Multifactorial chronic kidney disease

The burden of disease due to chronic kidney disease (CKD) has grown disproportionately in the last decades. This growth has not been similar in all regions. In the last few years, the results of clinical trials, particularly those evaluating sodium-glucose-cotransporter-2 (SGLT2) inhibitors and their efficacy in decreasing cardiovascular mortality and CKD progression, revealed the relevance of a common protective pathway that remains non-specific as it has been detected in multiple clinical scenarios. However, the injury pathways in kidney disease are now well-defined in immunological, toxic, and genetic kidney pathologies. Therefore, the multifactoriality of CKD is evident. Even prenatally, the number of nephrons is mostly determined by multiple factors that influence the maternal environment and, subsequently, throughout life, various exposures and pathologies gradually reduce the total number of nephrons. A better understanding of CKD as a multifactorial entity requires us to be aware of the primary injury pathways that can play a role throughout our lifetimes and implement more concrete measures to decrease the impact of CKD globally. Owing to the heterogeneity of the CKD burden between world regions, local epidemiological studies are essential to understand the factors associated with CKD in each region.