Multifactorial chronic kidney disease and the kidney capacity-workload balance

Area of Science:

• Nephrology
• Public Health

Background:

• Chronic kidney disease (CKD) affects approximately 10% of the global population.
• CKD is traditionally classified by a single presumed cause, a concept central to nephrology training.
• Identifying a single etiological driver is a cornerstone of diagnosing kidney disease.

Purpose of the Study:

• To challenge the traditional single-cause model of CKD.
• To propose and explore the concept of CKD as a multifactorial condition.
• To highlight the implications of a multifactorial perspective on CKD diagnosis and management.

Main Methods:

• Review and conceptual analysis of existing data on CKD etiology.
• Exploration of the life-course perspective on kidney insults and risk factors.
• Discussion of clinical implications derived from a multifactorial model.

Main Results:

• CKD frequently results from cumulative or concurrent exposure to multiple insults and risk factors.
• The single-cause model may not accurately reflect the complex reality of CKD development in many patients.
• A multifactorial view aligns better with clinical observations and patient outcomes.

Conclusions:

• CKD is typically multifactorial, resulting from serial or multiple simultaneous insults.
• Adopting a multifactorial concept of CKD has significant implications for diagnostic approaches, nomenclature, and therapeutic strategies.
• A risk factor-based, multifactorial approach provides a strong rationale for prioritizing risk factor control to preserve kidney health.