Chronic kidney disease, complex conditions, and advancing therapeutics: new hope and challenges

Chronic kidney disease (CKD) is increasingly recognised as a complex, multisystem condition that rarely occurs in isolation. This Series paper outlines major advances in therapeutics that target shared inflammatory, metabolic, and fibrotic pathways across CKD, cardiovascular disease, diabetes, obesity, and infection. Novel therapeutics, including SGLT2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and GLP receptor agonists, show substantial benefits for slowing CKD progression and improving cardiovascular outcomes, with combination strategies showing additive potential. This Series paper discusses complexities for therapeutic decision-making in CKD, highlighting multimorbidity, frailty, and polypharmacy care as major challenges for implementation in general or primary care settings. We identify under-recognised, groups of patients at high risk with infection and cancer-related CKD, in whom early detection and integrated care could markedly improve outcomes. Finally, we call for more inclusive and representative evidence generation, improved CKD screening within other disease pathways, and coordinated implementation of emerging therapies to reduce the global burden of CKD.