The 20th Annual Scientific Meeting (ASM) of the Cardiorenal Forum united clinicians and researchers to share advances in cardiovascular renal and metabolic care. Under the theme ‘Working together to meet future needs’, it showcased new evidence, therapies and integrated care models shaping future practice. Drs Annette Chanzu and Sarah Birkhoelzer report its highlights.
Transforming obesity and diabetes care
Advances in surgical and pharmacological treatments transforming outcomes in obesity in type 2 diabetes were covered in the first presentation of the day. Dr Julia Kenkre (Consultant in Metabolic Medicine, Imperial College Healthcare NHS Trust, London) outlined how bariatric surgery significantly reduces cardiovascular events, kidney disease and mortality,1 although access remains limited.2 Pharmacological treatment with glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, achieve 3–5 kg weight loss,3 improve glycaemic control,4 and reduce cardiovascular and renal risk,5 suggesting underlying mechanisms beyond weight loss. Newer dual agents, such as tirzepatide which combine GLP-1 and GIP receptor agonists, achieve up to 22% weight loss and consistent cardiovascular and renal protection.6 Dr Kenkre emphasised personalised treatment, improved tolerability and long-term adherence to achieve lasting benefits.
The power of weight loss
Dr Elizabeth Morris (General Practitioner and Clinical Research Fellow, University of Oxford) highlighted how effective weight management is central to preventing and treating cardiometabolic disease. Obesity significantly increases morbidity and mortality through its effects on blood pressure, lipid metabolism, and diabetes risk7 with each five-unit rise in body mass index (BMI) raising overall mortality by 30%.8
Small changes can achieve big cardiometabolic gains. A 5% weight reduction lowers blood pressure,9 while a 10–15% loss can improve diabetes or even induce diabetes remission.10,11 Structured behavioural and community programmes supersede lifestyle advice alone.12 Intensive interventions, such as total diet replacement and the NHS Path to Remission initiative,13 demonstrate that meaningful, long-lasting cardiometabolic improvements are attainable.
Move more, live longer
Physical activity is one of the most powerful yet underused therapies in cardiovascular and chronic disease prevention, Professor Thomas Yates (Professor in Physical Health and Activity, University of Leicester) highlighted at the meeting. Even small increases in movement from sedentary levels markedly reduces cardiovascular and all-cause mortality.14 He dispelled myths around the 10,000 daily step targets, showing that even lower step count and moderate-intensity activity delivers substantial benefit.15 Professor Yates emphasised that clinicians should treat movement as essential medicine, integrating physical activity advice into every patient encounter.
The evolving role of devices in heart failure care
Dr Andrew Flett (Consultant Cardiologist, University Hospital Southampton) outlined how device-based therapies complement pharmacological treatment in heart failure with reduced ejection fraction (HFrEF). Despite modern drug advances, mortality remains high due to pump failure and arrhythmia,16 making devices a vital adjunct (see table 1).17–21
Table 1. Landmark device trials
| Trial | Summary | Significance |
| DANISH17 | Challenged the mortality benefit of ICDs in non-ischaemic cardiomyopathy | Promoted renewed investigation of ICD indications |
| BRITISH18 | Ongoing trial – aims to clarify which patient groups gain greatest survival benefit from ICDs | Preliminary results support individualised ICD use based on arrhythmic risk and frailty |
| Subcutaneous-ICD19,20 | Fewer lead complications such as dislodgement and fracture in comparison to transvenous ICD | Safer ICD alternative |
| CardioMEMS21 | Enables early heart failure detection | Supports proactive management prior to decompensation. Representing a major advance in remote monitoring |
| Key: BRITISH = Benchmark Risk Indication Tool for Implantable cardioverter defibrillators in patients with Scar identified by Heart MRI; CARDIOMEMS = Cardio Micro-Electro-Mechanical Systems; DANISH = Danish Study to Assess the Efficacy of ICDs in Patients with Non-Ischemic Systolic Heart Failure; ICD = implantable cardiac defibrillator | ||
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Bridging the gap: safely restarting therapy after AKI
The challenges of restarting heart failure medications after acute kidney injury (AKI), were discussed by Ms Victoria Ruszala (Specialist Pharmacist in Cardiology, North Bristol NHS Trust). She emphasised that AKI often signals disease instability, rather than a contraindication to therapy, and that patients who resume treatment generally achieve better outcomes. Treatment should be guided by haemodynamic stability and clinical context rather than rigid creatinine thresholds. Clear follow-up plans and actionable discharge instructions are vital. Sodium-glucose co-transport 2 inhibitors (SGLT2) are well tolerated, beta blockers are renal-neutral, and mild hyperkalaemia or modest creatinine rises should not preclude reintroducing renin-angiotensin-aldosterone-system (RAAS) inhibitors, she advised.
