Clinical journal of the American Society of Nephrology : CJASN最新文献

{"title":"Contemporary Approaches to Kidney Dysfunction and Diuretic Resistance in Acute Decompensated Heart Failure.","authors":"Joyita Bharati, Zachary L Cox, Maria Clarissa Tio, Jeffrey M Testani, Wendy McCallum","doi":"10.2215/CJN.0000001238","DOIUrl":"https://doi.org/10.2215/CJN.0000001238","url":null,"abstract":"<p><p>Kidney dysfunction, characterized by either reduced estimated glomerular filtration rate (eGFR) of <60 ml/min per 1.73 m2 or reduced urinary response to diuretic therapy, is among one of the most powerful risk factors for mortality and adverse cardiovascular events among patients with acute decompensated heart failure (ADHF). Classically postulated hemodynamic mechanisms-including low cardiac output, arterial underfilling and venous congestion-likely interact through complex multi-directional pathways to contribute to kidney dysfunction in ways that remain incompletely understood. However, trials of therapies designed to improve cardiovascular hemodynamics have not consistently translated into improvements in kidney function. Non-hemodynamic contributors such as neurohormonal activation, inflammation, and endothelial dysfunction likely also play important roles in the development of kidney dysfunction in ADHF. A major challenge of the management of ADHF is intense tubular sodium and water avidity, leading to congestion that can be resistant to diuretic therapy. Overcoming diuretic resistance frequently requires escalation of loop diuretics as well as combination diuretic strategies targeting multiple nephron segments, and monitoring of diuretic response to guide titrations of diuretic therapy. Recent studies have also evaluated the safety of initiation of guideline directed medical therapy (GDMT) during hospitalizations for ADHF. Even though GDMT use has been shown to reduce cardiovascular events, rates of use remain low and hospitalizations for ADHF represent opportunities for initiation and/or resumption of GDMT. Many of therapies in ADHF, including decongestion and GDMT initiation, are associated with acute declines in kidney function that remain difficult to interpret and may be misleading if used in isolation without the larger clinical context to guide treatment decisions. Lastly, emerging novel targets for decongestion are being evaluated with the ultimate goal of achieving decongestion without declines in kidney function.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resistant Hypertension: State of the Art Review.","authors":"Muhammad Shahzeb Khan, Muhammad Sameer Arshad, Michael E Hall, Tazeen H Jafar, Anandita Kulkarni, Nicholas W S Chew, Daniel W Jones, Karol Watson, Matthew R Weir, Javed Butler","doi":"10.2215/CJN.0000001266","DOIUrl":"https://doi.org/10.2215/CJN.0000001266","url":null,"abstract":"<p><p>Resistant hypertension, defined as blood pressure above target despite treatment with at least three antihypertensive agents (including a diuretic) or controlled blood pressure requiring four or more medications, affects over 140 million individuals globally and confers increased risks of heart failure, stroke, and chronic kidney disease progression. A considerable proportion of cases represent apparent resistant hypertension, in which pseudo-resistance due to inaccurate blood pressure measurement, medication nonadherence, or white-coat effect has not yet been excluded. Ambulatory and home blood pressure monitoring are therefore central to confirming true resistance and identifying high-risk phenotypes, including nocturnal hypertension and abnormal dipping patterns. Excluding pseudo-resistance and secondary causes remains essential before escalating therapy. Resistant hypertension commonly coexists with obesity, type 2 diabetes, and chronic kidney disease (CKD), and is driven by overlapping mechanisms of aldosterone excess, sodium and water retention, and sympathetic activation. Guideline-directed treatment centers on optimization of lifestyle measures and triple therapy with renin-angiotensin system blockade, a calcium channel blocker, and a thiazide-like diuretic, followed by a mineralocorticoid receptor antagonist as preferred fourth-line agent. In patients with CKD, careful assessment of volume status, diuretic selection, kidney function, and hyperkalemia risk is particularly important. Recent therapeutic advances have expanded options for patients who remain uncontrolled. Newly FDA-approved agents aprocitentan and baxdrostat provide additional pharmacologic options for patients inadequately controlled on existing therapy. Renal denervation offers a separate device-based approach for selected patients, while investigational RNA-based and other neuromodulatory therapies may further broaden future treatment options. Future management is likely to move toward more precise, phenotype-guided treatment integrating ambulatory blood pressure patterns, renin-aldosterone biology, volume status, kidney function, and cardiometabolic comorbidities. Improved diagnostic precision and mechanism-based treatment strategies may reduce persistent treatment gaps and improve long-term cardiovascular and kidney outcomes.