Editorial: Insights in renal pharmacology: 2021

Kidney disease, either acute (AKI) or chronic (CKD), is an important contributor to morbidity and mortality from non-communicable diseases, and in under-resourced settings, also from communicable and maternal/neonatal diseases After the 1960s, the availability of renal replacement therapies (RRT) made possible the long-term application of life-saving but costly treatments for patients with end-stage kidney disease (ESKD) In many countries, however, the lack of access to RRT means an unacceptable premature death for millions of children and adults The global burden of CKD also extends well beyond the provision of RRT services. Indeed, acute and chronic loss of kidney function has been recognized as a risk factor for cardiovascular events independent of other conventional risk factors for cardiovascular disease There is evidence that slowing or halting kidney disease progression at early stages prevents the development of ESKD and cardiovascular complications, and can provide substantial economic benefits However, despite the available treatments and interventions, the global all-age burden of CKD has increased in the past three decades, highlighting the need for further research to dissect the in-depth pathophysiologic processes underlying kidney diseases and their progression to ESKD. Such mechanistic research is essential for the continued identification of targets for developing novel treatments for AKI and CKD and their consequences. The importance of this challenge has been further highlighted by the current COVID-19 pandemic, in which kidney involvement, through direct SARS-CoV-2 infection or as a consequence of multi-organ dysfunction, has emerged as a major risk factor for poor outcomes as well as one of the sequelae of long-COVID-19 (Perico et al., 2021a; Perico et al., 2021b).