Decoding antibody-mediated rejection in transplantation
Dr Ciara Magee (Consultant Nephrologist, Beaumont Hospital, Dublin) outlined progress in diagnosing and treating antibody-mediated rejection in transplantation. She highlighted the Banff 2022 classification,22 an international consensus system for diagnosing and categorising the pathology of transplanted organs. Novel diagnostics such as molecular microscopy and donor-derived cell-free DNA enable earlier detection23 and emerging treatments, such as complement inhibition and IgG depletion24 have expanded therapeutic options raising hopes. She advised personalised multidisciplinary care is vital for better transplant outcomes.
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Redefining multidisciplinary cardio-renal-metabolic care
The MRC clinic
Data from a metabolic cardiorenal (MRC) clinic set up in Salford to manage patients with overlapping metabolic, renal and cardiovascular disease, was presented at the meeting by Dr Saif Al-Chalabi (Clinical Research Fellow, Salford Royal Hospital). By uniting cardiology, nephrology, and metabolic expertise, the MRC clinic manages complex, high-risk cases, which are often excluded from trials. Compared to standard care, MRC patients achieved better kidney function, improved medication optimisation, and lower all-cause mortality.25 Although observational, findings highlight the power of integrated, team-based care to improve survival and quality of life in multimorbid populations.
Building bridges: lessons from integrating care
Professor Darren Green (Consultant Nephrologist, Salford Royal Hospital) discussed the evolution of integrated cardio-renal-metabolic (CRM) services in Salford and the infrastructure required for sustainable growth. He emphasised workforce development,26 partnerships with universities for specialist training,26 and web-based multidisciplinary platforms27 to streamline decision-making. Community initiatives26 identifying undertreated patients with kidney disease, diabetes, or heart failure have improved access through local care hubs. Sustainable CRM care relies on coordinated collaboration, digital tools, and community engagement to deliver patient-centred outcomes.
2025 cardiology and renal trials round-up
Two speakers in this popular session gave delegates their personal round-up of key cardiology and renal studies reporting in 2025.
Studies with implications for cardiovascular and heart failure management were presented by Dr Geraint Morton (Consultant Cardiologist, Portsmouth Hospitals NHS Trust) and are summarised in table 2.28–32
Table 2. Key 2025 cardiology trials
| Trial / therapy | Population | Findings | Significance |
| Clopidogrel vs. aspirin28 | Coronary artery disease – secondary prevention | 14% fewer major cardiovascular events with clopidogrel; no increased bleeding risk | Clopidogrel superior for secondary prevention |
| Digitoxin – Digit-HF29 | HFrEF | 18% reduction in HF hospitalisations and mortality | Not UK licensed; therapeutic option however weaker than SGLT2i |
| Tirzepatide30 (GLP-1 agonist) | HFpEF with obesity | 38% reduction in HF events; 14% average weight loss; improved QoL | Promising; more data required |
| Vericiguat31 | HF without recent hospitalisations | No significant difference in primary outcomes | Insufficient evidence for routine use |
| FRESH-UP32 | Mild HF | No significant QoL gain; mild symptom benefit | Routine restriction not advised |
| Key: FRESH-UP = Fluid Restriction in Heart Failure vs. Liberal Fluid Uptake; HF = heart failure; HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction; SGLT2i = sodium-glucose co-transporter-2 inhibitors; QoL = quality of life | |||
Key renal trials with implications for clinical practice were presented by Dr David Lappin (Consultant Nephrologist, Galway University Hospitals) and are summarised in table 3.33–6
Table 3. Key 2025 renal trials
| Study / topic | Population | Findings | Key concern / significance |
| Finerenone and empagliflozin in T2DM33 | T2DM with eGFR 30–90 | Combination of both drugs lowered urine ACR compared to each agent in isolation | Suggests benefit from dual therapy Monitor eGFR and potassium levels |
| Baxdrostat34 | Resistant hypertension | 10 mmHg extra BP drop vs placebo | Risk of hyperkalaemia Promising new class for management of resistant hypertension |
| Xenotranplantation of pig kidney35 | End-stage kidney disease | Kidney functioned Subsequent rejection and infection complications treated Death from cardiac cause |
Landmark step toward future xenotransplantation |
| Fasting-mimicking diet36 | CKD | Reduced proteinuria, improved inflammation | Suggests low risk adjunct to current CKD therapy |
| Key: ACR = albumin-to-creatinine ratio; CKD = chronic kidney disease; eGFR = estimated glomerular filtration rate; T2DM = type 2 diabetes mellitus | |||
New horizons in IgA nephropathy management
Advances in IgA nephropathy (IgAN) were explored by Dr Matthew Graham-Brown (Clinical Associate Professor of Renal Medicine, University of Leicester). Emerging therapies such as budesonide37 and sparsentan38 have achieved over 40% reductions in proteinuria, whilst iptacopan39 shows a similar benefit in a shorter time span. Dr Graham-Brown emphasised that early intervention in disease pathogenesis, alongside blood pressure and cardiovascular management, is critical to preserve renal function and delay progression to kidney failure.
