope change −0.7% per month; 95% CI −1.2 to −0.1). After the COVID-19 pandemic, ICU admission rates for hyperkalaemia also declined (slope change −4.2% per month; 95% CI −6.6 to −1.7). In-hospital mortality and initiation of maintenance haemodialysis remained stable across periods. 3

Finerenone meaningfully lowers proteinuria in idiopathic membranous nephropathy

This multicentre real-world study analysed 79 idiopathic membranous nephropathy patients with proteinuria ≥1 g/24 h receiving ACEi/ARB plus finerenone. Median baseline proteinuria was 3212.5 mg/24 h, and geometric mean proteinuria fell by 58.5% at 6 months (95% CI −67.7 to −46.6; P < 0.001). Proteinuria reduction was greater with concurrent immunosuppression than with supportive therapy alone (−67.1% vs −45.3%; P = 0.023). eGFR showed a small, non-significant decline then stabilised, while serum albumin increased and total cholesterol decreased significantly. 4