From progression to remission: a new paradigm for success in chronic kidney disease

Recent advances in treatment of chronic kidney disease have changed the clinical paradigm from slowing inevitable progression to achievable remission. Landmark trials involving sodium-glucose cotransporter 2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists, glucagon-like peptide 1 receptor agonists, and targeted immunotherapies for IgA nephropathy demonstrate that sustained estimated glomerular filtration rate preservation and normalization of albuminuria are now realistic goals in both diabetic and glomerular kidney diseases. Remission, defined by estimated glomerular filtration rate slopes of <1 ml/min per 1.73 m² per year or the absence of albuminuria with a normal estimated glomerular filtration rate, 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 chronic kidney disease: remission is not only possible-it must become our standard of care.