The power of integration: National Amyloidosis Centre
Ms Angelique Smit (Lead Clinical and Research Nurse, National Amyloidosis Centre [NAC], London) showcased NAC’s multidisciplinary model. Through cutting-edge diagnostics, imaging, targeted therapies, and comprehensive support, NAC delivers a patient-centred model which optimises both survival and quality of life in this rare, complex disease.
Overcoming resistance in dialysis
A patient case showing how the hypoxia-inducible factor, prolyl hydroxylase inhibitor (HIF-PHI) vadadustat improved haemoglobin parameters in erythropoiesis-stimulating agents (ESA) resistant dialysis was presented by Professor Phillip Kalra (Consultant Nephrologist, Salford Royal Hospital). He demonstrated how HIF-PHI stabilisers offer a novel, effective strategy to anaemia management in complex chronic renal patients.40
Conclusion
The 2025 Cardiorenal Forum ASM highlighted how rapidly evolving science, therapeutics, and service models are reshaping cardio-renal-metabolic care. Speakers underscored a unifying message: meaningful progress happens when disciplines work together. From weight-loss therapies and physical activity to precision diagnostics, integrated clinics, smarter device use, and safer medication optimisation after acute kidney injury, the meeting showcased practical solutions that improve outcomes today while preparing services for tomorrow to improve the care for patients with cardio-renal disease.
Acknowledgements
The Cardiorenal Forum would like to thank the following pharmaceutical companies for their sponsorship of this independent meeting: A Menarini Farmaceutica Internazionale SRL, AstraZeneca, Boehringer Ingelheim, Hansa Biopharma, Medice UK, Novo Nordisk, and CSL VIfor. Full sponsosrship details can be found here: https://cardiorenalforum.com/CRF-ASM-programme-2025.php
Conflicts of interest
AT reports honoraria/fees from Novartis, Daiichi Sankyo, Amgen and Amarin.
Diary date
The 21st Annual Scientific Meeting of the Cardiorenal Forum will be held on the 2nd October 2026 in London. Details will be available on https://cardiorenalforum.com
Annette K Chanzu
Foundation Doctor
Doncaster and Bassetlaw NHS Trust
Sarah M Birkhoelzer
Heart Failure and Imaging Fellow
University Hospital Dorset
References
1. Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial–a prospective controlled intervention study of bariatric surgery. J Intern Med 2013;273:219–34. https://doi.org/10.1111/joim.12012
2. Syn NL, Cummings DE, Wang LZ, et al. Association of metabolic–bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174,772 participants. Lancet 2021;397:1830–41. https://doi.org/10.1016/s0140-6736(21)00591-2
3. Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2016;375:1834–44. https://doi.org/10.1056/NEJMoa1607141
4. McGowan BM, Bruun JM, Capehorn M, et al. Efficacy and safety of once-weekly semaglutide 2.4 mg versus placebo in people with obesity and prediabetes (STEP 10): a randomised, double-blind, placebo-controlled, multicentre phase 3 trial. Lancet Diabetes Endocrin 2024;12:631–42. https://doi.org/10.1016/s2213-8587(24)00182-7
5. Lee MMY, Sattar N, Pop-Busui R, et al. Cardiovascular and kidney outcomes and mortality with long-acting injectable and oral glucagon-like peptide-1 receptor agonists in individuals with type 2 diabetes: a systematic review and meta-analysis of randomized Trials. Diabetes Care 2025;48:846–59. https://doi.org/10.2337/dc25-0241
6. Kasagga A, Assefa AK, Amin MN, et al. Dose-dependent efficacy and safety of tirzepatide for weight loss in non-diabetic adults with obesity: a systematic review and meta-analysis of randomized controlled trials. Cureus 2025;17(6):e85531. https://doi.org/10.7759/cures.85531
7. Islam MS, Wei P, Suzauddula M, et al. The interplay of factors in metabolic syndrome: understanding its roots and complexity. Mol Med 2024;30:279. https://doi.org/10.1186/s10020-024-01019-y
8. Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet 2009;373:1083–96. https://doi.org/10.1016/S0140-6736(09)60318-4
9. Magkos F, Fraterrigo G, Yoshino J, et al. Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metab 2016;23:591–601. https://doi.org/10.1016/j.cmet.2016.02.005
10. Gregg EW, Chen H, Bancks MP, et al. Look AHEAD Research Group. Impact of remission from type 2 diabetes on long-term health outcomes: findings from the Look AHEAD study. Diabetologia 2024;67:459–69. https://doi.org/10.1007/s00125-023-06048-6
11. Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 2018;391:541–51. https://doi.org/10.1016/s0140-6736(17)33102-1
12. Ahern AL, Wheeler GM, Aveyard P, et al. Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial. Lancet 2017;389:2214–25. https://doi.org/10.1016/s0140-6736(17)30647-5
13. Valabhji J, Gorton T, Barron E, et al. Early findings from the NHS Type 2 Diabetes Path to Remission Programme: a prospective evaluation of real-world implementation. Lancet Diabetes Endocrinol 2024;12:653–63. https://doi.org/10.1016/s2213-8587(24)00194-3
14. Martínez-Vizcaíno V, Fernández-Rodríguez R, et al. Physical activity is associated with lower mortality in adults with obesity: a systematic review with meta-analysis. BMC Public Health 2024;24:1867. https://doi.org/10.1186/s12889-024-19383-z
15. Banach M, Lewek J, Surma S, et al. The association between daily step count and all-cause and cardiovascular mortality: a meta-analysis. Eur J Prev Cardiol 2023;30:1975–85. https://doi.org/10.1093/eurjpc/zwad229
16. Packer M. What causes sudden death in patients with chronic heart failure and a reduced ejection fraction? Eur Heart J 2020;41:1757–63. https://doi.org/10.1093/eurheartj/ehz553
17. Pathak RK, Sanders P, Deo R. Primary prevention implantable cardioverter-defibrillator and opportunities for sudden cardiac death risk assessment in non-ischaemic cardiomyopathy. Eur Heart J 2018;39:2859–66. https://doi.org/10.1093/eurheartj/ehy344
18. Flett A, Cebula A, Nicholas Z, et al. Rationale and study protocol for the BRITISH randomized trial (Using cardiovascular magnetic resonance identified scar as the benchmark risk indication tool for implantable cardioverter defibrillators in patients with nonischemic cardiomyopathy and severe systolic heart failure). Am Heart J 2023;266:149–58. https://doi.org/10.1016/j.ahj.2023.09.008
19. Opielowska-Nowak BM, Raczak G, Badyoczek M. Advantages, limitations and new perspectives on the implantation of subcutaneous cardioverter-defibrillator. Eur J Translat Clin Med 2022;5:53–6. https://ejtcm.gumed.edu.pl/articles/156835
20. Fong KY, Ng CJ, Wang Y, Yeo C, Tan VH. Subcutaneous versus transvenous implantable defibrillator therapy: a systematic review and meta‐analysis of randomized trials and propensity score–tatched studies. J Am Heart Assoc 2022;11:e024756. https://doi.org/10.1161/jaha.121.024756
21. Iaconelli A, Pellicori P, Caiazzo E, et al. Implanted haemodynamic telemonitoring devices to guide management of heart failure: a review and meta-analysis of randomised trials. Clin Res Cardiol 2023;112:1007–19. https://doi.org/10.1007/s00392-022-02104-0
22. Naesens M, Roufosse C, Haas M, et al. The Banff 2022 Kidney Meeting Report: reappraisal of microvascular inflammation and the role of biopsy-based transcript diagnostics. Am J Transplant 2024;24:338–49. https://doi.org/10.1016/j.ajt.2023.10.016
23. Rizvi A, Faiz S, Thakkar PH, et al. Kidney allograft monitoring by combining donor-derived cell-free DNA and molecular gene expression: a clinical management perspective. J Pers Med 2023;13:1205. https://doi.org/10.3390/jpm13081205
24. Sorohan BM, Tacu D, Gîngu C, et al. Complement in antibody-mediated rejection of the kidney graft: from pathophysiology to clinical practice. J Clin Med 2025;14:2810. https://doi.org/10.3390/jcm14082810
