IgA Nephropathy
IgA nephropathy dominated the meeting and produced the most important therapeutic advances. The strongest data came from agents targeting the BAFF/APRIL pathway, which moved beyond proteinuria and demonstrated preservation of kidney function.
VISIONARY (sibeprenlimab)
Among 510 adults with IgA nephropathy, the 24-month eGFR slope was +0.3 mL/min/1.73m² compared with −4.2 in the placebo group. Kidney events occurred in only 0.4% of treated patients versus 11.2% of placebo-treated patients. Serious infections were not increased.
ORIGIN 3 (atacicept)
Atacicept similarly demonstrated substantial preservation of kidney function. Annualized eGFR decline through week 104 was −0.60 versus −5.60 with placebo, while the composite kidney outcome occurred in 5.1% versus 17.8%. Interpretation should acknowledge relatively limited long-term data contributors and protocol amendments.
Cross-Trial Perspective
Both therapies demonstrated clinically meaningful preservation of kidney function. However, differences in populations, placebo trajectories, endpoint definitions, and follow-up duration preclude valid efficacy comparisons. Durability of benefit after treatment discontinuation remains unknown.
Other Emerging IgAN Therapies
Povetacicept reduced proteinuria by 52.0% versus 4.3% with placebo and achieved hematuria resolution in 85.1% of patients. Ravulizumab (a C5 complement inhibitor) reduced proteinuria by 46.6% versus 5.6% with placebo and showed rapid onset of action. Sefaxersen (a liver-directed antisense oligonucleotide that inhibits factor B production) met its interim proteinuria endpoint without new safety concerns. Long-term eGFR outcomes remain the key unanswered question for all three agents.
Glomerular Disease Beyond IgAN
In membranous nephropathy, rituximab combined with HLX79/E-602 (a sialidase that strips sialic acid from immune cells) produced faster and more frequent responses than rituximab alone. Although the study was phase 2 and relatively small, it highlighted a novel potential therapeutic approach.
APOL1-Mediated Kidney Disease
The APOL1 inhibitor inaxaplin reduced albuminuria by 42.7% in patients with APOL1-mediated kidney disease and modest proteinuria. Safety findings were favorable. The phase 2/3 AMPLITUDE study has completed enrollment, with interim data expected in 2027.
Transplantation
In the PAES study, imlifidase successfully converted positive crossmatches to negative among highly sensitized deceased-donor kidney transplant recipients and was associated with excellent one-year graft function. Antibody-mediated rejection remains an ongoing concern. A separate study found higher risks of gestational hypertension, preeclampsia/eclampsia, and small-for-gestational-age infants among living kidney donors compared with matched controls.
CKD and Dialysis
The SIMPLIFIED trial, predicated on all clinical trials on vitamin D, demonstrated that high-dose vitamin D supplementation did not reduce mortality, cardiovascular hospitalization, infections, or fractures. Collectively, these findings add to a growing body of randomized evidence demonstrating limited clinical benefit from vitamin D supplementation in unselected CKD populations.
The VOICE trial found that three-times-weekly vadadustat maintained hemoglobin similarly to ESAs and was associated with fewer hospitalizations.
ATTACK suggested a possible net benefit from aspirin for primary prevention in CKD but was underpowered.
SWIFT showed that symptom monitoring improved discussions without improving quality of life.
VIDEO-KD increased advance-care-planning documentation.
In Catheter vs AV access (JASN, USRDS), the absolute 18-month mortality gap between CVC and AV access narrowed from 5.9% to 4.2% between 2013 and 2022, with BSI-related deaths a small fraction of it, findings that may reflect improvements in catheter care, changing patient selection, residual confounding, or a combination of these factors.
In contrast, in the Dialysis Access Trial, OASIS, it randomized about 150 patients in the Netherlands to central venous catheter vs arteriovenous fistula and showed no difference, with final publication awaited.
Bottom Line
Kidney Week 2026 was defined by emerging convincing kidney-function preservation data for BAFF/APRIL-directed therapies in IgA nephropathy. Additional advances in APOL1-mediated disease, complement inhibition, transplantation, and patient-centered CKD care suggest a rapidly expanding therapeutic landscape. Long-term durability, comparative effectiveness, and safety remain the major unanswered questions.
Dr. Atta has received institutional grants from Bayer, Dimerix, PureSpring, Novartis, Vertex, and Boehringer Ingelheim, and advisory board fees from Amgen.