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity in Living Kidney Donors from Risk to Ethics: Bridging Gaps in Evaluation and Management.","authors":"Pooja Budhiraja, Beata Bzoma, Aleksandar Denic, Naim Issa, Katie McKee, Carrie Schinstock, Sandra J Taler, Harini A Chakkera, Julie K Heimbach, Caroline C Jadlowiec, Kayla R Mirie, Diwan S Ty, Aleksandra Kukla","doi":"10.2215/CJN.0000001030","DOIUrl":"10.2215/CJN.0000001030","url":null,"abstract":"<p><p>Obesity is increasingly prevalent among living kidney donor candidates, presenting complex clinical, ethical, and logistical challenges. Although obesity is linked to increased post-donation hypertension, diabetes, proteinuria, and chronic kidney disease, the overall absolute risks are modest and may differ depending on metabolic health and patterns of fat distribution. Current reliance on body mass index alone fails to capture the full spectrum of obesity-related risks, leading to inconsistent donor selection practices and potential inequities. This review examines the pathophysiological mechanisms of obesity-related kidney injury and available evidence on comorbidities and postdonation outcomes related to obesity. We discuss tools for better risk stratification, such as imaging-based adiposity assessment and personalized weight management strategies, and note that some risks may remain after weight loss. Barriers such as rigid body mass index cutoffs, limited access to treatment, and lack of long-term follow-up exacerbate disparities in access to donation. We argue for a shift toward individualized, risk-based evaluation supported by multidisciplinary care. We underscore the importance of donor counseling and advocate for a comprehensive, rather than paternalistic approach to living kidney donor selection. Advancing safe and equitable living donation in the context of rising obesity rates will necessitate revised guidelines, improved access to treatment, and an ongoing commitment to donor well-being.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1814-1825"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146215424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-Glucose Cotransporter 2 Inhibitors in Patients with Primary Aldosteronism.","authors":"Li-Yang Chang, Chieh Huang, Ching-Chun Su, Cheng-Hsuan Tsai, Che-Hsiung Wu, Chun-Fu Lai, Vin-Cent Wu","doi":"10.2215/CJN.0000001144","DOIUrl":"10.2215/CJN.0000001144","url":null,"abstract":"<p><strong>Key points: </strong>Primary aldosteronism patients on mineralocorticoid receptor antagonists face high cardio-renal risks, but evidence for effective add-on therapies remains limited. Adding sodium-glucose cotransporter 2 inhibitors to mineralocorticoid receptor antagonists reduced 3-year mortality by 6.6%, major adverse cardiovascular events by 2.7%, and major adverse kidney events by 9.7% absolute risk. Mineralocorticoid receptor antagonist-sodium-glucose cotransporter 2 inhibitor combination therapy offers a promising strategy to improve long-term survival and organ preservation in primary aldosteronism.</p><p><strong>Background: </strong>Patients with primary aldosteronism (PA) are at an increased risk of cardiovascular and kidney complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have demonstrated protective effects in individuals at a high risk of cardiorenal events. This study investigates whether adding SGLT2is to mineralocorticoid receptor antagonists (MRAs) associates with better outcomes in patients with PA.</p><p><strong>Methods: </strong>We retrospectively analyzed TriNetX data (February 1, 2014 to February 1, 2025) using an incident cohort design in adults with PA treated with MRAs within 3 months before or after PA diagnosis, excluding those who underwent adrenalectomy. Patients were divided into two cohorts based on initiation of an SGLT2i within 3 months of the PA diagnosis. The primary outcome was 3-year all-cause mortality; secondary outcomes included major adverse cardiovascular events and major adverse kidney events. We performed 1:1 propensity score matching and estimated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) using Cox proportional hazards models.</p><p><strong>Results: </strong>A total of 24,074 patients with PA were included; 34% had comorbid diabetes, 26% had heart failure, and 2524 (11%) received SGLT2is. After a well-balanced propensity score matching, 2507 SGLT2i users were compared with 2507 nonusers. In the matched cohort, the incidence of all-cause mortality was 12% in SGLT2i users and 18% in nonusers. The combination of SGLT2i with MRA was associated with a lower risk of all-cause mortality (aHR, 0.59; 95% CI, 0.51 to 0.68; absolute risk reduction [ARR], 7%), major adverse cardiovascular event (aHR, 0.81; 95% CI, 0.69 to 0.94; ARR, 3%), and major adverse kidney event (aHR, 0.58; 95% CI, 0.52 to 0.65; ARR, 10%). Kaplan-Meier survival curves for all outcomes demonstrated early divergence and remained distinct through the 3-year follow-up period.</p><p><strong>Conclusions: </strong>In patients with PA, adding SGLT2is to MRAs is associated with lower mortality and cardiorenal complications. These associations offer a rationale for evaluation of this combined strategy to improve long-term outcomes in this high-risk population.