Personalised Care in CKD: Moving Beyond Traditional Biomarkers.

Abstract

The ultimate goal of precision medicine is to tailor treatment to specific disease processes, thereby optimising patient outcomes. This approach moves beyond the one-size-fits-all model, recognising at an individual level the unique combinations of molecular, genetic, and environmental factors determining disease progression and treatment response. Chronic kidney disease (CKD) exemplifies the need for precision medicine, given its complex and heterogeneous nature. Traditional biomarkers, such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR), have long been the cornerstone of CKD diagnosis and management. However, these markers homogenise a diverse group of distinct conditions within CKD with separate pathophysiologies and progression rates. The standardisation of CKD definition has improved clarity and consistency but has inadvertently led to a generic classification system, which categorises patients with CKD based on these non-specific markers and fails to capture the nuances of individual patient conditions. As a result, there is a critical need for novel biomarkers that can more accurately represent specific aetiologies and mechanisms of CKD progression. By identifying and utilising novel biomarkers, the field of nephrology could better understand individual mechanisms of CKD progression and move towards tailored risk prediction and treatment strategies, ultimately improving patient outcomes. This review is not intended to be a comprehensive review of all biomarkers in CKD but a proposal to the nephrology community to think more pathophysiologically about CKD, recognise the importance of distinct primary kidney diseases, and start working towards a more personalised medicine approach.