Nephrology

Staying Current in Nephrology: CKD, Dialysis, Transplant, and Glomerular Disease Research

Nephrology has been transformed in the past five years. SGLT2 inhibitors have become the most important advance in CKD management since ACE inhibitors. Sparsentan has the first approval for IgA nephropathy. The transplant immunosuppression landscape is evolving. This guide covers practical strategies for nephrologists to stay current across the full scope of the specialty.

The SGLT2 inhibitor revolution: the most important nephrology update in a generation

The renoprotective effects of SGLT2 inhibitors — demonstrated in CREDENCE (canagliflozin in diabetic nephropathy), DAPA-CKD (dapagliflozin across CKD etiologies including non-diabetic), and EMPA-KIDNEY (empagliflozin across a broad CKD population) — represent the most significant advance in CKD management since the ACE inhibitor and ARB trials of the 1990s and 2000s.

Nephrologists must now integrate SGLT2 inhibitors into CKD management across diabetic and non-diabetic etiologies, understand their mechanism of renoprotection (hemodynamic and non-hemodynamic effects), and navigate the expanding evidence base for their use in patients with lower eGFR ranges than originally studied.

Core journals for nephrologists

Journal of the American Society of Nephrology (JASN) — highest impact nephrology journal, covers basic and clinical research
Kidney International — ISN flagship, particularly strong on glomerular disease and transplant
American Journal of Kidney Diseases (AJKD) — NKF journal, clinically oriented, strong on dialysis and CKD epidemiology
Clinical Journal of the American Society of Nephrology (CJASN) — practice-focused JASN companion
Nephrology Dialysis Transplantation (NDT) — ERA-EDTA journal, European perspective

Glomerular disease: the new therapeutic era

Glomerulonephritis management has historically been limited to steroids and cyclophosphamide with modest evidence bases. Recent approvals and emerging data are changing this:

IgA nephropathy: Sparsentan (Filspari, 2023) — first FDA-approved, non-immunosuppressive therapy targeting endothelin and angiotensin pathways. Budesonide (Tarpeyo/Nefecon, 2021) — targeted-release corticosteroid. Multiple anti-complement therapies in trials.
Membranous nephropathy: Rituximab has established evidence; belimumab data emerging. PLA2R antibody monitoring now standard of care for seropositive patients.
Lupus nephritis: Belimumab (BLISS-LN) and voclosporin (AURORA-1) both approved 2021, changing induction and maintenance approaches.
ANCA vasculitis: Avacopan (ADVOCATE trial) — C5a receptor blocker as a glucocorticoid-sparing option.

Major shift: The KDIGO Glomerulonephritis guidelines were comprehensively updated in 2021 for the first time since 2012. Nephrologists who have not reviewed the 2021 KDIGO GN guidelines are managing glomerular disease on substantially outdated evidence — particularly for IgA nephropathy, membranous nephropathy, and lupus nephritis.

Dialysis: ongoing questions in an evidence-poor area

Despite decades of dialysis practice, many fundamental management questions remain incompletely answered. Current active areas of evidence generation:

Optimal dialysis frequency and duration — evidence for incremental hemodialysis in residual kidney function preservation
Home hemodialysis vs. in-center — outcomes data and access barriers
Cardiovascular risk reduction in dialysis — EVOLVE, SHARP, and ongoing trials
Anemia management — ESA dosing targets and ferric derisomaltose/ferric carboxymaltose IV iron data
Intradialytic hypotension — cool dialysate, volume profiling, and pharmacological management evidence

Transplant nephrology: evolving immunosuppression

Kidney transplant medicine continues to evolve in three key areas:

Desensitization protocols — imlifidase (IdeS), a novel IgG-cleaving enzyme, for highly sensitized recipients awaiting transplant
Calcineurin inhibitor minimization/elimination — ongoing trials of belatacept-based and costimulation blockade regimens
Donor-derived cell-free DNA (dd-cfDNA) — liquid biopsy for subclinical rejection surveillance, increasingly replacing protocol biopsies in some centers
COVID-19 in transplant recipients — ongoing data on vaccine response, Paxlovid use, and updated immunosuppression protocols during infection

KDIGO guidelines: the nephrology standard

The Kidney Disease: Improving Global Outcomes (KDIGO) organization publishes comprehensive guidelines across all major domains of nephrology. Active guidelines of highest clinical priority:

KDIGO CKD Guidelines (2024 update) — incorporating SGLT2 inhibitor data
KDIGO Glomerulonephritis (2021)
KDIGO Blood Pressure (2021)
KDIGO Diabetes in CKD (2022)
KDIGO Transplant Guidelines (under update)

Conference priorities in nephrology

ASN Kidney Week (October/November) — the primary nephrology conference, late-breaking clinical trials session is essential
ERA Congress (May) — European Renal Association, strong on European trial data
ERBP and KDIGO conferences — guideline development and evidence synthesis meetings

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