Nephrology Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped nephrology practice.

CKD Progression Therapies

A new era of renoprotection

ACEi/ARB alone → CREDENCE SGLT2i (2019) → DAPA-CKD → EMPA-KIDNEY → finerenone

Earlier is not better

Early-start trend → IDEAL (2010) no benefit → incremental dialysis → conservative management

Targeted therapy arrives

Steroids ± immunosuppression → STOP-IgAN → TESTING → sparsentan (PROTECT) → SGLT2i → targeted

Watchful waiting wins

Early-start → AKIKI (2016) → STARRT-AKI (2020) → watchful waiting → refined criteria

Was contrast nephropathy overblown?

Panic → IV hydration protocols → McDonald/Davenport challenges → prevention of prevention harm