Inflammation in CKD: Clinical relevance and the role of anti-inflammatory therapies

Chronic kidney disease (CKD) may progress to kidney failure requiring dialysis or kidney transplantation. However, it is also a major amplifier of cardiovascular risk. Although inflammation has long been recognized as a feature of CKD, its clinical relevance remains uncertain because inflammatory biomarkers are not routinely used to guide nephrology care and targeted anti-inflammatory therapies are not yet established in this population. This review summarises the biological basis, risk-stratification relevance, biomarker landscape, and potential therapeutic implications of inflammation in CKD, emphasising the distinction between biological plausibility, prognostic association, biomarker modulation strategies, and evidence of clinical benefit. This reviews highlights IL-6-targeted therapies, including the ongoing phase 3 POSIBIL6ESKD trial with clazakizumab in patients receiving maintenance dialysis and the preliminary results reported to date of the phase 3 ZEUS trial with ziltivekimab in patients with atherosclerotic cardiovascular disease, non-dialysis CKD, and systemic inflammation (high-sensitivity C-reactive protein [hsCRP] ≥2 mg/L) with neutral results. Evidence from phase 2 trials suggests that targeting inflammation directly, particularly IL-6, may improve nutritional parameters, anemia, iron utilization, and lipid profiles by reducing lipoprotein(a) levels in CKD patients. Whether these biological and metabolic effects translate into meaningful cardiorenal benefit remains to be established by ongoing and future randomized clinical trials.