Chronic kidney disease, now affecting 850 million people worldwide, is the focus of a major Lancet series outlining therapeutic breakthroughs and global health policy advances. Novel drugs like finerenone and atrasentan show significant benefits in slowing disease progression and improving outcomes, marking a shift toward multi-targeted treatment approaches.
The WHO's kidney health resolution, adopted in May 2025, calls on member states to integrate kidney care into national strategies, enhance prevention, and expand access to treatment. However, implementation faces challenges including opposition, inertia, and indifference, according to a Lancet editorial.
Finerenone reduced risks of CKD progression, kidney failure, heart failure hospitalization, cardiovascular death, and all-cause death in a pooled analysis of the INFINITY study. The findings support its use across a broad range of disease causes and severities. Meanwhile, atrasentan reduced proteinuria and preserved kidney function in IgA nephropathy patients over 2.5 years in the ALIGN trial.
A separate paper reveals that over 50% of incident kidney failure requiring replacement therapy stems from causes other than diabetes. Sex-based differences in kidney health are also under-recognized, with treatment guidelines ignoring variations in disease presentation and drug response between males and females.
Experts caution that while these therapies offer hope, access remains limited in low-income and middle-income countries where the burden is highest. Realizing the WHO resolution's promises will require sustained political will and funding.