Redefining kidney failure: broadening metrics to realize equity in kidney care

Renal registries worldwide primarily rely on the initiation of kidney replacement therapy to estimate the incidence of kidney failure. However, these methods systematically overlook individuals who are managed conservatively, remain undiagnosed, and die before commencing kidney replacement therapy, thereby underestimating the true burden of the disease. Liu et al. reported that integrating estimated glomerular filtration rate-based kidney failure definition captures a broader, higher-risk population, showing significant disparities in care and outcomes. Incorporating sustained estimated glomerular filtration rate decline into routine surveillance is crucial for accurate incidence estimation and for guiding equitable health service planning, ensuring that all individuals affected by kidney failure are recognized and appropriately supported.