Chronic kidney disease articles from across Nature Portfolio

Savvopoulos, Scheffner et al. develop a simple model that learns each kidney transplant recipient’s usual kidney function from routine tests and defines a personal failure threshold. This individualized threshold predicts future transplant loss more accurately than fixed cut-offs, helping to identify high-risk patients earlier.

Here, DeFronzo and colleagues explore the underappreciated adverse effects of insulin resistance and accompanying hyperinsulinaemia on the kidney, which is an insulin-responsive organ and has an important role in insulin homeostasis. The authors examine the interplay between insulin dysregulation, lipid metabolism and inflammation, and consider emerging therapies to address this metabolic dysfunction.

The kidney contains a heterogeneous endothelial cell population that serve distinct roles in the maintenance of tissue homeostasis and kidney function. This Review summarizes current understanding of the endothelial response to kidney injury, focusing on the response of vascular, glomerular and lymphatic endothelial cells in diverse kidney diseases, and describes the potential of emerging endothelium-targeted therapeutics to ameliorate injury and restore kidney function.

Early detection of vascular access dysfunction is critical for hemodialysis patients, but current monitoring lacks continuous solutions. Here, the authors develop a wireless, noninvasive sensor that enables VA monitoring by detecting thrill intensity changes.

Early detection, strong primary care and community-based active conservative kidney management must form the foundation of Samoa’s response to chronic kidney disease (CKD). With diabetes driving the majority of CKD and kidney failure cases, prevention and primary care investment must be prioritized to enable the later expansion of nephrology services.

For nearly three decades, my life has consisted of insulin injections, monitoring of glucose levels and emotional, mental and physical labour. Here, I share my experience of being a Black person living with type 1 diabetes mellitus, including cultural and systemic challenges that affected my access to the care I was entitled to.

Kidney health data have long highlighted the disproportionate burden of kidney disease among Indigenous populations across the globe. It is time for meaningful interventions that can create real change.

Rising demand for dialysis poses a central challenge to universal health coverage systems: not just whether to expand access, but how to sustain equitable, high-quality kidney failure care. In this Comment, I argue that long-term viability depends on system architecture, rather than modality choice alone.

Chronic kidney disease of unknown origin (CKDu) has been reported in various tropical settings over the past 20 years, but clarity on key disease drivers is lacking. Several factors have slowed progress in understanding this disease or diseases, including low research funding, difficult case definition and multiple risk factors for kidney disease.