A recent review from experts who attended the 2023 Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference calls for a major change in how chronic kidney disease (CKD) is addressed. Instead of primarily managing the disease and its complications, care should focus on maintaining kidney health and preventing CKD from developing in the first place.
The authors highlight that preventive strategies have been largely overlooked, despite their potential to save millions of lives, reduce healthcare costs, and lower environmental impacts. CKD is projected to become the fifth leading cause of death globally by 2040. Currently, about half of CKD-related deaths occur because patients lack access to dialysis or kidney transplants, which are extremely costly. Early intervention is therefore critical.
CKD is closely linked to cardiovascular and metabolic health. High blood pressure, high blood sugar, dyslipidemia, and obesity all increase the risk of both CKD and heart disease. Many of these risk factors can be managed through diet, exercise, and supportive environments. The authors suggest that CKD prevention could follow a model similar to diabetes or heart disease prevention, where early risk identification triggers lifestyle interventions.
By the time CKD is diagnosed, significant kidney damage has usually already occurred. The reviewers note that the disease’s early, “subclinical” stage presents a key opportunity for intervention, when treatments are likely to be most effective.
Lifestyle choices strongly influence kidney health. Diets high in sodium, red meat, processed foods, and sugary drinks increase CKD risk, while infections, environmental toxins, low nephron counts, and prolonged heat exposure without adequate hydration can also harm the kidneys. Screening programs could help identify people at high risk, though further research is needed to determine the most effective and cost-efficient approaches. Genetic testing and biomarkers may improve risk prediction in the future, but these methods still need validation.
Both lifestyle changes and medications can help prevent or even reverse CKD in some cases. Regular physical activity reduces the risk of CKD as well as type 2 diabetes and related complications. A post-hoc analysis of the Look AHEAD trial found that participants with obesity and type 2 diabetes who followed an intensive lifestyle program lost slightly more weight than those receiving standard support, but showed a 31% lower risk of developing severe CKD.
Certain medications can also protect kidney health in people with obesity or type 2 diabetes. These include sodium-glucose cotransporter-2 inhibitors (SGLT2i), nonsteroidal mineralocorticoid receptor antagonists, and GLP-1 receptor agonists. In contrast, traditional glucose-lowering drugs such as metformin, insulin, sulfonylureas, or DPP-4 inhibitors have not been shown to prevent CKD.
The consensus among experts is that kidney health should be managed across the lifespan, taking into account physical, mental, and social factors. Their recommendation: focus on early risk prediction and ensure safe, effective, and accessible interventions to maintain kidney health for all.
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