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1772-1782"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148612072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' Reply: Interpreting Biomarker Adjustment in Sex-Associated CKD Risk.","authors":"Thomas McDonnell, Philip A Kalra, Maarten W Taal","doi":"10.2215/CJN.0000001136","DOIUrl":"10.2215/CJN.0000001136","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1866-1867"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Determinants of Health and ESKD among Survivors of Critical Illness and Acute Kidney Injury.","authors":"Dilaram Acharya, Seda Babroudi, Udeme E Ekrikpo, Tomonori Takeuchi, Lama Ghazi, Orlando M Gutierrez, Javier A Neyra","doi":"10.2215/CJN.0000001141","DOIUrl":"10.2215/CJN.0000001141","url":null,"abstract":"<p><strong>Key points: </strong>During follow-up, 326 (1%) critical illness survivors with AKI developed ESKD; 2723 (9%) died. Black race and lack of health insurance were independently associated with higher risk of developing ESKD. Residence in a socioeconomically deprived neighborhood was independently associated with higher risk of ESKD.</p><p><strong>Background: </strong>Adverse social determinants of health (SDOHs) are associated with higher risk of AKI. This study evaluated the association of individual- and neighborhood-level SDOHs with incident ESKD among intensive care unit (ICU) survivors of AKI.</p><p><strong>Methods: </strong>Thirty thousand four hundred ninety-eight adult ICU survivors of AKI at a major academic medical center between January 1, 2012, and December 31, 2022, were included. Individual-level SDOHs (race, ethnicity, and insurance status) were obtained from the hospital electronic health record, whereas neighborhood-level SDOHs (Area Deprivation Index among others) were derived from census-based indices. ESKD was defined by kidney failure with an eGFR <15 ml/min per 1.73 m 2 or the initiation of KRT, including maintenance dialysis or kidney transplantation. Association of individual- and neighborhood-level SDOHs with incident ESKD was evaluated using multivariable cause-specific Cox proportional hazards models adjusting for clinical factors.</p><p><strong>Results: </strong>The median age was 58 years, 40% were women, 31% were Black, and 12% were uninsured. The median follow-up time was 730 days, during which 326 (1%) patients developed ESKD and 2723 (9%) died. In adjusted models, Black race was associated with a higher hazard of ESKD compared with White race (adjusted hazard ratio [aHR], 1.43, 95% confidence interval [CI], 1.05 to 1.94), whereas having health insurance was associated with a lower hazard of ESKD (aHR, 0.60; 95% CI, 0.39 to 0.92). Higher neighborhood-level socioeconomic disadvantage was also independently associated with higher risk of ESKD (Area Deprivation Index tertile 2: aHR, 1.42; 95% CI, 1.01 to 2.00; tertile 3: aHR, 1.58; 95% CI, 1.08 to 2.33).</p><p><strong>Conclusions: </strong>Black race, lack of health insurance, and residence in socioeconomically deprived neighborhoods were independently associated with a higher hazard of incident ESKD among ICU survivors of AKI. Standardized SDOHs assessment in clinical practice may improve risk stratification of ESKD and identify AKI survivors most likely to benefit from postdischarge interventions.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1691-1700"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148650284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Peritoneal Dialysis a Better Modality than Hemodialysis for Incident Autosomal Dominant Polycystic Kidney Disease Patients?","authors":"Ranine Ghamrawi, Neera K Dahl","doi":"10.2215/CJN.0000001230","DOIUrl":"10.2215/CJN.0000001230","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1678-1680"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peritoneal Dialysis Outcomes in Autosomal Dominant Polycystic Kidney Disease.","authors":"Samantha Gunning, Rita L McGill, Arlene B Chapman, Pranav S Garimella","doi":"10.2215/CJN.0000001134","DOIUrl":"10.2215/CJN.0000001134","url":null,"abstract":"<p><strong>Key points: </strong>Peritoneal dialysis can be used successfully in patients with autosomal dominant polycystic kidney disease. Compared with days receiving hemodialysis, peritoneal dialysis days were associated with better patient survival, which has increased over time. Compared with hemodialysis days, peritoneal dialysis days were associated with a higher rate of kidney transplant, which has increased over time.</p><p><strong>Background: </strong>Peritoneal dialysis (PD) is a form of home dialysis that is underutilized in the United States. Patients with autosomal dominant polycystic kidney disease (ADPKD) are frequently good PD candidates who are often young and have few comorbid conditions. However, clinicians may be hesitant to recommend PD to patients with ADPKD because of perceived concerns for mechanical complications and technique failure. Little is known about outcomes of patients with ADPKD undergoing PD in the United States.