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From progression to remission: a new paradigm for success in chronic kidney disease
Navdeep Tangri1, Brendon L Neuen2, David Z Cherney3
1Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada.
Abstract:
Recent advances in treatment of chronic kidney disease have changed the clinical paradigm from slowing inevitable progression to achievable remission. Landmark trials involving sodium-glucose cotransporter 2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists, glucagon-like peptide 1 receptor agonists, and targeted immunotherapies for IgA nephropathy demonstrate that sustained estimated glomerular filtration rate preservation and normalization of albuminuria are now realistic goals in both diabetic and glomerular kidney diseases. Remission, defined by estimated glomerular filtration rate slopes of <1 ml/min per 1.73 m2 per year or the absence of albuminuria with a normal estimated glomerular filtration rate, is increasingly attainable, especially with early detection and combination therapy. We believe that these findings mandate a shift in nephrology's therapeutic focus-from delaying progression to maintaining kidney health. Population-based screening, risk stratification, and implementation of guideline-directed therapy are essential to scale this opportunity. The time has come to redefine success in chronic kidney disease: remission is not only possible-it must become our standard of care.
Insights
New chronic kidney disease (CKD) treatments enable remission, not just slowed progression. Early detection and combination therapies make kidney health preservation a new standard of care.
Area of Science:
- Nephrology
- Internal Medicine
Background:
- Chronic kidney disease (CKD) management traditionally focused on slowing disease progression.
- Recent therapeutic advancements offer the potential for disease remission.
Purpose of the Study:
- To highlight the paradigm shift in CKD treatment from slowing progression to achieving remission.
- To emphasize the importance of early detection and combination therapies for kidney health.
Main Methods:
- Review of landmark clinical trials involving novel therapeutic agents.
- Analysis of data on sustained estimated glomerular filtration rate (eGFR) preservation and albuminuria normalization.
- Definition of remission based on eGFR slope and albuminuria status.
Main Results:
- Sodium-glucose cotransporter 2 inhibitors, mineralocorticoid receptor antagonists, and other agents demonstrate efficacy in diabetic and glomerular kidney diseases.
- Sustained eGFR preservation and normalization of albuminuria are achievable goals.
- Remission is increasingly attainable with early detection and combination therapy.
Conclusions:
- CKD treatment should shift focus from delaying progression to maintaining kidney health.
- Population-based screening, risk stratification, and guideline-directed therapy are crucial.
- Achieving remission in CKD should become the standard of care.
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