Chronic kidney disease (CKD) affects an estimated 9%–10% of the global population, with more than 850 million people worldwide living with kidney disease. Yet in real-world practice, many patients are still diagnosed only after substantial kidney damage has occurred.
On World Kidney Day 2026, new guideline updates, emerging trial data, and early innovations in transplantation are raising an important question:
Are we identifying and managing CKD early enough in everyday clinical practice?
Three developments are shaping the current CKD landscape.
Key Development 1: Many CKD Patients Are Still Diagnosed Late
A real-world analysis of more than 29 million U.S. patients with documented CKD from the LINQ Real-World Data Explorer (10-year lookback) found that Stage 3 was the most common stage at diagnosis, while fewer than 2 million patients were identified at Stage 1.
The KDIGO 2024 guideline emphasizes earlier identification of CKD and recommends annual assessment of eGFR and albuminuria in people with diabetes beginning at the time of type 2 diabetes diagnosis.
Key Development 2: Guideline-Recommended Therapies Continue to Expand
KDIGO 2024 recommends assessing CKD risk in individuals with:
- hypertension
- diabetes
- cardiovascular disease
Treatment guidance includes:
- SGLT2 inhibitors for adults with CKD and eGFR ≥20 mL/min/1.73 m², particularly those with albuminuria or heart failure
- GLP-1 receptor agonists with cardiovascular benefit for adults with type 2 diabetes and CKD who remain above glycemic targets despite metformin and SGLT2 inhibitor therapy
These recommendations reflect a growing emphasis on earlier cardiorenal risk reduction across the course of disease.
Key Development 3: New Evidence and Emerging Approaches Are Expanding the CKD Landscape
FLOW Trial (NEJM 2024)
Among 3,533 patients with type 2 diabetes and CKD, investigators reported:
- 24% relative risk reduction in the composite kidney outcome
- 1.16 mL/min/1.73 m² per year slower decline in eGFR
- 20% reduction in all-cause mortality
At baseline, 15.6% of participants were receiving SGLT2 inhibitors.
IgA Nephropathy: Updated KDIGO 2025 Guidance
KDIGO 2025 introduces a framework that separates:
- therapies targeting IgA immune complex formation
- therapies addressing downstream nephron injury
The guideline also lowers the proteinuria target to <0.5 g/day, ideally <0.3 g/day.
However, the guideline notes that long-term evidence demonstrating prevention of dialysis over a patient lifetime remains limited.
Xenotransplantation: Early Clinical Experience
Early clinical experience with genetically modified porcine kidney transplantation has been reported in compassionate-use cases. In one report, a porcine kidney with 69 genomic edits demonstrated immediate graft function in a living recipient, allowing discontinuation of dialysis.
With more than 100,000 patients currently on the U.S. kidney transplant waitlist, xenotransplantation is being explored as a potential future strategy to address organ shortages.
Join the Discussion
Q1: Real-world data suggest many patients are still diagnosed with CKD only after significant kidney damage has occurred.
In your experience, what is the biggest barrier to identifying CKD earlier in routine clinical practice?
Q2: Cardiorenal therapies are increasingly recommended for patients with CKD and type 2 diabetes.
How has the expanding role of these therapies changed the way you approach CKD management in your practice?
