Chronic Kidney Disease: A Benefit-Risk Panorama of Baricitinib through Integrating Network Toxicology, Molecular Docking and Real-World Evidence

Background Chronic kidney disease (CKD) poses substantial global morbidity and mortality burdens, yet current therapeutic strategies fail to halt or reverse renal fibrosis. Baricitinib, a selective JAK1/JAK2 inhibitor, demonstrates dual anti-inflammatory and anti-fibrotic properties in autoimmune conditions; however, its comprehensive therapeutic utility and safety constraints in CKD remain systematically uninvestigated. Methods Computational toxicity was assessed using ProTox3.0 and ADMETlab2.0 platforms. Network toxicology identified shared Baricitinib-CKD targets through integrated screening of ChEMBL, STITCH, SwissTargetPrediction, GeneCards, OMIM and TTD databases. Protein-protein interaction (PPI) networks were constructed using STRING and topologically analyzed via Cytoscape to pinpoint core targets (nodal degrees exceeding twice the median value). Molecular docking validation was performed with CB-Dock2. Adverse event (AE) data from 2018 to 2024 were retrieved from the Food and Drug Administration Adverse Event Reporting System (FAERS), coded according to the Medical Dictionary for Regulatory Activities (MedDRA), and evaluated by calculating reporting odds ratios (RORs) at both the System Organ Class (SOC) and Preferred Term (PT) levels. Results Integrated toxicity assessment predicted high respiratory and acute toxicity risks. Enrichment analysis demonstrated significant suppression of JAK-STAT/MAPK inflammatory cascades (adjusted p -value = 1.42 × 10 ^− 23 ) and TGF-β/Smad3 fibrotic signaling (adjusted p -value = 6.80 × 10 ^− 34 ). Integration revealed 229 shared targets, with AKT1, SRC, STAT3, EGFR, and ESR1 identified as core hubs. High-affinity binding was confirmed (Vina scores: SRC: -8.4; ESR1: -8.1; EGFR: -7.5; AKT1: -7.0; STAT3: -6.9 kcal/mol). FAERS analysis of 6,006 Baricitinib-related reports revealed elevated RORs for infections (ROR = 3.57, 95% CI: 3.41–3.74) and thromboembolic events (e.g., pulmonary artery thrombosis: ROR = 37.22, 95% CI: 15.38–90.07), while renal AEs showed a modestly reduced signal (ROR = 0.86, 95% CI: 0.75–0.98), suggesting a potential nephroprotective effect. Conclusion Baricitinib may benefit CKD patients by concurrently attenuating inflammatory cascades and fibrotic pathways. However, integrated computational toxicology predicts high respiratory and acute toxicity risks, alongside significant real-world signals for infections and thrombosis. These findings necessitate cautious dose reduction (30–50% in advanced CKD) with vigilant multi-organ toxicity monitoring. This risk-stratified approach informs personalized Baricitinib therapy in CKD and future trial design.