Recent advances in chronic kidney disease (CKD) treatment are challenging the traditional goal of merely slowing progression. The authors argue that remission, defined as maintaining a chronic estimated glomerular filtration rate (eGFR) decline of less than 1 mL/min/1.73 m² per year in more advanced CKD, or achieving normal kidney function without albuminuria in earlier disease, is becoming attainable for some patients. Evidence from trials of renin-angiotensin-aldosterone system inhibitors, SGLT2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists, GLP-1 receptor agonists, and targeted therapies for IgA nephropathy shows increasingly durable preservation of kidney function and substantial reductions in albuminuria. Combination therapy appears particularly promising. In diabetic kidney disease, contemporary regimens have brought eGFR decline toward approximately 1 mL/min/1.73 m² per year. Combination SGLT2 inhibitor and nonsteroidal mineralocorticoid receptor antagonist therapy has produced albuminuria reductions greater than 50% in many patients.

The proposed shift has important implications for everyday CKD management: earlier detection, routine assessment of both eGFR and urine albumin-to-creatinine ratio (uACR), risk stratification, and timely use of guideline-directed combination therapy may give more patients an opportunity to preserve kidney health rather than simply delay kidney failure. Albuminuria is especially important. Patients with uACR greater than 30 mg/mmol were five times less likely to experience regression or remission than those without albuminuria, reinforcing the value of identifying disease before severe albuminuria or substantial eGFR loss develops. The authors advocate faster initiation and escalation of kidney-protective therapies, with primary care playing a central role and nephrology providing support for higher-risk patients. Importantly, CKD remission remains a proposed clinical framework rather than a universally established treatment endpoint, but the evidence supports reconsidering how clinicians define success in CKD care.

Reference: Tangri N, Neuen BL, Cherney DZ, Tuttle KR, Perkovic V. From progression to remission: a new paradigm for success in chronic kidney disease. Kidney Int. 2026 Jan;109(1):17-21. doi: 10.1016/j.kint.2025.10.004.

Link: https://www.kidney-international.org/article/S0085-2538(25)00847-6/fulltext