Nephrology 2050: an evidence-informed roadmap from precision prevention to kidney regeneration.

BACKGROUND: Chronic kidney disease (CKD) is projected to become one of the leading causes of premature mortality worldwide by 2050. Simultaneously, advances in CKM medicine, artificial intelligence (AI), molecular biology, and regenerative science are transforming nephrology from a reactive specialty focused on kidney failure into one centered on lifelong kidney health preservation. RECENT FINDINGS: This review synthesizes contemporary evidence describing four converging revolutions that are reshaping kidney medicine: precision prevention, digital and precision nephrology, advanced kidney replacement, and regenerative kidney medicine. Disease-modifying therapies, albuminuria-first strategies, AI-enabled risk prediction, multi-omics profiling, wearable biosensors, and digital twins are enabling earlier diagnosis and personalized intervention. In parallel, genetically engineered pig kidney xenotransplantation, bioengineered kidneys, and implantable artificial kidneys are redefining future kidney replacement by addressing the limitations of conventional dialysis and transplantation. FUTURE PERSPECTIVES: Rather than representing competing innovations, these technologies are expected to function as an integrated kidney health ecosystem, combining continuous risk assessment, precision therapeutics, regenerative biology, and individualized organ replacement. Successful implementation will require equitable access, sustainable healthcare systems, adaptive regulatory frameworks, and a digitally competent nephrology workforce. CONCLUSIONS: The future of nephrology will be defined not by a single disruptive innovation, but by the convergence of prevention, precision medicine, digital health, regenerative biology, and advanced kidney replacement technologies. By 2050, the greatest achievement of nephrology may not be replacing the failing kidney, but preventing kidney failure while preserving lifelong kidney health.