Researchers at Oxford Population Health have produced a comprehensive new report outlining how a series of recent breakthroughs in treatment and early detection of chronic kidney disease (CKD) have markedly improved outcomes for more than 850 million people living with CKD worldwide. The “Seminar”, a clinically focused overview for the generalist, is published in The Lancet.
By 2050, CKD is likely to be the fifth leading cause of death globally. This report explains how CKD can be readily detected using simple, inexpensive tests, and that several widely available therapies substantially reduce the risks of kidney failure and cardiovascular disease, the two key serious consequences of the condition.
The authors emphasise that CKD often progresses silently for years, but two routine measurements are powerful predictors of future risk of disease progression: estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR). Combining these tests enables accurate staging of CKD and identification of individuals at high risk of complications or death long before symptoms develop.
Since 2019, several large-scale randomised trials have reported that:
- Results from the EMPA-KIDNEY trial have shown that SGLT2 inhibitors reduce the risk of kidney failure by about one-third and heart-failure hospitalisation by about two-fifths, with benefits extending to people with and without diabetes;
- RAS inhibitors remain a standard of care for many patients, particularly for those with increased levels of albumin protein (ie uACR) in the urine;
- GLP-1 receptor agonists (notably subcutaneous semaglutide) have recently demonstrated significant reductions in major kidney outcomes and cardiovascular events in people with type 2 diabetes and CKD;
- Finerenone, a non-steroidal mineralocorticoid receptor antagonist, provides additional kidney and heart protection in patients with diabetes and albuminuria.
The Seminar highlights that using these treatments together, where appropriate, could yield additive benefits, though evidence for optimal sequencing is still emerging.
The authors describe striking global inequalities in the treatment of people with CKD: 90% of people receiving kidney replacement therapy (such as dialysis) live in high-income or upper-middle-income countries, while access remains extremely limited in much of Africa and Asia. New WHO resolutions call for greater investment in prevention, early detection, and equitable access to kidney replacement therapy.
Most people with CKD die from cardiovascular disease before reaching kidney failure. The Seminar also stresses the need for monitoring and interventions to protect patients’ cardiovascular health, including prescribing statins for nearly all adults with CKD, to lower the risk of heart attack, stroke, and heart failure.
Will Herrington, Professor of Trials and Epidemiology of Kidney Disease at Oxford Population Health, said ‘Since the previous Seminar on CKD was published in The Lancet in 2021, there have been several advances in the recommendations for diagnosing and treating CKD. The KDIGO clinical practice guidelines were updated in 2024 for the first time in 12 years and, together with the WHO’s 2025 resolution on the global burden of non-communicable diseases, encourage a collective effort to adequately and equitably identify and treat the very large number of people with chronic kidney disease in low-income, middle-income, and high-income countries. In this Seminar, we provide a simple approach to chronic kidney disease diagnosis, staging, and management that can be applied by clinicians in most clinical settings.’
Professor Christoph Wanner, senior author and Visiting Professor at Oxford Population Health’s Renal Studies Group explained that ‘The Seminar concludes that CKD is highly detectable, largely manageable, and now supported by several proven therapies that are simple to implement across diverse health-care systems. If adopted widely, these measures could substantially reduce the global burden of kidney failure, cardiovascular disease, and premature death.’