Bridging Discovery with Clinical Practice: Biomarkers for Early Detection in Diabetic Kidney Disease

Diabetic kidney disease (DKD) is a major microvascular complication of diabetes and remains the leading cause of end-stage renal disease (ESRD) worldwide. It significantly contributes to reduced lifespan and cardiovascular morbidity in patients with both type 1 and type 2 diabetes. At present albuminuria and estimated glomerular filtration rate (eGFR) based on serum creatinine or cystatin C are the clinical biomarkers for diagnosis, prognosis, and monitoring. While albuminuria can be variable and is not always predictive (some patients progress with normoalbuminuria), eGFR decline occurs late and is a lagging indicator of disease progression, these markers have important limitations. Significant efforts have focused on identifying prognostic and surrogate endpoint biomarkers that could detect early kidney injury before functional decline. Predict progression to advanced DKD or ESRD, serve as surrogate endpoints in clinical trials to accelerate drug development. The past decade has seen an explosion of candidate biomarkers reflecting tubular injury, inflammation, fibrosis, and metabolic stress, yet none have successfully transitioned into regulatory-qualified or routinely used tools. This failure underscores persistent challenges in biomarker validation, assay standardization, and demonstrating clinical utility. As large-scale collaborative initiatives consortium drive harmonization and data integration, the field stands at a critical juncture: moving beyond discovery toward clinical translation will determine whether biomarkers can truly transform risk prediction and therapeutic development in DKD. To bridge the gap, a cultural shift toward reproducibility, open data sharing, and harmonized analytical platforms is needed. Future studies should prioritize longitudinal validation, evaluate biomarker-guided interventions, and engage early with regulatory agencies to define qualification pathways. We welcome original research, reviews, and perspectives articles addressing biomarker development, evolving therapeutic landscape—where risk stratification can identify patients most likely to benefit from novel therapies and help design more efficient, adaptive clinical trials. Novel biochemical and molecular biomarkers for DKD, Genomic, proteomic, and metabolomic approaches to early detection, Non-invasive diagnostic markers in urine, blood, or imaging, biomarker validation and translational studies, Clinical studies linking biomarkers with disease progression and outcomes, Integration of biomarkers with AI and predictive modelling. Topic editors: SURJYA NARAYAN DASH, Nikolaos Gkiourtzis Source: https://www.frontiersin.org/research-topics/77574/bridging-discovery-with-clinical-practice-biomarkers-for-early-detection-in-diabetic-kidney-disease