Kidney Week 2026 Recap: IgAN Advances, Value-Based Care, CKD Care Gaps

Phase 3 data for immune-targeted therapies in immunoglobulin A nephropathy (IgAN), the future of kidney care policy and practice, and persistent gaps in chronic kidney disease (CKD) detection and treatment were among themes at American Society of Nephrology Kidney Week 2026 in Denver, Colorado.^1-5 The meeting also included late-breaking trials of aspirin for primary prevention in CKD and of an oral anemia therapy in patients receiving hemodialysis, along with sessions on drug access, prior authorization, and CKD screening.

IgAN Data Take Center Stage

In the double-blind RAINIER trial (NCT06564142), adults with biopsy-proven IgAN were randomly assigned 2:1 to povetacicept (Vertex Pharmaceuticals), a dual inhibitor of B-cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL), or placebo every 4 weeks, and the interim efficacy population included the first 199 participants of 557 in the main cohort.¹ At week 36, povetacicept reduced proteinuria by 52.0% vs 4.3% with placebo (adjusted difference, –49.8 percentage points; 95% CI, –58.6 to –39.2; P < .001), and hematuria resolved in 85% vs 23% of participants with baseline hematuria. Serious adverse events occurred in 3% vs 4%, and none were judged related to povetacicept.

The FDA has set a target action date of November 30, 2026, for Vertex’s application seeking accelerated approval.⁶ In an interview with The American Journal of Managed Care^® (AJMC^®), senior author Richard A. Lafayette, MD, of Stanford University, said proteinuria was “rapidly and well controlled at around a 50% difference from placebo” and that blocking both cytokines appears to “work really harmoniously together to quiet the disease.”⁷ The 2-year data on loss of kidney function are still pending.

Two approved therapies also reported 2-year kidney function data. In ORIGIN 3 (NCT04716231), atacicept-vymj (Trutakna; Vera Therapeutics), which also inhibits BAFF and APRIL, produced an annualized estimated glomerular filtration rate (eGFR) slope of –0.6 mL/min/1.73 m² per year vs –5.6 with placebo and reduced the risk of composite kidney disease progression by 76% at week 104, presenter Jonathan Barratt, MBChB, PhD, of the University of Leicester, England, said at a media briefing.²

In VISIONARY (NCT05248646), the selective APRIL inhibitor sibeprenlimab-szsi (Voyxact; Otsuka) produced an eGFR slope of +0.3 vs –4.2 mL/min/1.73 m² per year over 24 months, and a composite kidney outcome occurred in 1 patient (0.4%) receiving sibeprenlimab vs 28 of 251 (11%) receiving placebo (HR, 0.029).^3,8

“I think it would be very difficult to justify not giving access to a B-cell–directed therapy in any patient at risk of progression of [IgA nephropathy],” Barratt said.

Earlier treatment may also matter. In the small, open-label SPARTAN study (NCT01946204) of 12 patients with newly diagnosed IgAN, sparsentan (Filspari; Travere Therapeutics) reduced proteinuria by about 70% within 36 weeks, and eGFR remained fairly stable over 2 years, Chee Kay Cheung, MBChB, PhD, told AJMC.⁹

Uptake, Prior Authorization Limit Access to Newer Glomerular Disease Drugs

Fewer than 5% of patients with IgAN were taking any newly approved drug in an analysis presented earlier this year at a National Kidney Foundation meeting, Jai Radhakrishnan, MD, MS, of Columbia University Irving Medical Center, told AJMC.¹⁰ He pointed to guidelines that trail drug approvals and to monitoring requirements that burden low-volume community nephrologists.

“Every time there’s a [Kidney Disease: Improving Global Outcomes] guideline, it’s almost obsolete at that point,” he said.

At a clinical practice session, Kaiser Permanente Southern California data showed about 12% of patients with IgAN were receiving newer therapies as of January 2026, and only 273 of 1039 patients (26.3%) met trial-style eligibility thresholds.¹¹ Speakers also noted that Medicare Advantage insurers denied 7.7% of 52.8 million prior authorization determinations in 2024, and although 80.7% of appealed denials were fully or partially overturned, only 11.5% of denials were appealed.

