2026 ESC Guidelines for the management of heart failure academic.oup.com/eurheartj/ar...
Important knowledge gap on hyperkalemia - No specific recommendations for the use of potassium binders are included in the guideline at current time, due to insufficient evidence for clinical benefit.
![Figure 1:The four established pillars supporting the diagnosis and management of CKD in glomerulonephritis: kidney histology, optimal blood pressure control, RAS blockade, and SGLT2 inhibition. These form the foundation of current best practice, highlighting the challenge for emerging therapies to integrate into this already optimized framework while still demonstrating additional benefit. The new treatment options for IgA nephropathy include targeting APRIL, BAFF, complement, and CD38, as well as combined AT1 and endothelin receptor inhibitors, and extended-release intestinal budesonide. Illustration created with BioRender and adapted from Li et al., 2025 [49].](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:33h4q6nw674jdcwfxaq2m2nl/bafkreibe6r5nknp6zjzmgwf3t2dgrazhkfvoycuzobvwtczkkz5jubl5uy)
![annual treatment costs of new therapies vary by region, with sparsentan ranging from €56 640 in Germany to $118 800 in the USA [43, 44], slow-release budesonide from €126 655 to $174,00 0 [45], and Iptacopan from €460 510 to $550 377 [45]. Anti-APRIL and anti-BAFF therapies are expected to be in the range of €100 000–150 000 or $100 000–150 000 per patient per year [46]. It is estimated that ~400 000 patients with IgA nephropathy live in the EU and the USA combined, and up to 50% of them may be eligible to receive these new therapies [47, 48].
Given these expenses, the revenue generated by the new specific therapies should be sufficient to support outcome studies conducted on a background of up-to-date therapies, particularly SGLT2 inhibition, as outlined before. At the same time, this is also a call to action for all nephrologists managing patients with glomerular diseases: novel and expensive therapies should not be prescribed uncritically before ensuring that the four fundamental pillars of supportive care are fully in place for at least several months, as demonstrated in the STOP-IgA trial [39].](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:33h4q6nw674jdcwfxaq2m2nl/bafkreiba5o4li72zhbaaipuqlkikslqikj6xmr5pe3dpdxvejfrmcwmzc4)
