DKDPulse Daily Digest — 2026-04-26

In a 24-month randomized controlled trial of patients with T2DM and macroalbuminuria (UACR >300), empagliflozin 10 mg reduced annual eGFR slope and lowered the composite of major adverse kidney events compared with placebo. Hyperkalemia was rare. Findings align with KDIGO 2024 guideline recommendations.

Real-world cohort of 18,000 patients with T2DM-DKD found dapagliflozin associated with a 22% relative reduction in hyperkalemia compared with non-SGLT2 users. eGFR slope was preserved. No new safety signals.

Patient-level meta-analysis (n=11,200) of T2DM-DKD with eGFR <30 found a 14% reduction in all-cause death with combined empagliflozin + finerenone vs either alone. Hyperkalemia not increased. Consistent with KDIGO 2024 hierarchical therapy.

Among normoalbuminuric patients with type 2 diabetes and eGFR 25-60, finerenone reduced UACR but had only modest effect on eGFR slope. Hyperkalemia incidence was 2.3 times higher than placebo. Authors discuss applicability to KDIGO and KDA guideline updates.

Pilot 24-week RCT of esaxerenone added to canagliflozin showed additional UACR reduction of 27% vs SGLT2i alone, with manageable potassium elevation. eGFR slope did not differ. Authors flag dose adjustment per KDIGO advice.

This sub-study of a dual GIP/GLP-1 agonist program enrolled patients with eGFR <30 and overt albuminuria. Tirzepatide reduced UACR by 38% versus placebo over 52 weeks. Severe hypoglycemia was rare. Effect on MAKE was a secondary endpoint.

Off-label comparison of two GLP-1 receptor agonists in T1DM-DKD demonstrated similar UACR reduction but a numerically lower all-cause mortality signal with semaglutide. Sample size limits inference.

KDA registry analysis of 4,300 Korean adults with T2DM and microalbuminuria. Liraglutide associated with 18% UACR reduction at 12 months. Severe hypoglycemia infrequent. Authors note alignment with Korean Diabetes Association 2025 statement.

Exploratory analysis of a triple agonist trial in T2DM patients with macroalbuminuria. Retatrutide 12 mg yielded marked weight loss but eGFR slope was non-inferior to placebo. UACR change was favorable but underpowered.

This non-systematic narrative review covers diet, exercise, and broad metabolic concepts. No specific kidney outcomes or DKD drug analyses are presented.