Advanced diabetic kidney disease (DKD) represents a critical stage in the progression of chronic kidney disease and remains one of the leading indications for kidney replacement therapy worldwide. With an aging population and increasing burden of metabolic and cardiovascular comorbidities, patients with advanced DKD frequently experience complex clinical challenges, including frailty, accelerated renal decline, cardiovascular complications, and heterogeneous responses to therapy. Despite recent advances in glucose-lowering and renoprotective treatments, many patients continue to progress toward dialysis or kidney transplantation.
Increasing evidence suggests that advanced DKD is not merely a late stage of kidney dysfunction, but rather a heterogeneous and dynamic disease state characterized by diverse pathological mechanisms, immune-inflammatory activation, metabolic dysregulation, and varying trajectories toward kidney replacement therapy. As a result, the transition from predialysis care to dialysis and transplantation requires increasingly individualized and multidisciplinary management strategies. At the same time, emerging studies on biomarkers, translational nephrology, and precision medicine are providing new opportunities to better understand disease progression and inform therapeutic decision-making. However, significant gaps remain in integrating mechanistic discoveries with real-world clinical management in advanced DKD.
This Research Topic aims to provide a comprehensive platform for integrating clinical management, translational research, and mechanistic advances in advanced DKD across the full care continuum from predialysis management through dialysis and transplantation. By bridging clinical observations with emerging insights into disease heterogeneity, immune-inflammatory mechanisms, and metabolic dysregulation, we seek to improve the understanding of progression patterns and support more precise, individualized therapeutic approaches. Particular emphasis will be placed on translational studies that connect mechanistic discoveries with clinical care optimization, dialysis strategies, and long-term renal outcomes. This collection will also highlight multidisciplinary management strategies, real-world clinical practice, biomarkers, and precision medicine approaches for patients with advanced DKD. Ultimately, we hope this Research Topic will foster more integrated and patient-centered approaches to advanced DKD management worldwide.
We welcome original research articles, reviews, and perspective papers addressing, but not limited to, the following topics: • Predialysis care and progression management in advanced DKD • Timing, selection, and optimization of kidney replacement therapy • Peritoneal dialysis, hemodialysis, integrated dialysis strategies, and kidney transplantation in DKD • Cardiovascular, metabolic, and frailty-related complications in advanced DKD • Disease heterogeneity, biomarkers, and predictive models • Individualized therapeutic decision-making and precision medicine approaches • Immune-inflammatory mechanisms, metabolic dysregulation, and fibrosis progression in DKD • Translational nephrology, multi-omics technologies, artificial intelligence, and real-world clinical studies in advanced DKD Submissions integrating mechanistic insights with clinical management strategies, translational perspectives, or multidisciplinary approaches to advanced DKD care are particularly encouraged.
Article types and fees
This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:
Brief Research Report
Case Report
Clinical Trial
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FAIR² Data
General Commentary
Hypothesis and Theory
Methods
Mini Review
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Article types
This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:
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