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Review
. 2025 Jan 30;11(1):8.
doi: 10.1038/s41572-024-00589-9.

Chronic kidney disease

Paola Romagnani  1   2 , Rajiv Agarwal  3 , Juliana C N Chan  4 , Adeera Levin  5   6 , Robert Kalyesubula  7   8 , Sabine Karam  9   10 , Masaomi Nangaku  11 , Bernardo Rodríguez-Iturbe  12 , Hans-Joachim Anders  13
Affiliations
Review

Chronic kidney disease

Paola Romagnani et al. Nat Rev Dis Primers. .

Erratum in

  • Author Correction: Chronic kidney disease.
    Romagnani P, Agarwal R, Chan JCN, Levin A, Kalyesubula R, Karam S, Nangaku M, Rodríguez-Iturbe B, Anders HJ. Romagnani P, et al. Nat Rev Dis Primers. 2025 Jul 21;11(1):53. doi: 10.1038/s41572-025-00641-2. Nat Rev Dis Primers. 2025. PMID: 40691448 No abstract available.

Abstract

Chronic kidney disease (CKD) is defined by persistent abnormalities of kidney function or structure that have consequences for the health. A progressive decline of excretory kidney function has effects on body homeostasis. CKD is tightly associated with accelerated cardiovascular disease and severe infections, and with premature death. Kidney failure without access to kidney replacement therapy is fatal - a reality in many regions of the world. CKD can be the consequence of a single cause, but CKD in adults frequently relates rather to sequential injuries accumulating over the life course or to the presence of concomitant risk factors. The shared pathomechanism of CKD progression is the irreversible loss of kidney cells or nephrons together with haemodynamic and metabolic overload of the remaining nephrons, leading to further loss of kidney cells or nephrons. The management of patients with CKD focuses on early detection and on controlling all modifiable risk factors. This approach includes reducing the overload of the remaining nephrons with inhibitors of the renin-angiotensin system and the sodium-glucose transporter 2, as well as disease-specific drug interventions, if available. Hypertension, anaemia, metabolic acidosis and secondary hyperparathyroidism contribute to cardiovascular morbidity and reduced quality of life, and require diagnosis and treatment.

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Conflict of interest statement

Competing interests: Related to the content of this paper, H.-J.A. received funding from Boehringer Ingelheim and consultancy fees from Novartis, AstraZeneca, Bayer, Boehringer Ingelheim, Vifor, Otsuka, Roche and Eli Lilly. H.-J.A. received payments from the European Renal Association for his role as Editor-in-Chief of Nephrology Dialysis Transplantation. H.-J.A. is a member of the Western-European Regional board of the International Society of Nephrology (ISN). Related to the content of this paper, M.N. received research funding from Kyowa-Kirin, Daiichi-Sankyo, Astellas, Ono, Mitsubishi-Tanabe, Japan Tobacco, Chugai, Bayer, Torii and Takeda. M.N. received honoraria and advisory fees from Kyowa-Kirin, Astellas, AstraZeneca, GlaxoSmithKline, Daiichi-Sankyo, Mitsubishi-Tanabe, Chugai, Torii, Japan Tobacco, Novo Nordisk and Boehringer Ingelheim. M.N. is President of the ISN, President of the Japanese Society of Nephrology, Immediate President of the Asian Pacific Society of Nephrology, President of the Japanese Society of Internal Medicine and Vice President of the Japanese Medical Science Federation. A.L. has no conflicts of interest regarding her contribution to this article, although she was the co-chair of the KDIGO Update on Chronic Kidney Disease Evaluation and Management 2024. B.R.-I. and P.R. declare no competing interests. R.A. reports personal fees from Akebia Therapeutics, Inc., Bayer Healthcare Pharmaceuticals Inc., Boehringer Ingelheim, Chinook, Vertex, Alynlam, Intercept, Eloxx and Novartis. R.A. is an associate editor at Nephrology Dialysis Transplantation and American Journal of Nephrology, and acting Editor in Chief of American Journal of Nephrology. He is a section editor of nephrology at UpToDate. J.C.N.C. reports receiving grants (through institutions) and/or honoraria for consultancy or giving lectures from Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Celltrion, Eli Lilly, Hua Medicine, Powder Pharmaceuticals, Roche, Merck, MSD, Pfizer, Sanofi, Servier, Viatris and Zuellig Therapeutics. She is a co-inventor of patents assigned to the Chinese University of Hong Kong with claims of using genetic and multiomic markers to identify patients at high risk for diabetes and its complications for personalized treatment. She is the co-founder of GemVCare, a technology company, with partial support from the Hong Kong Government, which uses biogenetic markers and information technology to implement precision diabetes care and prevention through partnerships. J.C.N.C. is the Chief Executive Officer (pro bono) of the Asia Diabetes Foundation that developed the web-based JADE platform for implementation of data-driven diabetes care. She is a member of the Global Council of the European Association for Study of Diabetes and a member of the International Diabetes Federation Global Guidelines for type 2 diabetes and member of working groups of KDIGO. R.K. is a member of the African board of the ISN. S.K. is a member of the North American board of the ISN, an adviser to the Middle-East board of the ISN, a member of the education workgroup and the social media team of the ISN, a member of the core program committee of the ISN, and the chair of the young nephrologists committee of the ISN. S.K. is also a member of the clinical nephrology commission of the Société Francophone de Néphrologie Dialyse et Transplantation (SFNDT) and of the webinars committee of the SFNDT. She is also the co-chair of the education committee of the American Society of Onco-nephrology.

References

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    1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group KDIGO 2024 Clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 105, S117–S314. Latest definition and classification of CKD, which sets the global standard on how to deal with CKD and all its consequences.
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