Chronic kidney disease progression.

W hether we like it or not, nephrologists around the world have been called to action. Our mission is to attenuate the growth of chronic kidney disease (CKD). Several conditions will need to gel for us to succeed. Although we now have a better understanding of its alarming incidence and prevalence within populations, however we choose to define it, better methods are needed to identify at risk and already affected individuals with progressive renal failure. Another major obstacle is the need for much more effective treatment strategies than are currently available. Furthermore, it has become clear the development of innovative new approaches to therapy will require a diverse armamentarium that together offers the best chance that renal progression can be halted and even forced to recede. It is time to strengthen alliances between academics and industry; among clinicians, clinical scientists, and basic scientists; and among nephrologists throughout each country (or, better yet, within several countries) to develop and test creative new treatment protocols in a way that is timely and that will enable us to provide our patients with evidence-based options. Our kidney patients who progress have a potentially malignant disease, one that certainly shortens life expectancy. We need only to look at our oncology colleagues who initiated such an approach many years ago with impressive improvement in survival for many cancers. At the same time, parallel efforts must be made to devise improved models of health care delivery so that that all affected individuals will have access to the most effective therapies. This issue’s Frontiers in Nephrology presents five articles that cover much of the modern work in renal progression that is relevant to the clinician. In this modern era of disease prevention, growing interest has been drawn to the early identification of patients with persistent renal injury, and, increasingly, chronic renal disease has been identified as an epidemic. The temptation to describe ESRD as an epidemic can be argued from various positions, and the article by Kiberd speaks to qualifications on both sides of the issue. That is, are we in the The topic of progression of chronic kidney disease addressed in the articles in this month’s Frontiers in Nephrology is also relevant to the discussion of albuminuria and the cardiovascular complication of left ventricular hypertrophy in diabetes reviewed by Nobakhthaghighi et al. in this month’s issue of CJASN (pp. 1187–1190).