A challenge for 2026 and beyond in cardiorenal medicine

2025 has been a standout year, with new and exciting research published across the spectrum of kidney and cardiorenal diseases. The last decade has seen an explosion in the number, size and quality of randomised controlled trials in patients with kidney disease, and it is a testament to the international nephrology community that the evidence base for treating complex diseases in, often, multi-morbid patients is becoming so robust. Evidence and knowledge are one thing; how they are used, however, is quite another. I do fear that knowledge mobilisation from these outstanding studies lags, and the translation of clinical trial findings into routine clinical practice takes years – and, even then, is incomplete. 

One of the issues is that, traditionally, nephrologists look after patients with advanced kidney disease, rare kidney diseases and those with kidney failure on renal replacement therapies. Many of us are divorced from the care of those with earlier stage CKD who are looked after in primary care, often with no input from specialist kidney teams and these patients are only referred in when their disease becomes more advanced. This is a problem, because many of the new therapies we have for the treatment of CKD (SGLT2 inhibitors, GLP-1 receptor agonists and non-steroidal mineralocorticoid receptor antagonists) are most beneficial when introduced early in the disease, to slow decline in function and protect from the complications of advancing CKD. It is not reasonable to expect primary care colleagues to keep up to date with every new piece of specialist evidence, nor to expect them to implement guidelines that we write (or co-write) on the management of CKD without support in how to administer the guideline-directed care. 

The challenge for the next 10 years is to improve the implementation of trial findings for the benefit of patients. If you are reading this and you conduct clinical research studies or care for patients with kidney or cardiorenal disease, you should not consider this a challenge for someone else – it is a challenge for everyone. Future trials can be adapted to consider implementation challenges early in the design phase. The use of implementation frameworks in clinical trial design and the inclusion of appropriate implementation or process outcomes can dramatically improve the speed and effectiveness with which study findings are translated into care pathways for patient benefit.

With the focus of care moving from treatment to prevention, secondary care teams have an increasing responsibility to work on solutions to mobilise knowledge and skills (perhaps through improved systems working), to support the delivery of specialist care in primary care settings, where the majority of patients are managed. It is these things that are going to help turn all the fantastic research we read about week after week into tangible changes in the care of real people in the real world. 

So, that is my challenge for 2026 and beyond. Use the knowledge we are growing, mobilise it in the places it is needed and only rest when the things we now know to be good for patients actually reach those who need them. 

Have a great Christmas everyone, and we will see you in 2026!