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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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Fig. 1: Patterns of CKD progression.


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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).

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Correspondence to Richard J. Johnson.

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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.

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Johnson, R.J., Rodriguez-Iturbe, B. Rethinking progression of CKD as a process of punctuated equilibrium. Nat Rev Nephrol 14, 411–412 (2018).

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