An aldosterone synthase inhibitor on top of an SGLT2 inhibitor cut blood pressure and albuminuria in CKD

The edition in brief

In the Explore-CKD crossover trial, 59 adults with uncontrolled hypertension, CKD (mean cystatin C eGFR 43) and albuminuria, already on a RAS blocker and an SGLT2 inhibitor, took lorundrostat 25 mg or placebo for four weeks each. Lorundrostat lowered office systolic pressure by 7.5 mmHg and albuminuria by about 26% versus placebo, with an early eGFR dip of about 3 mL/min and one discontinuation for hyperkalaemia. These are short-term surrogate results. A Kidney International commentary on the LIPS trial notes lanreotide did not slow measured GFR decline in ADPKD, supporting KDIGO's advice not to use somatostatin analogues solely to preserve kidney function. In a French real-world cohort of 76 patients with primary hyperoxaluria type 1, 73% met an oxalate response target at three months on lumasiran, with better responses in children and no clear genotype effect. A KDIGO Controversies Conference set research priorities for technology-supported, guideline-informed kidney care.