Value-Based Kidney Care Faces Payment Cuts at 5 Years

In a session on 5 years of CMS kidney payment models, speakers reported that the Kidney Care Choices model was associated in 2023 with 31% more optimal dialysis starts, 10% more home dialysis, and 22% more living donor transplants than matched comparisons, while net Medicare spending rose by $304.8 million, mainly from incentive payments.¹² For 2026, CMS cut the CKD quarterly capitation payment by 50%, eliminated the kidney transplant bonus, and added 1% benchmark discounts, and participation in the Kidney Care First option fell from 30 practices in 2022 and 2023 to 15 in 2025.

“Value-based care is the right destination. We just need a good financial model to get us there,” said Varun Chawla, MD, MPH, a nephrologist in private practice in the San Francisco Bay Area.

Alerts, Screening, and Therapy Gaps in CKD Care

In the ALMA-CKD pragmatic cluster randomized trial (NCT06386172) across 65 primary care centers in Stockholm, Sweden, CKD-specific electronic alerts did not improve screening; creatinine testing reached 62% of eligible patients in the intervention arm vs 65% with usual care, and albuminuria screening reached 42% vs 44%.¹³ “[H]ealth systems should not assume that electronic alerts alone will by themselves close these gaps,” Antoine Créon, MD, of Karolinska Institutet, told AJMC.

In a poster analysis of 106,383 adults with advanced CKD discussed by Jennifer Flythe, MD, MPH, of the University of North Carolina School of Medicine, cardiovascular event and death risks exceeded kidney failure risk, yet sodium-glucose cotransporter 2 inhibitor use was only 11% to 17%.¹⁴ “When everyone assumes someone else owns it, nobody does,” Flythe said.

Late-Breaking Trials of Aspirin in CKD and Vadadustat in Dialysis

In the open-label ATTACK trial (NCT03796156), 4633 adults with CKD and no history of cardiovascular disease were randomly assigned to aspirin 75 mg daily or no aspirin, short of the roughly 25,000 planned after the COVID-19 pandemic disrupted UK primary care recruitment.⁴ Major vascular events occurred in 2.4% vs 3.3% of patients (subdistribution HR, 0.73; 95% CI, 0.52-1.03), a difference that was not statistically significant, with 29 vs 19 major bleeding events.

“Consequently, aspirin is not indicated for primary prevention of cardiovascular disease in CKD,” presenter Hugh Gallagher, MB BS, PhD, of Epsom and St Helier University Hospitals NHS Trust and the University of Southampton, England, said.

In the pragmatic VOICE trial (NCT06520826) of 2116 patients receiving in-center hemodialysis, vadadustat (Vafseo; Akebia Therapeutics) dosed 3 times weekly met its hierarchical composite of mortality and hospitalization vs an erythropoiesis-stimulating agent (win odds, 1.16; 95% CI, 1.06-1.28; P = .0016), driven by fewer hospitalizations, with no significant difference in mortality.^5,15 “We asked a clinical outcomes question, not a hemoglobin question,” presenter Geoffrey A. Block, MD, of US Renal Care, which conducted the trial, said.

The Kidney Care Landscape Continues to Change

With the exception of RAINIER and ORIGIN 3, which were published simultaneously in the New England Journal of Medicine, much of the data presented at the meeting came from interim analyses, posters, and abstracts that have not yet been published in peer-reviewed journals. Radhakrishnan noted that many recently approved IgAN therapies were approved based on interim end points, leaving long-term preservation of kidney function as the measure that will ultimately define their value. “The money is really in the glomerular filtration rate,” he said.¹⁰

References

1. Barratt J, Zhang H, Han SH, et al; 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. doi:10.1056/NEJMoa2608682

2. Barratt J, Brenner RM, Barbour S, et al. The ORIGIN 3 trial: atacicept in IgA nephropathy. Paper presented at: American Society of Nephrology Kidney Week 2026; October 21-25, 2026; Denver, CO. Abstract TH-OR109.

