Advances in the Diagnosis, Treatment, and Prognosis of Chronic Kidney Disease: A Reflection on Recent Developments

Chronic kidney disease (CKD) remains a critical global health issue, affecting more than 840 million individuals globally [1]. This disease, marked by the gradual loss of kidney function, often progresses silently until reaching advanced stages, making early detection a vital intervention for preventing end-stage kidney disease (ESKD) and cardiovascular-related complications. The past decade has seen substantial progress in CKD research, enhancing diagnostic methods, risk reduction strategies, and outcome prognostication. This editorial synthesizes some of the recent developments and innovations, drawing from recent publications in a Special Issue of Applied Sciences.

Pathophysiology and aetiology of CKD: The pathophysiology of CKD is multifaceted, involving interplay between various factors. While type 2 diabetes mellitus (T2DM) and hypertension are well-established risk factors, this Special Issue explores other non-traditional risk factors, such as the gut microbiome [2]. A notable review emphasized the significant impact of the gastrointestinal (GI) tract and its microbiome on CKD progression and comorbidities [2]. Human clinical trials and rodent model experiments have shown that modulating the microbiome through dietary fiber addition and biotic interventions can reduce uremic toxins, decrease inflammation, and improve kidney function. This emerging evidence highlights the potential of gut microbiome modulation as a cost-effective and promising avenue for CKD management.

Comorbidity management: CKD has also been linked to increased mortality that is not completely explained by traditional cardiovascular risk factors. Mixson et al. explored the relationship between sleep disorders and mortality in patients with ESKD receiving hemodialysis [3]. Studies have shown that sleep disorders are prevalent in patients with CKD, particularly those with ESKD [4], and consequently associated with mortality. However, the study by Mixson et al. found that a diagnosis of hypersomnolence, insomnia, restless leg syndrome, or obstructive sleep apnea/central sleep apnea was associated with a decreased risk of death [3]. According to the authors, a possible explanation for this finding is that patients with sleep disorders and ESRD are diagnosed and treated or are more frequently in contact with medical professionals. As such, increased physician vigilance could result in earlier detection and treatment of complications. These findings underscore the complexity of CKD management and the potential benefits of comprehensive comorbidity management.

Genetic insights and personalized medicine: Recent genetic studies have provided insights into the hereditary components of CKD. Through genome-wide association studies (GWAS), single-nucleotide polymorphisms (SNPs) in more than 70 independent risk loci have been found to be associated with the estimated glomerular filtration rate (eGFR), CKD disease risk, and microalbuminuria [5,6,7]. Among these, genetic variants in the DAB2, PRKAG2, and DACH1 genes were found to be associated with eGFR [8]. The study by Kecskemétiné et al. [9], investigated the association between genetic variants DAB2 rs11959928, DACH1 rs626277, and PRKAG2 rs7805747, and prevalent CKD according to sex and found that PRKAG2 rs7805747 was associated with reduced risk of CKD in females, whereas the same variant and DAB2 rs11959928 were associated with increased risk in males. These findings suggest that the same genetic variants associated with prevalent CKD are different based on sex. This type of research paves the way for personalized medicine approaches, where genetic screening can inform individual risk profiles and tailored interventions.

Regional challenges and future directions: Africa, particularly sub-Saharan Africa (SSA), faces unique challenges regarding CKD [10,11]. A notable review by Rayner et al. emphasized the rising prevalence of CKD in this region which is driven by the combined effects of hypertension, T2DM, HIV infection, and the interaction between these conditions, as well as the impact of APOL1 genetic variants on CKD susceptibility. They further highlight that the epidemiological data on CKD prevalence in SSA are of low-to-medium quality, underscoring the urgent need for reliable data to inform public health strategies. Furthermore, there are significant deficiencies in creatinine-based equations for estimating CKD prevalence in African populations. The review highlights several key advances in understanding CKD in Africa, particularly regarding hypertension, diabetes, HIV, CKD of unknown etiology (CKDu), and the long-term effects of hypertension in pregnancy and pregnancy-related acute kidney injury (PRAKI) [12]. Addressing these challenges requires tailored interventions and improved diagnostic methods to enhance CKD management in SSA. The ongoing CKD-Africa Collaboration is addressing some of these challenges through an individual-participant data meta-analysis of completed surveys on CKD prevalence across Africa [13].

In conclusion, the landscape of CKD diagnosis, treatment, and prognosis has undergone significant transformation, driven by advances in biomedical research and technology. The insights and innovations documented in this Special Issue in the journal of Applied Sciences reflect a broader trend towards earlier diagnosis, targeted therapies, and personalized medicine in CKD management. As we continue to unravel the complexities of CKD, it is imperative to translate these findings into clinical practice, ultimately improving patient outcomes and quality of life.