Kidney failure is a life-threatening condition affecting over 2.5 million people worldwide, with a doubling of that number expected by 2030.1 Current kidney replacement therapies are limited to dialysis or transplantation. Dialysis can be done continuously (such as chronic ambulatory peritoneal dialysis) or intermittently multiple times per week (hemodialysis). Both dialysis options are expensive and limited in their efficacy as they cannot substitute all functions of the native kidneys. Hence, dialysis has a poor outcome and is still associated with high mortality rates. Furthermore, dialysis is demanding for patients living with kidney failure and has a significant impact on quality of life. In terms of kidney replacement, a kidney transplant comes closest to replacing the functions of the native kidneys, but there are by far not enough donor kidneys to treat all. And patients who do receive a donor kidney are exposed to the lifelong burden of taking immunosuppressive medication, thus, always facing the risk of transplant rejection.

Rational approaches to reduce the burden of end-stage kidney disease (ESKD) are prevention, and/or slowing the rate of progression. Mild kidney disease mostly goes unnoticed, whereas it significantly and independently increases the risk of cardiovascular mortality. Kidney disease has been described as the most neglected chronic disease, which calls for improved global partnerships for healthcare financing and regulation to improve patient outcomes, highlighting the need for innovation in this field.

Early detection and treatment of progressive kidney disease is key to reducing the need for kidney replacement therapies. But alongside prevention, there is also an urgent need to leverage innovations for kidney replacement in order to improve the quality of the treatment while containing the high costs.

Worldwide, we urgently need progress for prevention and/ or slowing progression, as well as for the development of alternatives to dialysis (as currently practiced) for the millions of people with ESKD who currently face a mortality risk worse than for most cancers.