Chronic kidney disease, complex conditions, and advancing therapeutics: new hope and challenges

Area of Science:

• Nephrology
• Cardiology
• Endocrinology
• Pharmacology

Background:

• Chronic kidney disease (CKD) is a complex, multisystem condition often co-occurring with cardiovascular disease, diabetes, obesity, and infections.
• Shared inflammatory, metabolic, and fibrotic pathways link these conditions, presenting therapeutic targets.
• CKD management is complicated by multimorbidity, frailty, and polypharmacy, especially in primary care settings.

Purpose of the Study:

• To outline advances in therapeutics targeting shared pathways in CKD and related conditions.
• To discuss challenges in implementing novel therapies for CKD.
• To identify high-risk patient groups and advocate for improved evidence generation and screening.

Main Methods:

• Review of recent therapeutic advances targeting inflammatory, metabolic, and fibrotic pathways.
• Analysis of clinical trial data for novel agents such as SGLT2 inhibitors, mineralocorticoid receptor antagonists, and GLP receptor agonists.
• Discussion of implementation challenges and recommendations for future research and clinical practice.

Main Results:

• Novel therapeutics, including SGLT2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and GLP receptor agonists, demonstrate significant benefits in slowing CKD progression and improving cardiovascular outcomes.
• Combination therapeutic strategies show additive potential for enhanced efficacy.
• Early detection and integrated care are vital for high-risk CKD patients, including those with infection and cancer-related CKD.

Conclusions:

• Emerging therapies offer substantial benefits for managing CKD and its comorbidities.
• Addressing multimorbidity, frailty, and polypharmacy is essential for effective CKD treatment implementation.
• More inclusive research, enhanced CKD screening, and coordinated therapy deployment are needed to reduce the global CKD burden.