25. Al-Chalabi S, Alderson H, Garratt N, et al. Improving outpatient clinic experience: the future of chronic kidney disease care and associated multimorbidity. BMJ Open Quality 2023;12(3):e002188. https://doi.org/10.1136/bmjoq-2022-002188
26. Fernando K, Connolly D, Darcy E, et al. Advancing cardiovascular, kidney, and metabolic medicine: a narrative review of insights and innovations for the future. Diabetes Ther 2025;16:1155–76. https://doi.org/10.1007/s13300-025-01738-3
27. Handelsman Y. Diabetes, cardiorenal, and metabolic multispecialty practice recommendations and early intensive management of cardio-renal-metabolic disease. Am J Man Care 2024;30(10 Suppl):S189–96. https://doi.org/10.37765/ajmc.2024.89671
28. Valgimigli M, Choi KH, Giacoppo D, et al. Clopidogrel versus aspirin for secondary prevention of coronary artery disease: a systematic review and individual patient data meta-analysis. Lancet 2025;406:1091–102. https://doi.org/10.1016/s0140-6736(25)01562-4
29. Bavendiek U, Großhennig A, Schwab J, et al. Digitoxin in patients with heart failure and reduced ejection fraction. N Engl J Med 2025;393:1155–65. https://doi.org/10.1056/NEJMoa2415471
30. Borlaug BA, Zile MR, Kramer CM, et al., SUMMIT Trial Study Group. Impact of body mass index, central adiposity, and weight loss on the benefits of tirzepatide in HFpEF: the SUMMIT trial. J Am Coll Cardiol 2025;86:242–55. https://doi.org/10.1016/j.jacc.2025.04.059
31. Butler J, McMullan CJ, Anstrom KJ, et al. Vericiguat in patients with chronic heart failure and reduced ejection fraction (VICTOR): a double-blind, placebo-controlled, randomised, phase 3 trial. Lancet 2025;406:1341–50. https://doi.org/10.1016/s0140-6736(25)01665-4
32. Herrmann JJ, Brunner-La Rocca HP, Baltussen LE, et al. Liberal fluid intake versus fluid restriction in chronic heart failure: a randomized clinical trial. Nature Med 2025;31:2062–68. https://doi.org/10.1038/s41591-025-03628-4
33. Green JB, Mottl AK, Bakris G, et al. Design of the COmbinatioN effect of FInerenone anD EmpaglifloziN in participants with chronic kidney disease and type 2 diabetes using a UACR Endpoint study (CONFIDENCE). Nephrol Dial Transplant 2023;38:894–903. https://doi.org/10.1093/ndt/gfac198
34. Flack JM, Azizi M, Brown JM, et al. Efficacy and safety of baxdrostat in uncontrolled and resistant hypertension. N Engl J Med 2025;393:1363–74. https://doi.org/10.1056/nejmoa2507109
35. Kawai T, Williams WW, Elias N, et al. Xenotransplantation of a porcine kidney for end-stage kidney disease. N Engl J Med 2025;392:1933–40. https://doi.org/10.1056/nejmoa2412747
36. Villani V, Frank CN, Cravedi P, et al. A kidney-specific fasting-mimicking diet induces podocyte reprogramming and restores renal function in glomerulopathy. Sci Translat Med 2024;16:eadl5514. https://doi.org/10.1126/scitranslmed.adl5514
37. Lafayette R, Kristensen J, Stone A, et al. Efficacy and safety of a targeted-release formulation of budesonide in patients with primary IgA nephropathy (NefIgArd): 2-year results from a randomised phase 3 trial. Lancet 2023;402:859–70. https://doi.org/10.1016/s0140-6736(23)01554-4
38. Heerspink HJ, Radhakrishnan J, Alpers CE, et al. Sparsentan in patients with IgA nephropathy: a prespecified interim analysis from a randomised, double-blind, active-controlled clinical trial. Lancet 2023;401:1584–94. https://doi.org/10.1016/s0140-6736(23)00569-x
39. Nester CM, Eisenberger U, Karras A, et al. Iptacopan reduces proteinuria and stabilizes kidney function in C3 glomerulopathy. Kidney Int Rep 2025;10:432–46. https://doi.org/10.1016/j.ekir.2024.10.023
40. Bartnicki P. Hypoxia-inducible factor prolyl hydroxylase inhibitors as a new treatment option for anemia in chronic kidney disease. Biomedicines 2024;12:1884. https://doi.org/10.3390/biomedicines12081884
