Up next, we are taking a break on 03/24/26.
Don’t forget to play NephMadness!
www. ajkdblog.org/2026/03/01/welcome-to-nephmadness-2026/
We will return in April with WCN late breaking news. #NephJC
Good night!
This is Dr. Sai Vani. It has been an honor to be your host tonight. I think all of us are celebrating WKD on March 12 and advocating for the importance of preventing kidney diseases and protecting planet Mother Earth.
Goodbye until next time!
I sincerely thank all my #NephJC 2025-2026 interns!
This is our last discussion. They are #FOAMed heroes.
We could not do what we do without them. ♥️
Please thank your #NephJC 2025-2026 interns!
This is their last discussion. They are #FOAMed heroes.
We could not do what we do without them. ♥️
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A heartfelt thank you to Brian,Christina and Swapnil for helping me with this beautiful script and to all of our mentors for the ongoing guidance and support! Brian Rifkin, @christina@nephroseeker.medsky.social, #NephJC
A sincere thank you to my #NephJC interim team members.
Akshaya Jayachandran Bogdan Agavriloaei @nataliaroxona.bsky.social
T3q
Great discussion! #NephJC
Do you think we are entering the era of remission, and dare I say it, cures for chronic kidney disease.
Slowing progression is great, but regenerative treatments are the future! #NephJC
T3p
What is the impact in pts with T1DM vs T2DM?
This study included T1D but did not report results separately.
FINEONE (nsMRA) study suggests similar pathology and benefits.
Should T1D get their own study?
#NephJC
T3o
REACT currently requires a kidney biopsy for harvesting.
Normally we don’t do biopsies in obvious DKD.
Do you think that your pts with DKD will experience more serious adverse events related to biopsy if the phase 3 trial of rilparencel is positive?
#NephJC
T3n
Limitations #NephJC
⬇️Small number of pts
Exclusion pts with severe CKD
Not blinded
Still determining optimal dosing and timing
T3m
Based on the available data, would you consider enrolling patients with DKD in the phase 3 trial of rilparencel?
Are there any patients you would advise not to participate?
Do you think REACT will be a viable option in 5-10 years?
#NephJC
T3l
Various studies are in the pipeline; some are completed, some are recruiting, and the majority of the studies are in the US. #NephJC
T3k
There are many potential advantages of REACT over RRT & transplant. Many pts would like to be able to regenerate their own tissue to prevent organ failure, and/or exposure to lifelong immunosuppression. Pts who don’t qualify for transplant might still get rilparencel. #NephJC
T3j
Current research is limited by a selection of pts at different CKD stages & different etiologies. Only a few trials, such as the REACT studies, specifically target DKD. Distinct types of kidney damage may affect the efficacy of the treatment. #NephJC
T3i
Various studies done with different cell lines in patients with AKI and CKD have been attempted, including stem cells and progenitor cells.
These studies are not without controversy, and unfortunately incorporate many elements that may lead to bias in observations. #NephJC
T3h
The 2ary endpoints were less insightful due to the limited number of events, & short study.
Most 2ary endpoints required a sig change in eGFR or UPCR. Notably, the probability of not meeting the end point was ≥80% for both cohorts through the 18-months. #NephJC
T3g
In this small study that received 2 doses of REACT the effect was more impressive on GFR slope than SGLT2/GLP1 with only 1.16-1.24 ml/min/1.73m2/year reduction.
If phase 3 trials show similar results, where do you see REACT being used (adjuvant or primary treatment)?
#NephJC
T3f
Do you think that if we implemented GDMT in a majority of DKD patients that we would even need/consider the use of REACT rilparencel infusions?
Is there a high risk group that might benefit significantly from this treatment?
Perhaps genetics will be the clue?
#NephJC
T3e
Pts received kidney protective medications:
💊80% ACEi
💊37% SGLT2i
💉39% GLP-1 RA
SGLT2i and GLP-1 RA had less administration because of the lack of CKD guidelines during the period of the study, still these are higher than the general US population. #NephJC
T3d
23/24 pts received 2 injections - cohort 1
15/25 pts received 2 injections - cohort 2
⬇️ time between injections in Cohort 1 - another possible explanation for differences in eGFR slope between this 2 cohorts
The best timing and dose has yet to be determined. #NephJC
T3c
Are you not impressed?! #NephJC
The findings of the study were significant, and the effect size was substantially larger than the approximately 1.2 mL/min/1.73 m² per year benefit observed with established therapies like SGLT2 inhibitors and GLP-1 RAs in large-scale trials. 🤯
T3b
The difference in eGFR slope⬇️ - 4.6 ml/min/1,73m2 in cohort 1
The difference in eGFR slope⬇️ - 1.7 ml/min/1,73m2 in cohort 2 - likely because of the different exposure to rilparencel. #NephJC
T3a
The study demonstrated a clinically meaningful difference in CKD progression, measured by change in eGFR slope before and after treatment with rilparencel. Take another look. #NephJC
Let’s inject some energy into the discussion. #NephJC
T2g
🩸Safety profile #NephJC
Adverse effects after injection occurred in 16 participants (33%)
Three participants experienced six biopsy-related serious adverse events
No biopsy-related & no product related death was reported
Any other complications you expected?
T2f
AND..Reduced 5 yr KFRE risk. #NephJC
At mo 18 after the first injection was:
Cohort 1: ⬇️29%
Cohort 2: ⬇️28%
Have you seen this trend with other GDMTs?
T2e
Reduced 2 yr KFRE risk. #NephJC
At 12 months after the first injection was:
Cohort 1: ⬇️29%
Cohort 2: ⬇️16%
