Towards Personalized Medicine in Chronic Kidney Disease: A Roadmap for the future of Early Detection, Diagnosis, and Management: A Consensus Roadmap from the EUTox, PerMedik and KidneyHealth networks

Abstract

Chronic kidney disease (CKD) affects more than 800 million individuals worldwide and represents one of the fastest‑growing causes of morbidity and mortality. Despite major therapeutic advances, CKD is frequently detected only after substantial and irreversible loss of kidney function. Current diagnostic strategies rely primarily on functional markers such as estimated glomerular filtration rate (eGFR) and albuminuria, which typically reflect relatively late stages of disease rather than early pathophysiological changes. In recent years, advances in molecular medicine, biomarker discovery, and digital health technologies have created opportunities to transform the management of CKD through personalized medicine. In particular, urinary proteomics, and integrative data analytics have enabled the identification of molecular signatures that precede clinical manifestations of disease, predict disease progression, enable differential diagnosis and inform therapeutic decision making. In parallel, genetic testing has emerged as a tool, particularly for kidney diseases with a monogenic aetiology. Here we propose a roadmap for implementing personalized medicine in CKD. We discuss diagnostic strategies that combine conventional clinical markers with emerging molecular tools such as urinary proteomics and genetic testing. We examine how digital health infrastructures, electronic health records, telemonitoring technologies, and clinical decision‑support systems can support precision nephrology in clinical practice. Finally, we review the economic implications of early detection and individualized treatment strategies, highlighting how earlier intervention can substantially reduce the burden of kidney failure and the need for kidney replacement therapy. The integration of clinical and molecular diagnostics, digital health platforms, and individualized therapeutic strategies has the potential to fundamentally transform kidney care. By enabling earlier detection, improved risk stratification, and targeted therapy, personalized medicine may significantly improve patient outcomes while enhancing the long‑term sustainability of healthcare systems.