GLP-1 RAs, Finerenone, and CKD: Key Data From Kidney Week 2026

In an interview with Pharmacy Times, Hiddo J. L. Heerspink, PharmD, PhD, professor of clinical trials and personalized medicine at the University Medical Center Groningen, discussed his presentations at the American Society of Nephrology’s Kidney Week 2026 in Denver, Colorado. These included an oral abstract on urine albumin-to-creatinine ratio (UACR) reduction with the oral glucagon-like peptide-1 (GLP-1) receptor agonist elecoglipron, talks on finerenone (Kerendia; Bayer) in focal segmental glomerulosclerosis (FSGS) and on glucagon’s role in the kidneys, and a session he moderated on GLP-1 receptor agonists for chronic kidney disease (CKD).

Heerspink said the SOLSTICE trial (NCT03869892) showed that once-daily elecoglipron at 5 mg to 75 mg reduced UACR versus placebo in people with type 2 diabetes, with the 50 mg dose comparable to semaglutide 14 mg daily. Those data supported the ongoing phase 3 ELEVATE-CKD trial (NCT07753993). Glucagon, he said, may benefit the kidney by reducing perirenal and sinus fat, improving metabolic markers and glomerular hemodynamics, and reducing profibrotic signaling. Together, these effects lower albuminuria and may protect the kidney long-term.

In patients with FSGS, finerenone slowed estimated glomerular filtration rate decline versus placebo and reduced proteinuria by 40%, though its effect on clinical kidney end points was not statistically significant. As combination therapy in CKD grows, he said, pharmacists should know these agents have few drug-drug interactions and can be combined safely.

Pharmacy Times: What did your SOLSTICE analysis show about elecoglipron and albuminuria in type 2 diabetes?

Hiddo J. L. Heerspink, PharmD, PhD: The SOLSTICE trial showed that the oral GLP-1 RA elecoglipron at doses ranging between 5 mg and 75 mg once daily reduced UACR compared to placebo. Elecoglipron 50 mg daily resulted in a similar reduction in UACR compared to semaglutide (Wegovy, Ozempic; Novo) 14 mg daily, and the 75 mg dose showed a nominally larger UACR reduction. In these patients, elecoglipron also reduced HbA1c up to 1.9% at the highest dose and reduced body weight by approximately 8%—[along with reductions] in high-sensitivity C-reactive protein. These data supported the design of a phase 3 clinical trial (ELEVATE-CKD), which is currently ongoing.

Pharmacy Times: Why does glucagon’s role in the kidney matter as multihormone therapies advance?

Heerspink: Glucagon plays an important role in the kidney, as it reduces peri-renal and sinus fat volume, improves metabolic markers, including insulin, HbA1c, and leptin, increases adiponectin, improves glomerular hemodynamics (as shown by a reduction in intraglomerular pressure and renal arterial resistance index, a measure of vascular resistance and arterial stiffness), and reduces pro-fibrotic signalling. Collectively, these effects result in a reduction in albuminuria and potentially [an increase] in long-term kidney protection.

Pharmacy Times: What could finerenone offer patients with FSGS, and what questions remain?

Heerspink: Finerenone reduces eGFR decline in patients with FSGS compared to placebo by 1.3 ml/min/1.73 m² and reduces the risk of clinical kidney end points by 40% (although this effect was not statistically significant (P = .06) likely due to the relatively small sample size). Finerneone also reduces proteinuria by 40%. These data provide evidence that finerenone is an effective therapy to preserve kidney function in patients with FSGS.

Pharmacy Times: How should pharmacists think about combining these therapies for patients with CKD?

Heerspink: In the future, many patients with CKD will be treated with a combination of treatments. It is important for pharmacists to be aware of these combination treatments and to know that there are few drug-drug interactions so that these drugs can be safely and efficiently combined.