New Kidney Disease Treatments: What Actually Works Now
Updated: 4 hours ago
The short answer
The treatments with real evidence protect the kidney tissue you still have, and nothing available today rebuilds the part that is already gone. The clearest win is an SGLT2 inhibitor: in EMPA-KIDNEY, kidney disease progression or cardiovascular death happened in about 13 of every 100 people on empagliflozin against about 17 on placebo over two years, from one tablet a day, with or without diabetes. Many people who qualify have never been offered it, partly because the urine protein test that identifies them is often skipped. The opposite case is stem cell therapy sold for cash at five figures, where the best trial measured kidney function two ways and only the estimated number moved.
What we cover
Which single pill has the strongest kidney evidence, and the result stated in people rather than percentages (EMPA-KIDNEY 2023)
Why your kidney number is expected to dip when you start it, and why the door to start and the door to stay on it are different doors (KDIGO 2024)
The three other protective drugs to ask for by name, and the one that is hard to get covered (Neuen 2026, FLOW 2024)
Which kidney disease needs a biopsy diagnosis, and the drug most videos will not name (PROTECT 2023)
How long the longest pig kidney recipient actually lasted, and what happened next (Ribas 2026)
What the best stem cell trial found when it measured kidney function two ways (NEPHSTROM 2023)
Timestamps
0:00 The check nobody gets back
0:34 The pill nobody offered you
1:14 What the empagliflozin trial found
2:59 The dip that scares people off
4:25 The other three to ask for by name
6:20 The access problem nobody says out loud
7:13 The bucket that needs a biopsy
8:11 The drug name most videos refuse to say
9:59 Pig kidneys: 271 days, and what it means
11:39 Stem cells and the number that did not move
13:19 What is still savable
References
EMPA-KIDNEY Collaborative Group. Empagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2023;388(2):117-127. PMID 36331190 https://pubmed.ncbi.nlm.nih.gov/36331190/
In 6,609 people over a median two years, progression or cardiovascular death hit 13.1 percent on empagliflozin against 16.9 percent on placebo, consistently with and without diabetes. Randomized trial.
Heerspink HJL, et al. Dapagliflozin in Patients with Chronic Kidney Disease (DAPA-CKD). N Engl J Med. 2020. PMID 32970396 https://pubmed.ncbi.nlm.nih.gov/32970396/
Same early dip then preserved kidney function pattern in chronic kidney disease. Randomized trial.
Perkovic V, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy (CREDENCE). N Engl J Med. 2019. PMID 30990260 https://pubmed.ncbi.nlm.nih.gov/30990260/
Same dip then benefit pattern in diabetic kidney disease. Randomized trial.
KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024. PMID 38490803 https://pubmed.ncbi.nlm.nih.gov/38490803/
Start an SGLT2 inhibitor at an eGFR of 20 or above, and it is reasonable to continue below 20 until kidney replacement therapy begins. Clinical guideline.
Neuen BL, et al. Finerenone in chronic kidney disease: pooled analysis of FIDELIO-DKD, FIGARO-DKD and FIND-CKD. Lancet. 2026. PMID 42248158 https://pubmed.ncbi.nlm.nih.gov/42248158/
Pooled data from 14,574 people found the kidney benefit held whether or not people also took an SGLT2 inhibitor. Pooled analysis of randomized trials.
Neuen BL, et al. Finerenone in Non-Diabetic Chronic Kidney Disease from Glomerular Disease (FIND-CKD). JAMA. 2026. PMID 42246414 https://pubmed.ncbi.nlm.nih.gov/42246414/
Extends the benefit to kidney disease with no diabetes involved; 46 percent of participants had IgA nephropathy. Randomized trial.
Perkovic V, et al. Effects of Semaglutide on Chronic Kidney Disease in Type 2 Diabetes (FLOW). N Engl J Med. 2024;391:109-121. https://doi.org/10.1056/NEJMoa2403347
In 3,533 people with type 2 diabetes and kidney disease, semaglutide cut the kidney outcome by 24 percent and the trial stopped early. Randomized trial.
Rovin BH, et al. Sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT). Lancet. 2023;402(10417):2077-2090. PMID 37931634 https://pubmed.ncbi.nlm.nih.gov/37931634/
In 404 people with biopsy-proven IgA nephropathy still leaking a gram of protein a day on full standard treatment, sparsentan slowed the yearly decline and left urine protein about 40 percent lower. Randomized trial.
Ribas GT, et al. Xenotransplantation in living human recipients. Nat Med. 2026;32(1):270-280. PMID 41507576 https://pubmed.ncbi.nlm.nih.gov/41507576/
Documents the living gene-edited pig kidney recipients since 2024, the longest at 271 days before the kidney was removed and the recipient returned to dialysis. Case series, early evidence.
Perico N, et al. Mesenchymal Stromal Cell (ORBCEL-M) Therapy in Diabetic Kidney Disease (NEPHSTROM). J Am Soc Nephrol. 2023;34(10):1733-1751. PMID 37560967 https://pubmed.ncbi.nlm.nih.gov/37560967/
In 16 adults followed 18 months, estimated kidney function favoured the cells while directly measured kidney function showed no difference. Early-phase randomized trial.
Regenberg AC, et al. Medicine on the fringe: stem cell-based interventions in advance of evidence. Stem Cells. 2009;27(9):2312-19. https://doi.org/10.1002/stem.132
Published prices for stem cell interventions sold direct to patients ran from 5,000 to nearly 39,500 US dollars.
One study explained in plain language every week, with sources attached, plus the free kidney health guide: https://guides.selfprinciple.org/kidney
This content is for educational purposes only and is not medical advice. Always consult your healthcare provider for individual care. The views expressed are Dr. Sean Hashmi's own and do not represent his employer.
Never start, stop, or change the dose of any prescription medication without consulting your physician.
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