Nephro Trial Files: CKD and Tirzepatide, Spironolactone vs. Amiloride for Resistant HTN, and Kidney Outcomes for Diabetes Meds
Interplay of Chronic Kidney Disease and the Effects of Tirzepatide in Patients With Heart Failure, Preserved Ejection Fraction, and Obesity (SUMMIT)
Packer M et al. JACC (May 2025)
Bottom Line: The SUMMIT trial was a randomized, double-blind study evaluating the effects of tirzepatide versus placebo in 731 patients with obesity-related heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD) over 104 weeks. Primary outcomes included cardiovascular death or worsening heart failure events and changes in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) after 52 weeks. Results showed an improvement in eGFR at 52 weeks assessed by cystatin C and a decline at 12 weeks assessed by eGFR-creatinine. The study concluded that tirzepatide improves renal function in this patient population, despite challenges in eGFR measurement due to body composition changes.
Spironolactone vs Amiloride for Resistant Hypertension
Lee CJ et al. JAMA (May 2025)
Bottom Line: This prospective, open-label, blinded end-point randomized clinical trial conducted at 14 sites in South Korea from November 16, 2020, to February 29, 2024, enrolled 118 patients with resistant hypertension. Patients were randomized to receive either amiloride 5 mg/d (increased to 10 mg/d if necessary) or spironolactone 12.5 mg/d (increased to 25 mg/d if necessary). The primary outcome was the change in home-measured systolic blood pressure (SBP) at week 12, with results showing -13.6 mm Hg for amiloride and -14.7 mm Hg for spironolactone, indicating noninferiority. Safety outcomes included one case of hyperkalemia in the amiloride group, with no gynecomastia observed.
Weight Gain Was Associated With Worsening Glycemia and Cardiovascular and Kidney Outcomes in Patients With Type 2 Diabetes Independent of Diabetes Medication in the GRADE Randomized Controlled Trial
Wexler DJ et al. Diabetes Care (April 2025)
Bottom Line: The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) is a randomized trial evaluating the effects of four diabetes medications added to metformin in participants with type 2 diabetes over 5 years. A total of 4,980 participants were included, with primary outcomes focusing on weight change and hazard ratios for HbA1c >7.5%. Results showed liraglutide and sitagliptin resulted in initial weight loss, while glargine and glimepiride led to slight weight gain, followed by weight loss. Weight gain was linked to worsening glycemia and increased risks of cardiovascular and kidney outcomes.
Nephro Trial Files Issue #NPH-2025-12
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