ASN Kidney Week 2025: Unveiling the CKD Remission Paradigm

At ASN Kidney Week 2025, presenters reframed chronic kidney disease care by proposing a remission paradigm that treats remission—not just slowing progression—as an achievable clinical goal.

The researchers defined remission as sustained normalization or clinically meaningful recovery of albuminuria coupled with stabilization or improvement in estimated glomerular filtration rate (eGFR) over a prespecified interval. This marks a shift from traditional risk-reduction aims toward active remission-seeking strategies that change how clinicians set therapeutic objectives.

Where prior practice emphasized slowing decline and reducing cardiovascular and renal risk, the remission framework reprioritizes endpoints and monitoring. Rather than composite progression measures, remission uses sustained albuminuria improvement and durable eGFR gains as operational criteria.

Presenters distilled three implementation pillars: earlier detection, robust risk stratification, and coordinated combination therapy. Combination regimens—SGLT2 inhibitors plus renin–angiotensin system blockade and nonsteroidal mineralocorticoid receptor antagonists, with targeted immunotherapies when indicated—were highlighted as central to achieving larger absolute kidney-function gains.

Earlier diagnosis and timely treatment materially alter downstream outcomes by increasing the likelihood of sustained eGFR recovery and reducing progression to kidney failure in higher-risk cohorts. Monitoring during active titration typically occurs every 1–3 months, shifting to 3–6 month surveillance once stability is achieved.

Target metrics focus on percent reduction in albumin-to-creatinine ratio (ACR) and stabilization or incremental rises in eGFR—measurement choices that make the pursuit of durable remission clinically plausible for a substantial subset of patients.

Risk stratification personalizes intervention intensity by integrating biomarkers, albuminuria degree, comorbidity burden, and disease phenotype to match treatment intensity to relapse risk. That tailored approach helps prioritize who should receive early combination regimens versus stepwise escalation, and it informs monitoring frequency and referral thresholds.

Looking ahead, operationalizing remission will require validated risk tools, pragmatic combination protocols, and consensus on sustained-change definitions to guide trials and practice.