Therapeutic approaches in the management of chronic kidney disease: the past, the present, and the future

Oct 6, 2025Minerva medica

Treating chronic kidney disease: past methods, current options, and future possibilities

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Abstract

Chronic kidney disease (CKD) significantly contributes to global morbidity, mortality, and healthcare costs.

Advancements in CKD management have evolved from dietary interventions to targeted pharmacological therapies.
Low-protein diets were initially used to slow renal impairment progression.
Blood pressure control and renin-angiotensin-aldosterone system blockade with ACE inhibitors and ARBs have improved renal outcomes.
Newer therapies like sodium-glucose cotransporter 2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists offer cardiorenal protection.
Ongoing research explores emerging therapies, including aldosterone synthase inhibitors and gene-editing technologies, which may target CKD progression drivers.

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Chronic kidney disease (CKD) remains a major global health burden, contributing significantly to morbidity, mortality, and healthcare costs. Over the past century, therapeutic approaches to CKD have evolved substantially, reflecting advances in the understanding of renal pathophysiology. Early strategies centered around dietary interventions, notably low-protein diets, aimed at mitigating the progression of renal impairment. Subsequently, rigorous blood pressure control and the introduction of renin-angiotensin-aldosterone system (RAAS) blockade with ACE inhibitors and ARBs markedly improved renal outcomes. In the modern era, the emergence of sodium-glucose cotransporter 2 (SGLT2) inhibitors, non-steroidal mineralocorticoid receptor antagonists (nsMRAs) such as finerenone, and glucagon-like peptide-1 receptor agonists (GLP-1RAs) has redefined the therapeutic landscape, offering robust cardiorenal protection. Despite these advances, CKD often remains a progressive disease, underscoring the need for continued innovation. Future therapeutic strategies, including aldosterone synthase inhibitors, soluble guanylate cyclase activators, and therapies currently in preclinical development - such as gene-editing technologies, novel peptide therapies, and renal regenerative approaches - aim to target the fundamental drivers of CKD progression. These emerging modalities hold the promise not merely of slowing disease progression but potentially restoring renal function. As the field moves toward personalized, mechanism-based interventions, early diagnosis and prompt initiation of therapy will remain pivotal. This review traces the historical evolution of CKD management, highlights contemporary advances, and explores the exciting horizon of future therapeutic opportunities.

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Therapeutic approaches in the management of chronic kidney disease: the past, the present, and the future

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