Bridging the Gap in Cardio-Renal Care: Expert Insights from ERA 2025
Prof Paola Fioretto emphasises the high burden of CKD in type 2 diabetes and its cardiovascular risks. She discusses the benefits of mineralocorticoid receptor antagonists, particularly when combined with SGLT2 inhibitors, which may reduce hyperkalemia risk. Referencing the FIGARO, FIDELIO and FIDELITY trials, she highlights finerenone’s cardiovascular and renal benefits. Given the complementary actions of both drug classes, Prof Fioretto introduces the CONFIDENCE trial as essential to evaluating their combined effect on early UACR reduction and safety.
Filmed on location at ERA 2025 in Vienna, Austria, this three-part video series brings together internationally recognised experts Prof Rajiv Agarwal (Indiana University School of Medicine, Indianapolis, US) and Prof Paola Fioretto (University of Padova, Padova, IT) for an insightful peer-to-peer discussion on the latest advances in chronic kidney disease (CKD) and cardio-renal management. Focusing on late-breaking data, primarily the CONFIDENCE trial, the series addresses the under-utilisation of emerging therapies and offers practical insights to help overcome clinical inertia in the management of patients with CVRM conditions.
Designed to support nephrologists and broader healthcare teams, this discussion explores what new trial data adds to existing knowledge, the evolving understanding of the cardio-renal link, and the real-world implications for clinical practice. The discussion delivers focussed, expert-led education aimed at improving risk stratification, enhancing interdisciplinary collaboration and translating evidence into actionable care.
Learning Objectives
- Understand the latest ERA 2025 trial data to address under-utilisation of emerging therapies in CKD and cardiorenal management
- Enhance comprehension of the cardiorenal link and its impact on patient outcomes
- Develop holistic knowledge of practical guidance for integrating ERA 2025 findings into clinical practice, helping to minimise patient pathway inertia and improving risk stratification
- Support interdisciplinary collaboration among nephrologists, cardiologists and other CVRM specialists
Audience
- Nephrologists
- Cardiologists
- Other CVRM specialists
More from this programme
Part 1
The Burden of Cardio-Renal Disease: Trials in Context
Prof Paola Fioretto emphasises the high burden of CKD in type 2 diabetes and its cardiovascular risks. She discusses the benefits of mineralocorticoid receptor antagonists, particularly when combined with SGLT2 inhibitors, which may reduce hyperkalemia risk. Referencing the FIGARO, FIDELIO and FIDELITY trials, she highlights finerenone’s cardiovascular and renal benefits. Given the complementary actions of both drug classes, Prof Fioretto introduces the CONFIDENCE trial as essential to evaluating their combined effect on early UACR reduction and safety.
Part 2
Late-Breaking Data: CONFIDENCE Trial
Principal investigator Prof Rajiv Agarwal reviews the CONFIDENCE trial, which assessed initiating finerenone and an SGLT2 inhibitor together in patients with type 2 diabetes and CKD. The trial showed over 50% reduction in albuminuria and confirmed the safety of combination therapy, with low hyperkalemia risk and manageable eGFR and blood pressure changes. He highlights the benefits of early combination therapy for improving kidney and heart outcomes, reducing treatment delays, and reinforcing updated clinical practice. The need to educate patients on expected, reversible kidney changes is also emphasised.
Part 3
CONFIDENCE in Context
Prof Rajiv Agarwal discusses the wider implications of CONFIDENCE. Safety data showed mild, reversible increases in potassium and eGFR, with an 18% lower hyperkalemia risk versus finerenone alone. Blood pressure dropped ~7.5 mmHg, and symptomatic hypotension was rare (1%). Acute kidney injury occurred in <2% of patients. But what does this mean for practitioners managing these patients and what does it mean for future practices?
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Faculty Biographies
Paola Fioretto
Prof Paola Fioretto is Professor of Medicine at the University of Padova, Italy and an expert in diabetic kidney disease. Her research began in renal physiology and expanded to renal structure during a postdoctoral fellowship at the University of Minnesota. She has made key contributions, including showing reversal of glomerular lesions in type 1 diabetes post-transplant and identifying diverse kidney lesions in type 2 diabetes.
Prof Fioretto has led and participated in major studies on diabetic kidney disease and served as President of the European Diabetic Nephropathy Study Group and Vice-President of the EASD. Prof Fioretto has received numerous awards, including the Albert Renold Award and the Camillo Golgi Prize. She has authored over 200 papers and 30 book chapters, focusing on the renal impact of glucose-lowering therapies.
Rajiv Agarwal
Prof Rajiv Agarwal is an Emeritus Professor of Medicine at Indiana University School of Medicine in Indianapolis, US. He earned his medical degree from the All India Institute of Medical Sciences, New Delhi, India, and completed his nephrology fellowship at the University of Texas Southwestern in Dallas, US. He joined Indiana University in 1997, earning recognition such as the Trustee’s Teaching Award and the Young Scholar Award from the American Society of Hypertension.
Internationally known for his work in hypertension and hemodialysis, Prof Agarwal has led multiple NIH- and VA-funded clinical trials since 2003. His research focuses on managing hypertension in chronic kidney disease, using methods such as GFR and renal plasma flow measurement, ambulatory blood pressure monitoring and vascular imaging. His lab includes a dedicated research echocardiography facility and performs assays for oxidative stress. Prof Agarwal is board-certified in Internal Medicine and…