3. Rizk DV, Barratt J, Suzuki Y, et al. Sibeprenlimab in IgA nephropathy: 24 months of data from the phase 3 VISIONARY trial. Paper presented at: American Society of Nephrology Kidney Week 2026; October 21-25, 2026; Denver, CO. Abstract TH-OR110.

4. Gallagher H, Fraser SD, Wilding S, et al. ATTACK (Aspirin To Target Arterial events in Chronic Kidney Disease): a multicentre randomised trial of aspirin vs. usual care for the primary prevention of cardiovascular events in patients with CKD. Paper presented at: American Society of Nephrology Kidney Week 2026; October 21-25, 2026; Denver, CO. Abstract FR-OR100.

5. Anand S, Chertow GM, Wolf M, et al. Vadadustat three times weekly for the treatment of anemia in patients receiving hemodialysis. Paper presented at: American Society of Nephrology Kidney Week 2026; October 21-25, 2026; Denver, CO. Abstract FR-OR106.

6. Phase 3 RAINIER results supporting best-in-class potential of povetacicept in IgA nephropathy published in the New England Journal of Medicine and presented at the American Society of Nephrology Kidney Week 2026. News release. Vertex Pharmaceuticals. October 23, 2026. Accessed October 29, 2026. https://investors.vrtx.com/news-releases/news-release-details/phase-3-rainier-results-supporting-best-class-potential

7. Gallagher A. Povetacicept cuts proteinuria in IgAN: Richard Lafayette, MD, FACP. AJMC. October 27, 2026. Accessed October 29, 2026. https://www.ajmc.com/view/povetacicept-cuts-proteinuria-in-igan-richard-lafayette

8. Otsuka unveils unprecedented phase 3 VISIONARY two-year eGFR results demonstrating Voyxact (sibeprenlimab-szsi) stabilizes kidney function decline to baseline physiologic rate, fundamentally altering disease progression in IgA nephropathy (IgAN). News release. Otsuka. August 3, 2026. Accessed October 29, 2026. https://otsuka-us.com/news/otsuka-unveils-unprecedented-phase-3-visionary-two-year-egfr-results-demonstrating-voyxactr

9. Joszt L. Sparsentan cuts proteinuria 70% in new IgAN: Chee Kay Cheung, MBChB. AJMC. October 23, 2026. Accessed October 29, 2026. https://www.ajmc.com/view/sparsentan-cuts-proteinuria-70-in-new-igan-chee-kay-cheung-mbchb

10. Gallagher A. FSGS treatment and low IgAN drug uptake: Jai Radhakrishnan, MD, MS. AJMC. October 23, 2026. Accessed October 29, 2026. https://www.ajmc.com/view/fsgs-treatment-and-low-igan-drug-uptake-jai-radhakrishnan-md-ms

11. McNulty R. Prior authorizations, trial gaps hinder glomerular disease drug access. AJMC. October 23, 2026. Accessed October 29, 2026. https://www.ajmc.com/view/prior-authorizations-trial-gaps-hinder-glomerular-disease-drug-access

12. McNulty R. Nephrologists weigh wins, losses from 5 years of value-based kidney care. AJMC. October 24, 2026. Accessed October 29, 2026. https://www.ajmc.com/view/nephrologists-weigh-wins-losses-from-5-years-of-value-based-kidney-care

13. Gallagher A. CKD alerts did not improve primary care screening: Antoine Créon, MD. AJMC. October 23, 2026. Accessed October 29, 2026. https://www.ajmc.com/view/ckd-alerts-did-not-improve-primary-care-screening-antoine-cr-on-md

14. Joszt L. One-size dialysis volume goals fall short in CKD: Jennifer Flythe, MD. AJMC. October 24, 2026. Accessed October 29, 2026. https://www.ajmc.com/view/one-size-dialysis-volume-goals-fall-short-in-ckd-jennifer-flythe-md

15. US Renal Care and Akebia announce interim analysis of VOICE trial demonstrated overwhelming statistical evidence of improved safety outcomes for patients treated with Vafseo versus an ESA. News release. Akebia Therapeutics. June 30, 2026. Accessed October 29, 2026. https://ir.akebia.com/static-files/7a3f2e4f-0394-4db4-8716-879d6b0768a4