Highlights
- Chronic kidney disease is a growing global health issue, needing urgent prevention strategies.
- Innovations in diagnostics and treatment can enhance care and slow disease progression effectively.
Summary and Overview
Chronic kidney disease (CKD) affects about 14% of adults globally, with diabetes and hypertension as leading causes. Rising obesity and insulin resistance, especially in younger populations, predict increased CKD burden by 2025. Advances in understanding CKD genetics and pathophysiology have improved diagnostic tools like the Mayo Imaging Classification for ADPKD and biomarker panels, facilitating earlier detection and personalized care. However, early diagnosis remains challenging due to underused screening and limitations of traditional markers.
CKD management emphasizes early identification, risk factor modification, and multidisciplinary care to delay progression and reduce complications. Pharmacological treatments targeting the renin–angiotensin–aldosterone system (RAAS), sodium-glucose cotransporter 2 inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1 RA) show efficacy. Despite progress, global disparities and socioeconomic inequities hinder outcomes, highlighting the need for comprehensive prevention, improved screening, and equitable healthcare access.
Epidemiology and Risk Factors
CKD prevalence has risen from 12% in 1990 to 14% in 2023, affecting approximately 788 million adults worldwide. Highest rates occur in North Africa and the Middle East. CKD is the ninth leading cause of death globally, with racial, ethnic, and socioeconomic disparities influencing incidence and outcomes; minority groups in the US face higher risks and poorer access to care. Both non-modifiable factors (age, race, genetics) and modifiable factors (hypertension, diabetes, obesity, smoking) contribute to CKD development and progression.
Pathophysiology and Clinical Manifestations
CKD progression involves declining glomerular filtration rate (GFR), inflammation, fibrosis, and extracellular matrix remodeling mediated by factors like the NLRP3 inflammasome and matrix metalloproteinases (MMPs). Gut microbiome alterations also influence disease progression. Genetic variants, such as APOL1, increase susceptibility in specific populations.
Clinically, ADPKD presents with kidney cysts, hypertension, infections, and eventual kidney failure. CKD symptoms often develop insidiously, including proteinuria and declining eGFR. Diabetic kidney disease may show retinopathy and albuminuria but can be asymptomatic initially. Early detection is critical to prevent progression to end-stage kidney disease.
Diagnosis
Early CKD detection is hindered by underutilization of routine tests like eGFR and albuminuria screening, especially in high-risk groups. Advances include genetic testing and imaging (e.g., Mayo Imaging Classification in ADPKD). Novel urinary biomarkers (e.g., KIM-1, calprotectin) show promise for improved sensitivity and specificity but require further validation. Integration of multi-omics and artificial intelligence may enhance risk stratification and personalized diagnosis.
Treatment and Management
CKD management focuses on controlling blood pressure, glucose, and proteinuria to slow progression. RAAS inhibitors (ACE inhibitors, ARBs, MRAs) remain foundational, supplemented by SGLT2 inhibitors and GLP-1 receptor agonists, which reduce kidney decline and cardiovascular risks. Dialysis is essential for advanced disease but does not halt progression. Emerging therapies and regenerative approaches are under investigation.
Prevention
Preventing CKD involves early detection through enhanced screening of high-risk populations and addressing modifiable risk factors such as hypertension, diabetes, and obesity. Public health interventions targeting lifestyle changes and equitable healthcare access are vital to reduce disparities and disease burden. Pharmacological prevention incorporates RAAS inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists. Future advances in precision medicine and omics technologies hold potential for improved prevention strategies.
Impact on Society
CKD affects over 850 million people worldwide, with disproportionate burdens in low- and middle-income countries due to limited healthcare infrastructure. Socioeconomic and demographic factors contribute to disparities in care access and outcomes, especially among ethnic minorities and women. Aging populations and lifestyle changes drive rising CKD prevalence globally. Addressing these challenges requires policies promoting early detection, equitable care, and targeted interventions to improve health equity and social justice.
Research and Technological Advances
Recent advances include novel biomarkers (NGAL, KIM-1, suPAR, cystatin C) and multi-omics approaches improving CKD diagnosis, classification, and personalized treatment. RNA therapeutics and human pluripotent stem cell-derived kidney models offer new avenues for disease modeling and drug development. Molecular targets like the NLRP3 inflammasome and MMPs are under investigation. Multidisciplinary research and collaborative programs aim to enhance early detection and risk modification, though further validation is needed for widespread clinical adoption.
Future Outlook
CKD prevalence and mortality are projected to rise, potentially becoming the fifth leading cause of death by 2040, driven by diabetes, hypertension, and metabolic syndrome. Advances in biomarkers, multi-omics, and AI promise earlier detection and personalized care. However, challenges remain in translating these into routine practice and addressing global disparities in kidney care. Continued research, improved healthcare infrastructure, and tailored interventions are essential to mitigate CKD’s growing global impact.
The content is provided by Blake Sterling, Scopewires
