Advances in the diagnosis and detection of chronic kidney disease.

Chronic kidney disease affects 788-844 million adults worldwide and is projected to become the fifth leading cause of death by 2040. Global burden estimates remain limited by ascertainment bias and inadequate access to testing, particularly in low-income and middle-income countries. Advances in detection include improved estimation of glomerular filtration rate (GFR) using cystatin C and the recognition of albuminuria as a key marker for screening and risk stratification. Kidney biopsy is improving diagnostic accuracy and prognostic prediction, and multiomics approaches are advancing our understanding of disease mechanisms and hold promise for precision medicine. Advanced imaging and artificial intelligence are enabling non-invasive diagnostics and case detection. Population screening strategies using estimated GFR and albuminuria are increasingly cost-effective, particularly with the availability of novel therapies. Disease-specific prediction models support individualised risk stratification and clinical decision-making. However, inequitable access, limited validation across diverse populations, gaps in biomarker standardisation, and insufficient health-care system capacity constrain implementation globally. Addressing these challenges requires coordinated investment in diagnostics, workforce training, laboratory infrastructure, and health-care system strengthening alongside continued technological advancement.