Integrative therapeutic strategies in chronic kidney disease: from precision to regeneration

Chronic kidney disease (CKD) affects over 850 million individuals globally, largely driven by aging, diabetes, and hypertension. Current therapeutic strategies primarily focus on renal replacement and symptom management, with limited capacity for prevention or tissue regeneration. This review addresses the urgent need for integrative, individualized frameworks in CKD management, encompassing precision medicine, regenerative therapies, multidisciplinary care (MDC), and nutraceutical interventions. We conducted a narrative synthesis of the recent literature across four domains: (1) precision medicine utilizing omics-based biomarkers (e.g., suPAR, Col5a1) for early detection and stratified risk profiling; (2) regenerative strategies including mesenchymal stem cells, induced pluripotent stem cells, and bioengineered tissues, which show anti-inflammatory and nephroprotective effects; (3) MDC models integrating nephrologists, nurses, dietitians, and social workers, which are linked to improved outcomes in mortality, dialysis initiation, and hospitalizations; and (4) emerging nutraceuticals derived from culinary spices (e.g., curcumin, allicin, flavonoids, capsaicin), which demonstrate antioxidative, anti-inflammatory, and antifibrotic activity, including modulation of the gut–kidney axis. Preliminary studies indicate that combining these strategies may yield synergistic benefits: biomarkers enhance targeting, MDC improves adherence and coordination, and bioactives offer molecular-level modulation. Early-phase trials report improvements in estimated glomerular filtration rate (eGFR), systemic inflammation, patient adherence, and cost-efficiency. Additionally, representative genetic panels, such as COL4A3–5, NPHS1/2, WT1, PKD1/2, UMOD, HNF1B, APOL1, and complement-related genes (e.g., CFH, C3), are increasingly used in CKD phenotyping. Their clinical utility spans early diagnosis, prognostication, familial risk assessment, and therapeutic stratification across glomerular, cystic, tubulointerstitial, syndromic, and APOL1-associated nephropathies. Integrative, personalized therapies promote proactive, reparative, and sustainable CKD management.