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suPAR predicts incident CKD and ESKD in adults with preserved kidney functionsuPAR Levels May Predict Risk of Chronic Kidney Disease

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Key Takeaway
Note that suPAR predicts CKD and ESKD in adults with preserved function, but lacks current evidence for routine use.

This systematic review synthesized evidence from 31,416 patients to evaluate the prognostic value of soluble urokinase plasminogen activator receptor (suPAR) in various kidney conditions. The review found that suPAR significantly predicted incident CKD in adults with preserved kidney function (OR 3.13; 95% CI 2.11-4.65) and ESKD (HR 1.53; 95% CI 1.10-2.12). While suPAR provided a modest gain in discrimination for CKD and ESKD (C-statistic increase 0.027-0.08), it failed to distinguish FSGS from other glomerular diseases.

In pediatric CKD and metabolic cohorts, suPAR lost its independent association after adjustment for inflammatory markers or baseline kidney function. Furthermore, while cardiovascular outcomes showed directionally consistent associations, these findings were observational and of low certainty. The authors noted several limitations, including a lack of sex-stratified analyses and the fact that FSGS evidence relied on a single moderate-quality study.

Clinical utility is currently limited. The authors state that routine clinical measurement of suPAR is not supported until assay harmonization, prospective validation with decision curve analysis, and trials of suPR-targeted therapy are conducted.

How this fits prior evidence

This systematic review addresses a gap in identifying biomarkers for kidney disease progression. It builds upon the finding that multiple biomarkers show potential associations with kidney function decline in patients with type 2 diabetes. While the current review identifies suPAR as a predictor for CKD and ESKD in adults with preserved function, it notes that suPAR loses independent association in metabolic cohorts when adjusted for baseline factors.

Researchers reviewed data from over 31,000 people to see if a specific marker called suPAR could predict kidney issues. The study found that higher suPAR levels were linked to a higher risk of developing chronic kidney disease and end-stage kidney disease in adults who still had preserved kidney function. However, the marker did not help distinguish certain specific types of kidney diseases, such as FSGS, from others.

While the data showed some links to heart health, these findings were based on observational data and are considered to have low certainty. Additionally, the marker lost its predictive power in children and certain metabolic groups when other factors like inflammation were taken into account.

It is important to note that this research is currently limited by a lack of diverse data and consistent testing methods. Because of these gaps, doctors do not currently use suPAR as a routine tool for clinical decisions. More large-scale studies and consistent testing methods are needed before it can be used reliably in everyday medical practice.

What this means for you:
suPAR levels may predict kidney disease risk, but more research is needed before it can be used in routine care.

Common questions

What is suPAR and can it predict kidney disease?

suPAR is a marker that researchers found can predict incident chronic kidney disease and end-stage kidney disease in adults with preserved kidney function. However, it did not show a clear way to distinguish specific diseases like FSGS from other types of kidney problems.

Is suPAR a reliable tool for doctors to use right now?

No, routine clinical measurement of suPAR is not currently supported for medical decisions. Doctors need more consistent testing methods and larger studies to prove its reliability before it can be used as a standard tool in a clinic.

Does suPAR help predict heart problems?

The study found some links between suPAR and cardiovascular outcomes. However, these results were based on observational data and are considered to be of low certainty, meaning they are not yet strong enough to be used for certain medical conclusions.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
BackgroundSoluble urokinase plasminogen activator receptor (suPAR), a circulating marker of innate immune activation, has been proposed as a risk biomarker in chronic kidney disease (CKD) and related cardiometabolic conditions, but its clinical utility remains uncertain.MethodsWe performed a systematic review according to PRISMA 2020 and the Synthesis Without Meta-analysis (SWiM) guideline, searching PubMed, Embase, Web of Science, Scopus, the Cochrane Library, medRxiv, ClinicalTrials.gov, and WHO ICTRP from inception to May 15, 2026. Two reviewers independently screened records, extracted data, and assessed quality using the Newcastle-Ottawa Scale, the JBI checklist, RoB 2, and QUADAS-2; certainty of evidence was rated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.ResultsTwenty studies comprising 31,416 participants were included. In adults with preserved kidney function, elevated suPAR predicted incident CKD (adjusted odds ratio (OR) 3.13 for the highest versus lowest quartile, 95% confidence interval (CI) 2.11–4.65) and end-stage kidney disease (ESKD) (adjusted hazard ratio (HR) 1.53 for the highest versus lowest tertile, 95% CI 1.10–2.12), but the gain in discrimination was modest (absolute C-statistic increase 0.027–0.08) and no study performed decision curve analysis (DCA). suPAR did not distinguish focal segmental glomerulosclerosis (FSGS) from other glomerular diseases, and prognostic evidence in FSGS rested on a single moderate-quality study. In pediatric CKD and in metabolic cohorts, suPAR lost independent association after adjustment for baseline kidney function or inflammatory markers. Associations with cardiovascular outcomes were directionally consistent but observational and of low certainty. No study reported sex-stratified analyses.ConclusionsRoutine clinical measurement of suPAR is not currently supported; assay harmonization, sex-disaggregated analyses, prospective validation with decision curve analysis, and trials of suPAR-targeted therapy are needed first.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261320503, identifier CRD420261320503.
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