This is a summary of a presentation I attended at the National Kidney Foundation Spring Clinical Meeting on May 8, 2026 in New Orleans, LA. Below are some of my key takeaways and notes from the sessions.
Development of a Core Education Curriculum for CKD Stages 4–5
Speaker: Sherry Rivera DNP, APRN, ANP-C, FNKF, FAANP
Objectives
- Outline the development of a national CKD education curriculum
Why do we need CKD education?
Many patients remain unaware they have chronic kidney disease. Although approximately 1 in 7 adults in the United States has CKD, nearly 90% do not know they have it.
We also know that CKD education varies significantly depending on the care setting and provider. This inconsistency can make it harder for patients to understand their condition, treatment options, and what to expect as kidney disease progresses.
There are also important disparities in CKD education and shared decision-making. Many patients report feeling that dialysis was not truly a decision, but rather something that “just happened” to them. Awareness appears to be particularly low during earlier stages of CKD, though even many patients with advanced CKD still lack a clear understanding of their disease.
Who helped inform this work?
- Patients
- Providers, including physicians and multidisciplinary care teams
The overall goal is to identify quality measures that span the full spectrum of CKD care.
What has been done so far?
- A patient panel and plenary session
- An education framework review
- Formation of a Technical Expert Panel
KDOQI Commentaries on KDIGO Guidelines
Speaker: J. Kevin Tucker MD
Objectives
Review the KDOQI commentaries on recent KDIGO guidelines related to:
- Autosomal Dominant Polycystic Kidney Disease (ADPKD)
- IgA nephropathy
- Anemia management
Why does KDOQI develop commentaries?
KDOQI commentaries help contextualize global KDIGO recommendations within the United States healthcare system, taking into account insurance coverage, operational workflows, and regulatory environments.
These commentaries may help improve implementation by:
- Identifying barriers to care
- Suggesting practical management strategies
- Outlining how to apply emerging evidence in real-world practice
- Highlighting ongoing gaps in evidence
There is also a growing emphasis on patient-centered perspectives, including the involvement of patients on commentary working groups.
Commentary on ADPKD
Screening Adults at Risk of ADPKD
The first-line diagnostic approach remains abdominal imaging via ultrasound, combined with assessment of family history. The guidelines also discuss the importance of genetic counselling for individuals at risk of ADPKD, recognizing that this diagnosis can carry a significant emotional burden.
Key points regarding genetic testing
- Imaging remains the primary diagnostic tool, as genetic testing may not always provide definitive results.
- Genetic testing may also have downstream implications for disability insurance eligibility and other forms of coverage.
- As a result, genetic testing is recommended on a case-by-case basis.
- Even in patients without a known family history of ADPKD, imaging remains the primary diagnostic approach, with genetic testing considered as follow-up when appropriate.
Hypertension Management
The guidelines emphasize standardized blood pressure measurement techniques, including proper patient preparation. However, obtaining truly standardized office blood pressure readings can be challenging in clinical practice.
Home blood pressure monitoring may be a practical and cost-effective strategy that complements office measurements.
Blood pressure targets
- Adults aged 18–49 years: KDIGO recommends a target blood pressure of <110/75 mmHg measured by home monitoring, as this may help slow total kidney volume growth.
- Adults over 50 years: More liberal targets may be reasonable depending on the patient’s overall clinical situation.
Medication therapy
- RAAS inhibitors remain first-line therapy.
- Potassium binders may be considered if hyperkalemia limits RAAS inhibitor use.
Comments on Tolvaptan
Tolvaptan is recommended for patients with an eGFR >25 mL/min/1.73m² who are at risk of rapid disease progression.
Clinical trials have demonstrated that Tolvaptan is associated with a slower rate of eGFR decline. However, potential benefits and harms must be carefully balanced.
Potential harms
- Thirst
- Polyuria
- Polydipsia
- Need for ongoing monitoring and routine blood work
Potential benefits
- Slower decline in eGFR
- Reduced total kidney volume growth
- Reduced pain
Earlier initiation is generally recommended for younger individuals at risk of rapid progression. For older adults, a shared decision-making approach is recommended.
Commentary on IgA Nephropathy
For patients with proteinuria >0.5 g/day, kidney biopsy is now recommended. This represents a more aggressive approach than previous guidance, which generally recommended biopsy only when proteinuria exceeded 1 g/day.
The guidelines also recommend that all patients be treated with:
- RAAS inhibitors
- SGLT2 inhibitors
These therapies aim to help slow progressive nephron loss.
One major barrier to implementation is the lack of medication coverage for SGLT2 inhibitors for many patients.
The guidelines also continue to emphasize the importance of blood pressure control.
Commentary on Anemia
Treatment decisions involving ESAs and HIF-PHIs should be made collaboratively with patients, balancing potential benefits against the risk of adverse events.
Alternate causes of anemia, such as iron deficiency, should be corrected before initiating these therapies.
ESAs versus HIF-PHIs
The commentary generally favors ESAs over HIF-PHIs at this time.
Why?
- ESAs have been available for much longer and have more established safety and efficacy data.
- HIF-PHIs are newer agents, and there remains greater uncertainty regarding their long-term safety profile.
- HIF-PHIs are also not yet approved for use in Canada.
Overall, these sessions highlighted the growing emphasis on patient-centered care, earlier intervention, and the practical challenges of implementing guideline recommendations in real-world settings. It will be interesting to see how these recommendations continue to evolve as additional evidence and therapies emerge.
