From progression to remission: a new paradigm for success in chronic kidney disease
Navdeep Tangri, Brendon L. Neuen, David Z. Cherney, Katherine R. Tuttle, Vlado Perkovic
Abstract
Recent advances in treatment of chronic kidney disease (CKD) have changed the clinical paradigm from slowing inevitable progression to achievable remission. Landmark trials involving SGLT2 inhibitors, nonsteroidal MRAs, GLP-1 receptor agonists, and targeted immunotherapies for IgA nephropathy demonstrate that sustained eGFR preservation and normalization of albuminuria are now realistic goals in both diabetic and glomerular kidney diseases. Remission, defined by eGFR slopes (<1 ml/min per 1.73m 2 per year) and absence of albuminuria with a normal eGFR, is increasingly attainable, especially with early detection and combination therapy. We believe that these findings mandate a shift in nephrology's therapeutic focus—from delaying progression to maintaining kidney health. Population-based screening, risk stratification, and implementation of guideline-directed therapy are essential to scale this opportunity. The time has come to redefine success in CKD: remission is not only possible—it must become our standard of care.