Comment in 2025

Chronic kidney disease is a silent epidemic that is disproportionately affecting low- and middle-income countries. The landmark WHO global kidney health resolution signals urgency, but impact depends on action. Point-of-care diagnostics are essential to bridge the gap between recognition and reality, enabling equitable early detection, prevention and strengthening of health systems.

Implementation of the recently adopted World Health Organization resolution on kidney health will require not only additional funding, but also strategic investment. Embedding kidney health interventions into primary care and community-based non-communicable disease prevention and treatment platforms can rebalance resource allocation across the care continuum, improving both sustainability and fairness.

Digital twins are a key computational technology for the implementation of personalized approaches to medical care. They are based on computational models that have been calibrated to an individual patient and can be used to identify personalized treatment approaches. Nephrology offers several promising potential applications for this technology.

In early 2025, nearly 2,100 research projects funded by the US National Institutes of Health (NIH) were terminated. Numerous calls for depoliticization of the NIH’s scientific mission culminated in the Bethesda declaration, which has now been signed by over 32,000 individuals. However, little attention has been given to the effect of these terminations on people who stand to benefit most from scientific discoveries: the patients, care partners and community leaders.

Africa has a high prevalence of chronic kidney disease (CKD), but efforts to address this burden lag behind those of high-income regions. In the past 20 years, progress has been made in collaborative efforts to share clinical and diagnostic skills and better define the epidemiology and pathophysiology of CKD in Africa.

In the past 20 years, awareness of the huge environmental impact of kidney care has increased considerably. Although opportunities to reduce this impact have been identified and innovative approaches developed, implementation of these strategies remains slow. System-wide action is urgently required to improve the sustainability of kidney care.

The involvement of patients with lived experience of kidney disease in nephrology research can strengthen the relevance and uptake of evidence to achieve better outcomes. The past two decades have seen increased efforts to involve patients and caregivers, particularly in research priority setting, study design and dissemination. However, further efforts are needed to improve the transparency and diversity of patient involvement in research.

Chronic kidney disease (CKD) is associated with the highest occurrence of catastrophic healthcare expenditure (CHE) both globally and across all diseases. However, CHE alone does not provide a complete measure of the financial burdens of CKD on a household, especially for those with very low incomes or who forego therapy altogether. A more comprehensive assessment of direct, indirect and long-term costs is crucial to advancing equitable and effective universal health coverage.

People with chronic kidney disease and cognitive impairment are at an increased risk of adverse health outcomes, and these intersecting comorbidities are increasing in prevalence worldwide. Innovative care models that involve a cognitive-aware lens and consider the needs of family caregivers are needed to provide quality care to patients.

Prevalence of cognitive impairment and dementia in people with kidney disease is disproportionately high, and improved detection is needed. Implementing routine screening for dementia in people receiving dialysis, who are at high risk of cognitive decline, would facilitate diagnosis and enable patients to receive appropriate therapeutics and support.

Artificial intelligence approaches that link patient data with chemical-induced kidney injury patterns are revolutionizing nephrotoxicity risk assessment. Substantial progress has been made in the development of integrated approaches that leverage big data, molecular profiles and toxicological understanding to identify at-risk patients, provide insights into molecular mechanisms and advance predictive nephrology.

The prohibitive costs of new pharmacological agents, particularly biologicals, have largely limited their use to high-income countries, resulting in widening of health disparities. Urgent action from the pharmaceutical industry, governments and healthcare organizations is needed to improve access to treatment and address these inequities.

The inclusion of individuals with disabilities and patients as partners in biomedical research is critical for driving innovation. Equally important are patient–researchers, who are instrumental in identifying key research problems and driving research towards areas of direct benefit. We call for institutions to actively work towards accommodating patient–researchers.

Awareness of chronic kidney disease (CKD) and uptake of evidence-based interventions (EBIs) that increase awareness and/or slow progression to kidney failure remain alarmingly low. The global rise in immigration might exacerbate CKD prevalence among minoritized groups, which underscores the need for the nephrology community to acknowledge the diverse contexts that influence EBI implementation and to integrate health equity approaches.

Kidney disease disproportionately affects American Indian and Alaska Native (AI/AN) communities, largely owing to adverse social drivers of health that stem from systemic issues including colonization, structural racism and historical trauma. Kidney health equity for AI/AN communities requires systemic and multilevel interventions across the CKD spectrum and life course.

A growing burden of diabetic kidney disease in Fiji threatens to overwhelm newly established nephrology services. Greater attention to early detection and intervention, incorporation of kidney health into national strategic plans, and international support to prioritize chronic kidney disease as a global priority is imperative.

The late diagnosis of chronic kidney disease (CKD) is a global problem that limits the opportunity to initiate disease-modifying therapies. Artificial intelligence approaches using imaging or laboratory-based models can facilitate the early detection and risk stratification of CKD and thereby enable optimal treatment to reduce the burden of the disease.

Premature birth and low birth weight disrupt kidney development substantially, which leads to an increased risk of acute kidney injury, chronic kidney disease and hypertension. Broader awareness of these risks, implementation of preventive strategies and optimization of neonatal care are key to safeguarding kidney health and ensuring better long-term outcomes.

Improved awareness of chronic kidney disease (CKD) is vital to enable at-risk individuals to benefit from new therapies. Investment in primary care, improved recognition of CKD by primary care providers and public health approaches to increase CKD awareness are required to enhance CKD care delivery and improve kidney and cardiovascular outcomes.

The high global burden of kidney disease highlights an urgent need for early diagnosis and the implementation of interventions to prevent disease progression. Such an approach requires the identification and management of risk factors and equitable access to quality care.