At the 62nd European Renal Association (ERA 2025) Congress, HCPLive’s flagship nephrology podcast Kidney Compass: Navigating Clinical Trials delivered 3 focused conversations with leading nephrologists breaking down pivotal trial data and shifting paradigms in chronic kidney disease (CKD) and IgA nephropathy (IgAN). Below is a summary of each episode and a short clip previewing the first 3 minutes of each episode.

Kidney Compass at ERA 2025

CONFIDENCE Trial at ERA 2025, with Rajiv Agarwal, MD, MS

In the opening episode, host Brendon Neuen, MBBS, PhD, sat down with Rajiv Agarwal, MD, to unpack results from the CONFIDENCE trial, which evaluated simultaneous initiation of finerenone (Kerendia) and empagliflozin (Jardiance) in patients with CKD and type 2 diabetes.

The phase 2 trial randomized 800 patients across 3 arms—empagliflozin alone, finerenone alone, or the combination. At 180 days, combination therapy produced a 52% reduction in urinary albumin-to-creatinine ratio (UACR), outperforming both monotherapy groups (29% greater reduction vs. finerenone, 32% vs. empagliflozin; P < .001 for both). Additionally, the combination was well-tolerated.

Agarwal and Neuen discussed how these findings support dual-agent initiation as a potentially practice-changing approach, offering early and amplified renal protection in a high-risk population.

Sibeprenlimab and the VISIONARY Trial, with Vlado Perkovic, MBBS, PhD, at ERA 2025

In a second special edition episode, Vlado Perkovic, MBBS, PhD, joined hosts Neuen and Shikha Wadhwani, MD, MS, to discuss the VISIONARY trial—the largest phase 3 study in IgAN to date.

The international trial enrolled 510 patients and evaluated the efficacy of sibeprenlimab, an APRIL inhibitor, versus placebo. After 9 months, sibeprenlimab led to a 50.2% reduction in 24-hour urine protein-to-creatinine ratio (uPCR), while placebo saw a slight increase, yielding a net between-group difference of 51.2% (P < 0.0001).

Perkovic emphasized the significance of these findings in a cohort where 98% were already on RAS inhibitors and nearly 40% were on SGLT2 inhibitors. The additive benefit of sibeprenlimab supports APRIL inhibition as a new frontier in targeted IgAN therapy.

Key Updates in IgA Nephropathy at ERA 2025, with Chee Kay Cheung, MBChB, PhD

In the final ERA 2025 episode, Wadhwani caught up with Chee Kay Cheung, MBChB, PhD, for a forward-looking discussion on the rapidly evolving IgAN pipeline.

Cheung revisited VISIONARY data on sibeprenlimab but also called attention to other APRIL/BAFF-targeting agents in development. Zigakibart showed promising long-term results, while atacicept—targeting both APRIL and BAFF—delivered encouraging topline proteinuria reductions. While direct comparisons are lacking, biomarker-driven treatment selection may be on the horizon.

The conversation also touched on data from approved agents: budesonide’s consistent efficacy across eGFR ranges in post-hoc NefIgArd analysis, and sparsentan’s continued benefit in the PROTECT trial’s open-label extension.

Looking ahead, Cheung previewed the SPARTAN study’s biopsy data, expected to provide insight into how sparsentan modulates renal inflammation and fibrosis at the tissue level.