In the first of this new short series featuring expert perspectives from our faculty, we speak with Dr Sourabh Sharma, a nephrologist and transplant physician at Safdarjung Hospital and Vardhaman Mahaveer Medical College in New Delhi, and was nominated as a touchENDORINOLOGY Future Leader 2025.

Dr Sharma shares his thoughts on this year’s key advances, the challenges that remain, and the growing impact of AI on nephrology.

What do you see as the single biggest challenge facing your specialty today?

The single biggest challenge facing renal endocrinology and metabolic nephrology today is the integration of metabolic care into traditional nephrology practice. Chronic kidney disease (CKD) is increasingly driven by metabolic disorders including type 2 diabetes, obesity, metabolic syndrome and bone-mineral disturbances, yet our systems often manage these conditions in silos. The challenge lies in bridging this gap through a holistic, multidisciplinary approach that addresses the metabolic, cardiovascular and renal axes simultaneously.

We now have powerful tools – the four pillars of guideline directed medical therapy: RAAS inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists and non-steroidal MRAs – but their optimal use requires a paradigm shift. Nephrologists must evolve from being “dialysis doctors” to metabolic physicians who can prevent progression long before kidney failure occurs. This means greater emphasis on early detection, endocrine-metabolic understanding and patient-centred metabolic risk modification.

What development this year has had the biggest impact on your clinical practice?

The most impactful development this year has undoubtedly been the growing clinical evidence supporting the use of GLP-1 receptor agonists (GLP1RAs) in patients with diabetic kidney disease, particularly following the results of the FLOW trial. For the first time, a GLP1RA – semaglutide – has demonstrated not only robust glycaemic and cardiovascular benefits but also a significant renal protective effect across diverse patient groups, including those with established CKD.

This has reshaped my clinical practice in several ways. I now consider GLP1RAs earlier in the therapeutic algorithm for patients with type 2 diabetes and CKD, even beyond glycaemic control, as part of a broader “metabolic kidney protection” strategy. These agents also aid in weight reduction and blood pressure control, addressing multiple risk factors simultaneously. In essence, the FLOW trial has moved GLP1RAs from being viewed primarily as antidiabetic agents to being recognized as comprehensive cardio-renal-metabolic modulators – a shift that is redefining how we approach metabolic nephrology.

What excites you most about the potential of AI in your field?

What excites me most about the potential of AI in nephrology – particularly in renal endocrinology and metabolic nephrology – is its ability to enable precision nephrology: integrating complex datasets from labs, imaging, genomics and wearables to predict CKD progression, personalise metabolic interventions (such as timing and response to SGLT2 inhibitors or GLP-1RAs) and support earlier, data-driven decisions that can transform prevention and long-term kidney health outcomes.

If you could give one piece of advice to early-career HCPs entering the field now, what would it be?

My advice to early-career healthcare professionals entering nephrology would be: embrace the breadth of the specialty – go beyond dialysis and learn the expanding horizons of metabolic, preventive and transplant nephrology. Cultivate curiosity, compassion and collaboration; stay grounded in patient-centred care while keeping pace with evolving evidence and technology. Remember, nephrology is not just about treating kidney failure – it’s about preserving kidney health and improving lives through early intervention and holistic metabolic care.

Disclosures: This short article was prepared by touchENDOCRINOLOGY in collaboration with Dr Sharma . No fees or funding were associated with its publication.