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PubMed14 Apr 2026·Annals of internal medicine● 3/10i

Nephrology: What You May Have Missed in 2025.

Akbari S, Alharbi S, Al-Magooshi A, Jarrar F, Sehgal AR

Finerenone plus empagliflozin combination data emerged alongside other nephrology findings including AI models for AKI prediction and interventions for patients on dialysis. Annual review article covering multiple 2025 nephrology studies across AKI management, kidney function factors, and dialysis complications. This provides the first mention of dual finerenone-empagliflozin use data, potentially signaling combination therapy development in chronic kidney disease.

Strategic signal

The mention of finerenone-empagliflozin combination therapy signals potential label expansion discussions for Bayer's Kerendia beyond its current heart failure and CKD indications. This combination approach could strengthen Bayer's position against Novo Nordisk and Eli Lilly's GLP-1 agents in cardiorenal protection. US CMS and EU HTA bodies will likely require dedicated combination studies with hard outcomes data, not just review article mentions, to support reimbursement for dual SGLT2-MRA therapy.

Original Abstract

This article highlights some important nephrology studies published in 2025 that are relevant for many nonnephrologist physicians. Two studies examined aspects of acute kidney injury (AKI), including the use of sodium bicarbonate infusion to treat severe metabolic acidemia and the use of artificial intelligence models to predict AKI onset, severity, and complications. Three studies examined factors that may influence kidney function, including high-intensity long-term physical exercise, pregnancy, and the combined use of finerenone and empagliflozin. Three studies examined interventions to address common problems among patients receiving maintenance dialysis, including cognitive behavioral therapy for chronic pain, factor Xa inhibitors for atrial fibrillation, and fish oil for cardiovascular events.

Related signals

PubMed28 Mar 2026·JAMA cardiology● 8/10iHigh impact

Cardiorenal Outcomes With Tirzepatide Compared With Dulaglutide in Patients With Diabetes and Cardiovascular Disease: A Post Hoc Analysis of the SURPASS-CVOT Randomized Clinical Trial.

Tirzepatide reduced a 6-component cardiorenal composite endpoint by 16% versus dulaglutide (23.7% vs 27.4%, HR 0.84) in people with type 2 diabetes and cardiovascular disease. Post hoc analysis of SURPASS-CVOT double-blind RCT, 13,165 patients, median 46.9 months follow-up. This provides the first head-to-head cardiorenal comparison between tirzepatide and a GLP-1 agonist in high-risk cardiovascular patients, extending beyond the primary non-inferiority finding. Gastrointestinal adverse events were higher with tirzepatide (42.5% vs 35.9%).

GLP-1CardiovascularKidneyType 2 diabetesDrug comparisonsEli LillyNovo Nordisk
ClinicalTrials16 Apr 2026·Phase 3● 7/10i

A Randomised, Double-blind, Placebo-controlled, Multicentre, Phase III Trial Evaluating Long-term Efficacy and Safety of Survodutide Weekly Injections in Adult Participants With Noncirrhotic Non-alcoholic Steatohepatitis/Metabolic Dysfunction-associated Steatohepatitis (NASH/MASH) and (F2) - (F3) Stage of Liver Fibrosis

Boehringer Ingelheim is testing survodutide, a weekly injectable, versus placebo in 1,800 adults with MASH and moderate to advanced liver fibrosis (F2-F3). This placebo-controlled trial runs up to 7 years with dual primary endpoints: MASH resolution without fibrosis worsening and composite clinical outcomes including progression to cirrhosis. This positions Boehringer as the first major pharma to advance a dedicated MASH program into Phase 3, targeting a liver indication where Novo's semaglutide and Eli Lilly's tirzepatide have shown promise but lack specific approvals. The 7-year duration reflects the extended timeline needed to demonstrate meaningful liver outcomes in this progressive disease.

Liver/NASHGLP-1Boehringer Ingelheim
ClinicalTrials16 Apr 2026·Phase 3● 7/10i

A Phase III Double-blind, Randomised, Placebo-controlled Trial to Evaluate Liver-related Clinical Outcomes and Safety of Once Weekly Injected Survodutide in Participants With Compensated Non-alcoholic Steatohepatitis/Metabolic Dysfunction Associated Steatohepatitis (NASH/MASH) Cirrhosis

Boehringer Ingelheim is testing survodutide, a once-weekly injectable, in people with compensated NASH/MASH cirrhosis in a phase 3 trial targeting liver-related clinical outcomes. The randomized, placebo-controlled study aims to enroll 1,590 participants over 4.5 years, measuring time to death, liver transplant, hepatic decompensation, or disease progression. This represents Boehringer's entry into the competitive NASH space where Novo Nordisk's semaglutide is already in phase 3 trials for non-cirrhotic NASH. The trial focuses on advanced cirrhotic patients, a population with high unmet need but challenging regulatory pathway.

PubMed14 Apr 2026·Circulation● 7/10iPick of the week

Risk of Heart Failure Hospitalization for GLP-1 Receptor Agonists Versus DPP-4 Inhibitors or SGLT-2 Inhibitors in Patients With Type 2 Diabetes: A Target Trial Emulation.

GLP-1 receptor agonists reduced heart failure hospitalization risk by 23% versus DPP-4 inhibitors (HR 0.77) but matched SGLT-2 inhibitors (HR 1.02) in adults with type 2 diabetes. Target trial emulation of Swedish health records, 63,083 patients across two comparisons, 3-year follow-up. This provides the first direct head-to-head comparison of GLP-1RAs versus SGLT-2 inhibitors for heart failure prevention, confirming cardiovascular benefits extend beyond major adverse events to heart failure hospitalization.

GLP-1SGLT2Type 2 diabetesCardiovascularReal-world evidenceNovo NordiskEli Lilly

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