Rethinking progression of CKD as a process of punctuated equilibrium

Although most nephrologists spend their days managing patients with acute and chronic kidney disease (CKD), it is useful to occasionally consider the landscape of our current treatment approach. Here, we present the hypothesis that the major mechanisms that drive CKD are changing and will necessitate new approaches to manage this disease.

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Research conducted in the authors’ laboratories is funded by grants from FONACYT, Venezuela (FC-2005000283, to BR-I) and Asociación de Amigos del Riñón (to BR-I) and by the National Institutes of Health NIDDK Institute (1RO1DK109408-01A1 and R01 DK108859-01).

Author information


  1. Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    • Richard J. Johnson
  2. Nephrology Service Hospital Universitario, Universidad del Zulia, Instituto Venezolano de Investigaciones Científicas (IVIC-Zulia), Maracaibo, Venezuela

    • Bernardo Rodriguez-Iturbe


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Competing interests

R.J.J. is on the Scientific Board of XORT Therapeutics, has patent and patent applications related to lowering uric acid or blocking fructose metabolism in the treatment of hypertension and metabolic disorders, and is a member of Colorado Research Partners, LLC, which is developing inhibitors of fructose metabolism. B.R.I. declares no competing interests.

Corresponding author

Correspondence to Richard J. Johnson.