A Comprehensive Framework for Kidney Function Assessment: Summary of the National Institute of Diabetes and Digestive and Kidney Diseases Reimagining Kidney Function Assessment Workshop.

Current kidney function assessment primarily relies on estimation of glomerular filtration rate (GFR), which fails to capture the full spectrum of kidney functions and may limit accurate disease classification and targeted treatments. To propose innovative strategies to comprehensively assess kidney functions, aiming to improve our capacity to uncover pathophysiologic mechanisms and delineate novel disease subgroups, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) convened a workshop titled "Re-imagining Kidney Function Assessment." This workshop brought together experts to discuss current limitations and potential advancements in kidney function evaluation. Key themes emerged, including the following: (i) the need for standardized protocols for measured GFR using exogenous filtration markers, (ii) the potential of kidney functional reserve (KFR) and stress tests to reveal subclinical kidney dysfunction, (iii) the importance of assessing tubular secretion alongside glomerular filtration, (iv) the value of glomerular permselectivity measurements in predicting disease progression; and (v) the promise of integrating molecular profiling with functional assessments for precision medicine in nephrology. The workshop highlighted the critical need for a more comprehensive approach to kidney function assessment. Integrating diverse kidney function measures into tailored, individual-level assessments could lead to more accurate disease classification, targeted interventions, ability to track response to therapies, and improved patient outcomes. Future research should focus on developing and validating these novel assessment strategies to advance precision medicine in nephrology.