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# Weekly · Oct 26: IgA Nephropathy's Turning Point, Access in the Very Old, SGLT2 in ADPKD and the Federal Kidney Plan
- URL: https://nephspace.com/weekly-oct-26/
- Published: 2026-10-26T10:00:00.000Z
- Updated: 2026-10-26T10:00:02.000Z
- Description: Your weekly digest: IgA nephropathy's two-year test, catheters by design in the very old, and the federal kidney plan that names nephrologists.
- Author: Dr Wael Hussein
- Tags: Episodes, Glomerular disease, Dialysis, Policy and news, #weekly, #has-audio, #tr-c3adc8c4

It was ASN Kidney Week, and IgA nephropathy took center stage: four phase 3 trials in the New England Journal of Medicine and an FDA accelerated approval for ravulizumab. Two drugs first approved on proteinuria, sibeprenlimab and atacicept, reported their two-year results, and kidney function barely declined. We explain why the trials arrived all at once, how the proteinuria stand-in earned its place, and where stand-ins have misled us before. Then the access center: a randomized trial in people 70 and older in which catheters needed the fewest procedures, and a bioengineered vessel for women (both conference abstracts so far). Also: empagliflozin in polycystic kidney disease, where kidneys grew faster on the drug in a small pilot; whether the PUSH stone trial tested water or coaching; how few hemodialysis guidelines say what to do with residual kidney function; a patient's view of incremental PD; and the new HHS Kidney Care National Plan, which names the ties between dialysis chains and nephrologists.

**Disclosure:** Dr. Hussein serves on the Fresenius Medical Care US Home Medical Advisory Board. The HHS plan segment discusses the dialysis market and the responses of dialysis companies, including Fresenius Medical Care, and the residual kidney function and incremental PD segments concern dialysis prescription, including home dialysis. Industry funding of the studies discussed: VISIONARY (Otsuka), ORIGIN 3 and PIONEER (Vera Therapeutics), I CAN (Alexion, AstraZeneca Rare Disease), RAINIER (Vertex), the iptacopan extension (Novartis), IMAgINATION (sefaxersen, Roche and Ionis) and the tissue-engineered vessel trial (Humacyte, with Humacyte authors). The empagliflozin trial in ADPKD was funded by the NIDDK and the PKD Foundation, among other non-industry sources. These disclosures were not read on air this week.

## Chapters

- **01:56** IgA nephropathy: the year the endpoint changed · [Read the story](https://nephspace.com/igan-two-year-results-ravulizumab-approval/)
- **07:43** Vascular access: what to do on Monday · [Read the story](https://nephspace.com/vascular-access-older-adults-women-kidney-week/)
- **10:20** Empagliflozin in ADPKD · [Read the story](https://nephspace.com/empagliflozin-adpkd-pilot-kidney-volume/)
- **12:35** Stones and water · [Read the story](https://nephspace.com/push-trial-hydration-stones-commentary/)
- **14:10** Residual kidney function · [Read the story](https://nephspace.com/residual-kidney-function-hemodialysis-guidelines/)
- **16:15** Incremental PD: a patient's voice · [Read the story](https://nephspace.com/incremental-pd-patient-voice/)
- **17:37** The HHS Kidney Care National Plan · [Read the story](https://nephspace.com/hhs-kidney-care-national-plan/)

