Biomarkers for incident CKD: a new framework for interpreting the literature

Nat Rev Nephrol. 2013 Aug;9(8):478-83. doi: 10.1038/nrneph.2013.108. Epub 2013 Jun 11.


Biomarkers are a useful tool for the investigation of chronic kidney disease (CKD), although the design, analytical tools and outcomes used in many biomarker studies are suboptimal. In part, this situation might reflect a lack of appreciation of the nature of different biomarkers. A particular biomarker could, for example, be implicated in the pathogenesis of CKD because it is a physiological risk factor for declining kidney function, an indicator of impaired kidney function, or a marker of ongoing injury within the kidney. Such risk factors enable us to understand the process of disease and to identify treatment targets. By contrast, risk markers enable us to distinguish persons who will or will not develop CKD, even though the markers themselves are not required to be modifiable by (or directly involved in) the disease process. Accurate prediction of CKD risk will probably require a combination of biomarkers of several types, however. This Review offers a conceptual framework for interpreting the results of studies evaluating biomarkers of declining kidney function and incident CKD.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Acute-Phase Proteins / metabolism
  • Aldosterone / metabolism
  • Biomarkers / metabolism
  • Connective Tissue Growth Factor / metabolism
  • Creatinine / metabolism
  • Cystatin C / metabolism
  • Genetic Markers
  • Genetic Predisposition to Disease
  • Glomerular Filtration Rate
  • Hepatitis A Virus Cellular Receptor 1
  • Homocysteine / metabolism
  • Humans
  • Lipocalin-2
  • Lipocalins / metabolism
  • Membrane Glycoproteins / metabolism
  • Peptides / metabolism
  • Proto-Oncogene Proteins / metabolism
  • Receptors, Virus / metabolism
  • Renal Insufficiency, Chronic / diagnosis*
  • Renal Insufficiency, Chronic / metabolism*
  • Risk Factors
  • Transforming Growth Factor beta / metabolism
  • Trefoil Factor-3
  • Uromodulin / genetics
  • Uromodulin / metabolism


  • Acute-Phase Proteins
  • Biomarkers
  • Cystatin C
  • Genetic Markers
  • HAVCR1 protein, human
  • Hepatitis A Virus Cellular Receptor 1
  • LCN2 protein, human
  • Lipocalin-2
  • Lipocalins
  • Membrane Glycoproteins
  • Peptides
  • Proto-Oncogene Proteins
  • Receptors, Virus
  • TFF3 protein, human
  • Transforming Growth Factor beta
  • Trefoil Factor-3
  • UMOD protein, human
  • Uromodulin
  • Homocysteine
  • Connective Tissue Growth Factor
  • Aldosterone
  • Creatinine