A Comprehensive Review of Advanced Biomarkers for Chronic Kidney Disease in Older Adults: Current Insights and Future Directions.

Chronic kidney disease (CKD) is a growing health concern, particularly in older adults, due to its high prevalence and association with increased morbidity and mortality. Early detection and effective management are crucial to slowing disease progression and reducing complications such as cardiovascular events and end-stage renal disease (ESRD). Traditional biomarkers, including serum creatinine and estimated glomerular filtration rate (eGFR), often have limitations in older populations, where age-related physiological changes can obscure early signs of kidney dysfunction. Advanced biomarkers offer a more precise and comprehensive understanding of kidney health, providing insights into pathological processes such as inflammation, fibrosis, oxidative stress, and tubular injury. These biomarkers have the potential to enhance early diagnosis, predict disease progression, and inform personalized treatment approaches, particularly in the elderly. This review explores the current landscape of advanced biomarkers for CKD in older adults, highlighting their clinical utility and limitations. Key biomarkers, including those related to inflammation (C-reactive protein, interleukin-6), fibrosis (transforming growth factor-beta, collagen degradation products), oxidative stress (F2-isoprostanes, malondialdehyde), and tubular injury (kidney injury molecule-1, neutrophil gelatinase-associated lipocalin), are examined in the context of CKD. Emerging technologies, such as multi-omics and machine learning, are also discussed as they offer new opportunities for biomarker discovery and integration into clinical practice. While challenges remain, including the need for longitudinal studies and better standardization, advanced biomarkers hold promise for transforming CKD management in older adults, paving the way for earlier detection, better risk stratification, and more targeted therapeutic interventions.