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Biomarkers for incident CKD: a new framework for interpreting the literature

Nature Reviews Nephrology volume 9, pages 478–483 (2013)Cite this article

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Abstract

Biomarkers are a useful tool for the investigation of chronic kidney disease (CKD), although the design, analytical tools and outcomes used in many biomarker studies are suboptimal. In part, this situation might reflect a lack of appreciation of the nature of different biomarkers. A particular biomarker could, for example, be implicated in the pathogenesis of CKD because it is a physiological risk factor for declining kidney function, an indicator of impaired kidney function, or a marker of ongoing injury within the kidney. Such risk factors enable us to understand the process of disease and to identify treatment targets. By contrast, risk markers enable us to distinguish persons who will or will not develop CKD, even though the markers themselves are not required to be modifiable by (or directly involved in) the disease process. Accurate prediction of CKD risk will probably require a combination of biomarkers of several types, however. This Review offers a conceptual framework for interpreting the results of studies evaluating biomarkers of declining kidney function and incident CKD.

Key Points

  • Biomarkers can be classified as either risk factors, injury makers, or tools for risk prediction

  • A conceptual framework for interpreting results of biomarker studies in chronic kidney disease (CKD) can be generated

  • Our particular framework classifies biomarkers for CKD into four different categories: susceptibility factors, systemic risk factors, injury biomarkers, and biomarkers of early loss of glomerular filtration rate

  • It is likely that a combination of biomarkers will be required to improve risk prediction for the development of CKD

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Figure 1: Framework for classifying biomarkers of incident CKD.
Figure 2: Candidate biomarkers of kidney injury from specific regions of the nephron.

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Acknowledgements

The authors acknowledge research grant support (M. G. Shlipak as principal investigator) from the National Institutes of Health, Bethesda, MD, USA (5R01AG034853-04; 5R01AG027002-07; 5R01DK087961-02).

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Authors and Affiliations

  1. San Francisco Veterans Administration Medical Center, 4150 Clement Street, 111A1, San Francisco, 94121, CA, USA

    Michael G. Shlipak & Erica C. Day

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  1. Michael G. Shlipak
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Contributions

M. G. Shlipak and E. C. Day contributed equally to all aspects of the manuscript, including researching data for the article, writing the manuscript and review or editing of the manuscript before submission.

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Correspondence to Michael G. Shlipak.

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The authors declare no competing financial interests.

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Shlipak, M., Day, E. Biomarkers for incident CKD: a new framework for interpreting the literature. Nat Rev Nephrol 9, 478–483 (2013). https://doi.org/10.1038/nrneph.2013.108

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