TNFR1/2 and KIM-1 consistently associate with faster eGFR decline, incident stage 3 CKD and ESKD across several cohorts (50–54,49, 53–55, 60, 64). Adding these markers to clinical models improves prediction of DKD progression and kidney failure. The KidneyIntelX.dkd test has undergone analytical and clinical validation and shows improved risk stratification for a composite endpoint of ≥40% eGFR decline or kidney failure in early DKD (56–59, 62, 63). This evidence concerns the gene TNFRSF1A and kidney failure.