Given the profound implications of CKD remission for reducing the risk of premature death and kidney failure, we advocate establishing CKD remission as a clear and achievable clinical goal.
CKD remission is most likely to be achieved when the disease is detected early — before substantial eGFR loss or severe albuminuria develops. Population-based screening combining eGFR and albuminuria testing in at-risk groups may therefore be needed to identify these patients and provide them with the best opportunity to attain remission.
For these screening strategies to succeed, they must be integrated with risk stratification and clinical decision support to optimize the use of guideline-directed medical therapy. A growing body of evidence indicates that combination therapy is more likely to achieve remission, particularly in patients with diabetic kidney disease. Clinical inertia must be overcome; we should not settle for a 30%–50% reduction in UACR when safe and effective therapies can achieve reductions of 60%–80% or even normalization.
A risk-based approach can accelerate the initiation of such therapies — for example, starting RAASi and SGLT2i concurrently, with additional agents added as needed to reach remission. This treatment paradigm should be led by primary care, with nephrologists providing consistent messaging and support to enable effective intervention before renal function is irreversibly lost.