Chronic Kidney Disease: Current Insights into Epidemiology, Molecular Mechanisms, Biomarkers and Management

Chronic Kidney Disease (CKD) affects approximately 14% of adults globally and is a progressive, multifactorial disorder of the kidney characterized by structural or functional nephron impairment. CKD has been linked with several other comorbidities, including diabetes, hypertension, obesity, and aging, which increase the complexity of the disease. Because early-stage CKD is frequently asymptomatic, diagnosis is frequently delayed, resulting in increased risk of progression to End-Stage Kidney Disease (ESKD). Diagnostic tools such as estimated glomerular filtration rate (eGFR) and albuminuria remain limited for early diagnosis, making the condition more threatening. Recent molecular biology research has identified chronic inflammation, oxidative stress, mitochondrial dysfunction, fibrosis, and regulated cell death as central mechanisms driving CKD progression. Novel biomarkers, including kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and cystatin C, along with multi-omics technologies, have created opportunities for earlier diagnosis, risk stratification, and precision-based therapies, although most remain investigational rather than established for routine clinical use. Current treatment approaches, such as renin–angiotensin–aldosterone system inhibitors and sodium-glucose cotransporter-2 inhibitors, can slow but not halt disease progression. This review describes CKD epidemiology, molecular mechanisms, current and experimental diagnostics, advances in therapeutic strategies, and future directions. It emphasizes the role of molecular biomarkers and precision medicine in optimizing patient care and outcomes.