Introduction and context: the past, present and future of CKD research

Chronic kidney disease (CKD) and its progression to the need for renal replacement therapy (RRT) are important causes of distress for patients and their families, but also a very important economic and logistic burden for society. Even more importantly, a great majority of CKD patients die due to cardiovascular disease (CVD) before reaching the need for RRT. Thus, nephrologists should focus their efforts not only on preventing or at least delaying CKD progression, but also in reducing the risk of CVD. Unfortunately, CKD is not a homogeneous disease and its progression varies considerably, even among patients with the same underlying disease and the same level of renal function, making its therapeutic approach more and more complicated. This complexity in outcomes has led to vigorous efforts of groups of outstanding nephrologists and their collaborators working within the realm of basic science, clinical research and knowledge translation. The high impact that CKD and its complications have on organizational and economic systems has prompted enquiry into all aspects of care delivery from screening to multidisciplinary care. Given the breadth and depth of the problem internationally, the current special issue of NDT is focused entirely on the public health and research agenda for CKD. It is hoped that this edition will increase the awareness of readers regarding the immensity of problems still facing the nephrology community while acknowledging the strides made to date. In the last 30 years, important progress has been made regarding the physiology of CKD progression and treatment.