Rethinking Renal Pathways: Recent Advances in Diagnosis, Vascular Access, and Targeted Therapy in Chronic Kidney Disease (CKD)

Dear Colleagues,

Chronic kidney disease (CKD) affects over 850 million people worldwide and represents a growing public health burden, with significant personal, societal, and economic implications. As life expectancy increases and conditions such as diabetes and hypertension become more prevalent, both the incidence and progression of CKD are expected to rise in the coming decades. Despite important advances in nephrology, CKD remains frequently underdiagnosed in its early stages, and further research is needed to better understand the mechanisms and factors associated with disease progression and adverse outcomes. This underscores the importance of earlier detection and more individualized intervention across the CKD continuum.

In recent years, diagnostic and therapeutic paradigms in renal care have evolved substantially. Novel biomarkers and artificial intelligence-driven risk stratification tools are increasingly being developed to improve early detection, refine prognostic assessment, and support personalized clinical decision-making. At the same time, growing attention is being paid to non-traditional but highly impactful determinants of outcomes, such as protein-energy wasting and malnutrition. Malnutrition remains highly prevalent across all stages of CKD and is closely associated with inflammation, cardiovascular morbidity, frailty, and increased mortality, highlighting the need for improved assessment strategies and targeted nutritional interventions.

Advances in vascular access planning and preservation remain essential for optimizing dialysis outcomes and minimizing complications, particularly among patients referred late or those with a high comorbidity burden. In parallel, targeted therapeutic approaches—including sodium–glucose co-transporter 2 (SGLT2) inhibitors, non-steroidal mineralocorticoid receptor antagonists, and therapies with anti-inflammatory effects—are demonstrating benefits beyond glycemic control by modulating key molecular pathways such as oxidative stress, advanced glycation end-product accumulation, cytokine activation, and renal fibrosis.

In this context, proteomics, metabolomics, and other high-throughput omics technologies are emerging as key tools for precision nephrology. These approaches provide deeper insights into disease mechanisms, facilitate biomarker discovery, and help characterize molecular heterogeneity in CKD and glomerular diseases, with promising applications in early diagnosis, risk stratification, and prediction of treatment response.

This Special Issue aims to highlight recent advances in the diagnosis, management, and targeted treatment of chronic kidney disease. We welcome contributions addressing biomarker discovery, omics-based approaches, artificial intelligence-driven risk prediction, nutritional and metabolic factors, vascular access optimization, and innovative therapeutic strategies aimed at improving patient outcomes in kidney disease.

Topics of interest for publication include, but are not limited to, the following:

• Novel biomarkers for early detection and risk stratification in CKD
• Artificial intelligence and machine learning applications in nephrology
• Precision medicine approaches in chronic kidney disease
• Malnutrition, protein–energy wasting, and metabolic disturbances in CKD
• Nutritional assessment and targeted nutritional interventions in kidney disease
• Innovations in vascular access planning, monitoring, and preservation
• Outcomes, complications, and management of dialysis vascular access
• Targeted therapies in CKD, including SGLT2 inhibitors, mineralocorticoid receptor antagonists, and anti-inflammatory or antifibrotic strategies
• Cardiovascular–renal interactions in CKD
• Translational and multidisciplinary approaches to CKD management
• Personalized therapeutic strategies in diabetic and non-diabetic kidney disease
• Metabolic profiling, uremic toxins, and biomarker discovery in kidney disease

Dr. Alina Ramona Potra
Dr. Ina Maria Kacsò
Dr. Diana Tania Luminița Moldovan
Guest Editors

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• chronic kidney disease
• biomarkers in kidney disease
• precision nephrology
• artificial intelligence in nephrology
• vascular access for dialysis
• targeted therapies in CKD
• malnutrition and protein-energy wasting in CKD
• renal fibrosis and disease progression
• translational nephrology research