</p><p><strong>Methods: </strong>A retrospective cohort of patients with ESKD 30 years and older registered in the United States Renal Data System with a diagnosis of cystic kidney disease from January 1, 2000, to December 31, 2021, was followed until death or January 1, 2023, whichever occurred first. A time-dependent variable for kidney treatment modality was created, allowing calculation of hazard ratios (HRs) and confidence intervals (CIs) on the basis of time proximity of PD exposure to death and kidney transplantation, compared with hemodialysis. Cox models were adjusted for age, sex, race, body mass index, serum albumin, hemoglobin, year of incident ESKD, insurance status, and comorbid conditions at the time of inclusion.</p><p><strong>Results: </strong>Among 53,651 incident ADPKD patients with ESKD, 26% received some PD. Over a median follow-up of 75 months, 26,375 (49%) of the patients received kidney transplants and 23,427 (44%) died. PD exposure was more likely among patients with ADPKD who were younger, were female, and had lower burden of comorbid diseases. In the adjusted models, PD was associated with lower mortality (HR, 0.84; 95% CI, 0.80 to 0.88, P < 0.001) and higher likelihood of transplant (HR, 1.12; 95% CI, 1.08 to 1.16; P < 0.001) compared with hemodialysis. The associations with lower mortality and higher transplantation became progressively more prominent with each passing year.</p><p><strong>Conclusions: </strong>These data indicate that PD is a safe and advantageous dialysis option for patients with ADPKD that is associated with longer patient survival and opportunities for kidney transplant.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1762-1771"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148650189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpreting Biomarker Adjustment in Sex-Associated CKD Risk.","authors":"Lei Wang, Dongxiang Zheng","doi":"10.2215/CJN.0000001097","DOIUrl":"10.2215/CJN.0000001097","url":null,"abstract":"","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1865"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Renin-Angiotensin-Aldosterone System Inhibitors in IgA Nephropathy: A Meta-Analysis of Randomized Controlled Trials.","authors":"Anjay Rastogi, Mrinalini Sarkar, Kosuke Kawai, Gabriel Munoz, Lewis Simon, Michelle Hwang, Maham Khalid, Connie M Rhee","doi":"10.2215/CJN.0000001130","DOIUrl":"10.2215/CJN.0000001130","url":null,"abstract":"<p><strong>Key points: </strong>Standard-of-care therapy for IgA nephropathy has historically relied on renin-angiotensin-aldosterone system inhibitors. Current treatment goals aim to slow eGFR decline to reduce the risk of ESKD. Analysis of renin-angiotensin-aldosterone system inhibitor therapy alone found an eGFR decline of -4.5 ml/min per 1.73 m 2 per year, which may not limit ESKD risk.</p><p><strong>Background: </strong>IgA nephropathy is a chronic autoimmune kidney disease characterized by deposition of immune complexes in the glomeruli, leading to inflammation and progressive, irreversible, kidney damage. Patients with IgA nephropathy face a lifetime risk of ESKD, and an associated increase in mortality unless their annual eGFR decline is generally maintained at or below 1 ml/min per 1.73 m 2 . The current standard of care in IgA nephropathy involves supportive CKD therapies, notably renin-angiotensin-aldosterone system inhibitors (RAASi). Importantly, the long-term effectiveness of RAASi in slowing IgA nephropathy disease progression remains uncertain. Meta-analyses of randomized controlled trials with comparable designs offer an opportunity to assess the impact of RAASi therapy on kidney function. Such analyses facilitate outcome comparisons across studies and may generate important evidence and contribute to informed clinical decision making.</p><p><strong>Methods: </strong>A meta-analysis was conducted using randomized controlled trials that reported the slope of eGFR decline and included one arm receiving maximally tolerated doses of RAASi. The analysis aimed to evaluate the impact of RAASi therapy on kidney function in high-risk patients with IgA nephropathy.</p><p><strong>Results: </strong>A systematic literature review of four databases returned 171 studies published between January 2006 and November 2024. Of these, ten included a control arm of participants with IgA nephropathy receiving maximized RAASi treatment ( N =1366) and reported eGFR annualized slope decline. Meta-analysis of the pooled data demonstrated a mean annual eGFR slope decline of -4.5 ml/min per 1.73 m 2 (95% confidence interval, -5.3 to -3.8) among participants treated with RAASi therapy alone.</p><p><strong>Conclusions: </strong>Treatment with maximally tolerated RAASi alone does not sufficiently slow the rate of eGFR decline in high-risk patients with IgA nephropathy, leaving patients at risk of ESKD. These findings underscore the need for disease-modifying therapies capable of effectively preserving kidney function, particularly in this predominantly young patient population.</p>","PeriodicalId":520592,"journal":{"name":"Clinical journal of the American Society of Nephrology : CJASN","volume":" ","pages":"1701-1709"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}