Society of Diabetic Nephropathy Prevention Journal of Nephropharmacology 2345-4202 15 2 2026 07 01 When kidneys and joints collide; bidirectional pathogenic crosstalk in CKD and osteoarthritis; from molecular mechanisms to clinical management e12880 e12880 10.34172/npj.12880 EN Kianoush Saberi https://orcid.org/0000-0002-4292-2252 Sevara Mukhammadieva https://orcid.org/0000-0002-5010-257X Sarvinoz Isirgapova https://orcid.org/0009-0004-7717-8517 Davron Khozhimetov https://orcid.org/0000-0002-7468-7023 Qaxramon Mashrapov https://orcid.org/0009-0009-6567-9855 Maxbuba Nazarova https://orcid.org/0000-0002-7214-9686 Lola Xamdamova https://orcid.org/0009-0003-1595-8940 Dildora Mengliyeva https://orcid.org/0009-0004-4679-3162 Sharifa Rahmonova https://orcid.org/0009-0001-8602-4593 Elham Kebriyaei https://orcid.org/0009-0002-4557-7412 Journal Article 10.34172/npj.12880 2026 04 17 2026 06 17 Chronic kidney disease (CKD) and osteoarthritis frequently coexist, particularly in aging populations, imposing a significant burden on patients and healthcare systems. Emerging evidence reveals a complex, bidirectional pathogenic crosstalk between these conditions, extending beyond shared risk factors like aging and obesity. In CKD, the accumulation of uremic toxins, systemic inflammation driven by cytokines and disturbances in mineral bone disorder (CKD-MBD), characterized by dysregulated fibroblast growth factor-23 (FGF23), Klotho deficiency, hyperparathyroidism, and vascular calcification, actively contribute to accelerated articular cartilage degradation, synovitis, and subchondral bone sclerosis, thereby promoting osteoarthritis initiation and progression. Conversely, osteoarthritis-induced chronic pain, joint dysfunction, and reduced mobility lead to physical inactivity, sarcopenia, and metabolic dysregulation, potentially exacerbating CKD progression through strengthened inflammation, insulin resistance, and cardiovascular strain. This bidirectional relationship creates significant clinical challenges; since, standard osteoarthritis analgesics like non-steroidal anti-inflammatory drugs are nephrotoxic and contraindicated in chronic renal failure, since CKD-related complications complicate joint replacement surgery and rehabilitation. Effective management requires a paradigm shift towards integrated care. Treatment modalities include aggressive CKD-MBD control, cautious selection of joint-friendly analgesics, structured exercise programs tailored to renal and joint limitations, and early specialist collaboration. Identification of these intertwined molecular pathways is necessary for developing targeted therapies that simultaneously protect both renal and musculoskeletal health, eventually improving outcomes for this high-risk comorbid population.