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Chronic Kidney Disease: Modern Understanding, Early Diagnosis, and New Treatment Opportunities

Updated: Jul 10


What Is Chronic Kidney Disease (CKD)?

Chronic Kidney Disease (CKD) is a progressive, long-term impairment of kidney function in which the kidneys gradually lose their ability to filter blood and eliminate waste products from the body. CKD is diagnosed when there is impaired kidney function or structural changes that persist for more than three months—often without noticeable symptoms in the early stages.

Globally, CKD is one of the most significant public health issues, affecting more than 35 million people in the United States alone. It is the 12th leading cause of death worldwide. Since 1990, mortality from the disease has increased by over 40% (The Lancet, 2019).


Why Is CKD Called a “Silent Killer”?

Up to 90% of affected individuals are unaware they have the condition, as the early stages are usually symptom-free. It is often discovered incidentally during blood and urine tests. The kidneys can compensate for the loss of function until advanced stages—making early diagnosis and prevention critically important.


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Main Causes and Risk Factors

The most common causes of CKD are:

  • Diabetes (Type 1 and especially Type 2) – High blood sugar damages the small blood vessels in the kidneys.

  • High blood pressure (hypertension) – Elevated pressure harms the kidney's filtering structures.

  • Cardiovascular disease, obesity, family history, and older age.

  • Genetic factors – Mutations in genes such as ACE, PKD1, PKD2, UMOD, and others also increase risk. New research shows that even without clear mutations, various genetic variations may influence disease susceptibility and progression.

  • Race and socioeconomic factors – African Americans, Hispanic/Latino populations, and individuals from certain Asian groups are at higher risk, as are people with limited access to healthcare.

  • Unhealthy lifestyle – Smoking, low physical activity, poor diet, excessive salt intake, dehydration, and frequent use of certain medications (e.g., nonsteroidal anti-inflammatory drugs) contribute significantly.



Symptoms: What Do Patients Experience?

There are typically no symptoms in the early stages. As the disease progresses, the following may appear:

  • Fatigue, weakness (often linked to anemia)

  • Swelling in the legs, ankles, and face

  • Changes in urination (reduced/increased volume, dark or foamy urine)

  • Muscle cramps, especially at night

  • Nausea, loss of appetite

  • Itchy, dry skin

  • Insomnia, difficulty concentrating, “metallic taste” in the mouth

In the late stages, serious complications can occur—including higher risk of infections, bone disorders, hormonal imbalances, and dangerous electrolyte imbalances (e.g., high potassium levels that may cause heart arrhythmias).



Diagnosis and Expert Opinions

CKD detection mainly relies on:

  • Blood tests for creatinine (used to calculate estimated Glomerular Filtration Rate – eGFR; values below 60 mL/min/1.73 m² for more than 3 months indicate CKD)

  • Urine tests for albumin/protein (albuminuria) – an early and sensitive marker of kidney damage

  • Kidney ultrasound – used when structural abnormalities are suspected

International guidelines (KDIGO, KDOQI, CDC) emphasize that the two most important tests are simultaneous evaluation of eGFR and albuminuria. In recent years, new equations for calculating eGFR have been introduced that eliminate race-based adjustments to promote equitable access to diagnosis.

Routine screening for high-risk groups (people with diabetes, hypertension, or family history) is recommended, as early detection significantly slows disease progression.



Modern Treatment and Official Guidelines

Treatment is complex and individualized, aiming to slow disease progression, manage complications, and improve quality of life.

Core pillars include:

  • Blood pressure control – primarily with ACE inhibitors or angiotensin receptor blockers (ARBs)

  • Strict blood sugar management (for people with diabetes) – SGLT2 inhibitors (like dapagliflozin) slow kidney function decline and reduce cardiovascular risk

  • Lifestyle changes – low-salt diet, adequate fluid intake, smoking cessation, regular physical activity

  • Management of coexisting conditions – such as dyslipidemia, anemia, and mineral-bone disorders

  • Innovative therapies – for some patients, new drugs are used such as endothelin receptor antagonists (e.g., zibotentan) in combination with SGLT2 inhibitors; new agents for controlling hyperkalemia (e.g., patiromer, sodium zirconium cyclosilicate)

  • Integrated multidisciplinary approach – involving a team of specialists including nephrologists, dietitians, social workers, pharmacists, and others

In advanced disease (End-Stage Renal Disease, ESRD), treatment shifts to dialysis or kidney transplantation.



New Research and Scientific Advances

The past five years have brought a true revolution:

  • SGLT2 inhibitors – Studies like DAPA-CKD and ZENITH-CKD have shown dramatic slowing of disease progression regardless of underlying cause

  • New diagnostic tools – Non-invasive devices for measuring GFR (e.g., MediBeacon Transdermal GFR Measurement System) are expected to make diagnostics faster and more accessible

  • Artificial intelligence and mathematical modeling – Helping to tailor treatment to the individual

  • Genomic analysis – Increasingly accurate identification of hereditary forms, enabling personalized approaches

  • COVID-19 – Has proven especially dangerous for people with CKD, leading to higher mortality, more complications, and more severe illness



Expert Consensus and the Future

  • Early detection through widespread screening of high-risk groups is essential

  • SGLT2 inhibitors are the new gold standard, and innovative medications and personalized medicine are becoming standard in practice

  • Multidisciplinary teams and active patient involvement in decision-making are the future of successful treatment

  • The global medical community calls for public health policies that support screening and timely therapy



Conclusion

Chronic Kidney Disease is the “silent pandemic” of our time—often unnoticed but with serious consequences for health and life. Thanks to scientific breakthroughs, innovative medications, and personalized approaches, we now have a real opportunity to slow the disease, improve quality of life, and reduce mortality. The key remains: prevention, early screening, and active collaboration between doctors, patients, and institutions.



Main References with DOI Links:


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