TWIST1 and chronic kidney disease: Activation of hypoxia-inducible factor-1a/Twist–Bmi1 signaling in renal epithelial cells is associated with the development of chronic kidney disease (CKD) and may promote fibrosis by promoting EMT to regulate PI3K/AKT/snail signaling.[33] The PI3K/AKT pathway plays an important role in RF by mediating multiple signaling pathways and biological processes.