## Papers in this episode

- Rizk DV, Barratt J, Suzuki Y, et al., for the VISIONARY Trial Investigators Group. Sibeprenlimab in IgA Nephropathy — Final Phase 3 Trial Analysis. N Engl J Med. Published online October 22, 2026\. [Link](https://doi.org/10.1056/NEJMoa2609127?ref=nephspace.com)
- Barratt J, Brenner RM, Barbour SJ, et al., for the ORIGIN Phase 3 Trial Investigators. Atacicept in IgA Nephropathy — Phase 3 Trial Final Efficacy Analysis. N Engl J Med. Published online October 22, 2026\. [Link](https://doi.org/10.1056/NEJMoa2610103?ref=nephspace.com)
- Barratt J, Farag YMK, Rice K, et al., for the I CAN Trial Group. Ravulizumab in IgA Nephropathy — Interim Analysis of a Phase 3 Trial. N Engl J Med. Published online October 23, 2026\. [Link](https://doi.org/10.1056/NEJMoa2607544?ref=nephspace.com)
- Heggen B, et al., for the OASIS Study Group. Arteriovenous Fistulas, Grafts, or Central Venous Catheters as Vascular Access for Older Adults Starting Hemodialysis: A Randomized Controlled Trial. ASN Kidney Week 2026, abstract TH-OR112 (conference abstract), October 22, 2026\. [Link](https://www.asn-online.org/education/kidneyweek/2026/program-abstract.aspx?controlId=4593007&ref=nephspace.com)
- Hussain MA, Roy-Chaudhury P, Bou-Ghannam S, Niklason LE, Parikh SJ. Randomized Controlled Trial of an Acellular Tissue Engineered Vessel vs. Arteriovenous Fistula for Hemodialysis Access in Female Patients with ESKD: A Phase 3 CLN-PRO-V012 Interim Analysis. ASN Kidney Week 2026, abstract TH-OR113 (conference abstract), October 22, 2026\. [Link](https://www.asn-online.org/education/kidneyweek/2026/program-abstract.aspx?controlId=4593585&ref=nephspace.com)
- Roetker NS, Wetmore JB, Liu J, Gilbertson DT, Johansen KL. Trends in Mortality of Patients with Central Venous Catheters versus Arteriovenous Accesses for Hemodialysis. J Am Soc Nephrol. Published online October 22, 2026\. [Link](https://doi.org/10.1681/ASN.0000001293?ref=nephspace.com)
- Seliger SL, Gitomer B, You Z, et al. Empagliflozin Therapy in Autosomal Dominant Polycystic Kidney Disease: A Feasibility Randomized Controlled Trial. J Am Soc Nephrol. Published online October 24, 2026\. [Link](https://doi.org/10.1681/ASN.0000001271?ref=nephspace.com)
- Letavernier E, Drüeke TB. Kidney stone disease: to drink or not to drink—that is the question. Kidney Int. 2026;110:1078-1080\. [Link](https://doi.org/10.1016/j.kint.2026.07.025?ref=nephspace.com)
- Hiba SI, Woldemichael J, Awad AS, Abdel-Rahman E, Warfel OR, Gautam SC, Murea M. Clinical Practice Guidelines on the Integration of Residual Kidney Function in Hemodialysis Prescription: A Global Scoping Review. Hemodial Int. 2026\. [Link](https://doi.org/10.1111/hdi.70123?ref=nephspace.com)
- van Cruchten J. A Kidney Patient's Perspective on Incremental Peritoneal Dialysis and Shared Decision-Making. Clin J Am Soc Nephrol. Published online October 16, 2026\. [Link](https://doi.org/10.2215/CJN.0000001259?ref=nephspace.com)
- U.S. Department of Health and Human Services. Kidney Care National Plan. 2026 (released October 20, 2026). [Link](https://aspe.hhs.gov/reports/kidney-care-national-plan?ref=nephspace.com)

## Also mentioned

- Barratt J, Zhang H, Han SH, et al., for the RAINIER AIS-D08 Trial Group. Interim Analysis of a Phase 3 Trial of Povetacicept in IgA Nephropathy. N Engl J Med. Published online October 23, 2026\. [Link](https://doi.org/10.1056/NEJMoa2608682?ref=nephspace.com)
- Rovin BH, et al. Iptacopan in IgA nephropathy, long-term extension (up to 48 months). Kidney Int. 2026, journal pre-proof (open access). [Link](https://www.kidney-international.org/article/S0085-2538%2826%2900826-4/fulltext?ref=nephspace.com)
- ASN Kidney Week 2026 late-breaking abstracts (conference abstracts): atacicept in the PIONEER study (SA-OR079, Lafayette RA, et al., October 24, 2026) and the IMAgINATION trial of sefaxersen (FR-OR104, October 23, 2026). [Link](https://www.asn-online.org/education/kidneyweek/2026/KW26%5FLBAs%5FTitlesAuthors.pdf?ref=nephspace.com)
- Desai AC, et al. Prevention of urinary stones with hydration: a randomised clinical trial of an adherence intervention (PUSH). Lancet. 2026;407:1171-1181\. [Link](https://doi.org/10.1016/S0140-6736%2825%2902637-6?ref=nephspace.com)
- Selwood J, Shuaib R, FitzGerald TJ, et al. Evaluating patterns and outcomes in the prescription of incremental peritoneal dialysis in support of shared decision-making. Clin J Am Soc Nephrol. 2026;21(11):1959-1967\. [Link](https://doi.org/10.2215/CJN.0000001187?ref=nephspace.com)
- Healio, October 22, 2026: FDA approves Ultomiris for proteinuria reduction in adults with primary IgA nephropathy. [Link](https://www.healio.com/news/nephrology/20261022/fda-approves-ultomiris-for-proteinuria-reduction-in-adults-with-primary-iga-nephropathy?ref=nephspace.com)
- Healio, October 22, 2026: HHS launches new Kidney Care National Plan (with responses from DaVita, Fresenius Medical Care and Kidney Care Partners). [Link](https://www.healio.com/news/nephrology/20261022/hhs-launches-new-kidney-care-national-plan?ref=nephspace.com)

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*Physician-led, AI-assisted. Dr. Wael Hussein chooses the papers, reviews and edits every script, and approves every episode. AI (Claude, by Anthropic) writes the first draft from the full text of each paper, and a separate AI check compares every number with the papers; Dr. Hussein then reviews and edits the draft before the AI hosts (ElevenLabs) voice it. Everything is summarized in our own words. For education and information only, not medical advice. Please talk to your own physician or care team about your health. Clinicians: read the original before changing practice. See our [disclaimer](https://nephspace.com/disclaimer/). Views are the creator's own and not those of his employer. No sponsors.*