Lipids and Lipid Metabolites in the Diagnosis, Risk Prediction and Treatment of Chronic Kidney Disease and Acute Kidney Injury: A Narrative Review.

Abstract

Background: Acute kidney injury (AKI) and chronic kidney disease (CKD) represent the principal nephrological conditions encountered globally. Despite the diverse etiologies and pathogeneses associated with these disorders, both are characterized by disruptions in lipid metabolism, largely due to the frequent involvement of inflammatory mechanisms in the onset and progression of acute and chronic renal dysfunction. This review will examine two key areas: the diagnostic and prognostic relevance of lipids and their metabolites, particularly fatty acids (FAs), in AKI and CKD; and the potential therapeutic application or external modulation of lipid components in the management of these diseases. The following databases were utilized for reference identification: PubMed, Web of Science, Cochrane Library, and Scopus. The search period spanned from 2010 to 2025. The search terms employed in various combinations included "CKD," "AKI," "CRP," "inflammation," "serum fatty acids," "lipids," "lipid profile."

Summary: A total of 28 studies were selected for further analysis. Twelve studies focused on diagnostics and prognostics in CKD, while nine addressed treatment strategies for CKD. The number of studies performed in AKI 5 (diagnostics/prognostics) and 2 (therapy). In CKD, free FAs may help predict three clinical outcomes: mortality, progression of CKD, and cardiovascular risk. However, therapy-related references remain inconsistent, anti-proteinuric effects of omega-3 FAs have been reported sporadically. The current data on lipids in AKI diagnostics, prognostics, and therapy are still too limited to draw any definitive conclusions.

Key messages: Free FAs enable the prediction of significant outcomes associated with CKD. Omega-3 FAs may exhibit anti-proteinuric properties. Evidence regarding FA-based diagnostics and therapies in acute kidney injury remain limited.