Chronic Kidney Disease Progression and Management Strategies

Chronic kidney disease (CKD) is a global health challenge characterised by a gradual loss of renal function that may culminate in end-stage renal disease. The rate of progression is governed by both modifiable and non-modifiable factors, notably hypertension, diabetes mellitus and the degree of proteinuria. Early stages are often silent, making screening based on estimated glomerular filtration rate (eGFR) and urine albumin measurements essential. Pathophysiological drivers include haemodynamic stress, inflammatory pathways and metabolic derangements, which together promote glomerular scarring and tubular atrophy. Risk stratification through serial eGFR slopes has emerged as a valuable prognostic tool, revealing patients at greatest risk of rapid decline. Management strategies combine lifestyle measures—such as dietary sodium restriction, weight control and smoking cessation—with pharmacological therapies that target the renin–angiotensin system and correct metabolic risk factors. Recent therapeutic advances include sodium–glucose cotransporter 2 (SGLT2) inhibitors, which confer renal protection beyond glycaemic control, and non-steroidal mineralocorticoid receptor antagonists that attenuate inflammation and fibrosis. Patient education, self-management support and digital health interventions help to optimise adherence and empower self-monitoring of blood pressure, diet and fluid status. A concerted approach to early detection, individualised therapy and regular monitoring is pivotal to delay progression, reduce cardiovascular complications and improve quality of life for individuals with CKD.

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Chronic Kidney Disease Progression and Management Strategies publication trend

The graph below shows the total number of articles in chronic kidney disease progression and management strategies across all publications each year (not limited to Nature Index journals).

Technical terms

eGFR: Estimated glomerular filtration rate, a calculated index of kidney filtration function based on serum creatinine.

Albuminuria: Excretion of albumin in urine, reflecting glomerular injury and a marker of disease severity.

UACR: Urine albumin-to-creatinine ratio, a standardised measure of albuminuria used in CKD staging.

SGLT2 inhibitor: Drug class that reduces glucose reabsorption in the proximal tubule and confers cardiorenal protection.

Renin–angiotensin–system inhibitor: Agent that lowers intraglomerular pressure and proteinuria by blocking angiotensin action.

References

1. Effectiveness of DialBetesPlus, a self-management support system for diabetic kidney disease: Randomized controlled trial. npj Digital Medicine (2024).
2. Treatment strategies to reduce cardiovascular risk in persons with chronic kidney disease and Type 2 diabetes. Journal of Internal Medicine (2024).
3. Association between estimated glomerular filtration rate slope and cardiovascular disease among individuals with and without diabetes: a prospective cohort study. Cardiovascular Diabetology (2023).