Addressing the Growing Burden of Chronic Kidney Disease

Credit: Adobe Stock/mi_viri

Chronic kidney disease (CKD) is estimated to affect about one in seven people — more than 35 million adults in the United States alone. As the condition is often underdiagnosed and therefore undertreated, CKD progresses silently until it reaches advanced stages, ultimately leading to kidney failure. These numbers are expected to increase as risk factors associated with kidney disease, including hypertension, diabetes and obesity, are also on the rise.

CKD remains widely underrecognized by the public, often delaying crucial interventions that could help slow its progression and improve patient outcomes. Without earlier detection and more effective treatments, the burden of CKD will continue to grow. While recent advancements in diagnostics, therapeutics and public awareness initiatives provide optimism, addressing the gaps in CKD care requires a collaborative effort from various stakeholders.

The Growing Epidemic of CKD

Pranav Garimella, MBBS, MPH, chief medical officer of the American Kidney Fund, emphasizes three key reasons why CKD is a public health crisis today:

1. CKD is extremely common.
2. The consequences of CKD can be devastating, both economically and personally.
3. A lack of awareness leads to late-stage diagnoses, making treatment more challenging.

“Almost 90% of people with CKD don’t know they have the disease,” says Garimella. “This lack of awareness prevents them from taking steps to slow its progression, resulting in advanced kidney disease. Currently, more than 800,000 Americans suffer from kidney failure.”

The global impact is even more severe. Salvatore Viscomi, M.D., chief executive officer of Carna Health, estimates that over 1 billion people worldwide may have CKD. “By 2040, CKD is expected to be the fifth-leading cause of mortality globally. In some places, it already is,” he warns. “We’re seeing more cases, younger patients and emerging risk factors such as heat stress. This crisis is worsening.”

The Role of Diabetes, Hypertension and Obesity

A major driver of the CKD epidemic is the rise in obesity and diabetes, which significantly increase CKD risk. As these conditions surge, more individuals develop kidney disease, often without symptoms or awareness until significant damage has occurred.

“Diabetes and high blood pressure are the most common causes of CKD in the U.S.,” explains Garimella. “High blood sugar damages the blood vessels and filters in the kidneys, impairing their function. Obesity adds further strain, compounding the problem. Managing these conditions — both individually and together — is critical to reducing CKD prevalence.”

Joseph Vassalotti, M.D., associate clinical professor of medicine in the division of nephrology at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation, emphasizes the close link between kidney disease and cardiovascular disease. “A sedentary lifestyle, abdominal fat and chronic inflammation create a vicious cycle involving kidney disease, cardiovascular disease and Type 2 diabetes. Addressing cardiovascular health is essential in preventing and managing CKD.”

The Importance of Early Detection

Because CKD progresses silently, many patients don’t realize they have it until significant damage has occurred. By then, treatment options become more limited, and the risk of complications increases dramatically.

“Early detection and treatment are crucial,” says Garimella. “If CKD is caught early, progression can be slowed. New treatments are extending the time before kidney failure, potentially by years or even decades. But by the time symptoms appear — such as fatigue, swelling and high blood pressure — irreversible damage has often occurred.”

Viscomi agrees, emphasizing the importance of screening. “When CKD is identified early, lifestyle changes or medications can slow its progression. The goal is to prevent people from ever reaching the point of needing dialysis or a transplant.”

Despite the benefits of early detection, routine screening remains inconsistent, leaving millions undiagnosed. Limited public awareness further exacerbates the problem, as many at-risk individuals don’t seek medical attention until it’s too late.

A Collaborative Approach to CKD Management

Effectively managing CKD requires a multidisciplinary, patient-centered approach. Unfortunately, care is often fragmented, making it difficult for patients to navigate the system.

“Primary care physicians are vital in early detection,” says Garimella. “They conduct routine checkups, test kidney function, and manage risk factors like diabetes and hypertension. However, many patients aren’t referred to nephrologists until later stages.”

Viscomi highlights the importance of nephrologists in CKD care but acknowledges the shortage of specialists. “In many parts of the world, there aren’t enough nephrologists to manage early-stage disease. Instead, they oversee programs and provide guidance to primary care doctors, nurses, pharmacists and other health care professionals on the front lines.”

Beyond medical professionals, patient engagement is critical. Aja Best, a kidney transplant recipient, describes her experience navigating CKD care. “I wanted to be a partner in my care, but the system often felt impersonal — more instructional than collaborative.”

She challenged her providers to tailor care to her lifestyle and goals. Over time, she found clinicians who supported her active role in managing her condition.

The Path Forward: Prevention, Treatment and Awareness

Proven screening methods, effective therapies and multidisciplinary approaches exist to slow CKD progression — but they must be used more consistently and equitably. Drug development for CKD is also advancing, with several new treatments introduced in recent years.

We now have multiple pharmacological interventions — angiotensin-converting enzyme (ACE) inhibitors, sodium-glucose cotransporter 2 (SGLT2) inhibitors, mineralocorticoid receptor antagonists (MRAs) and glucagon-like peptide-1 (GLP-1) receptor agonists — all of which can help protect kidney function.

“It’s an exciting time in nephrology,” Garimella emphasizes.

However, treatment alone is not enough. Increasing public awareness, improving early detection and ensuring access to care are crucial steps in addressing the CKD crisis.

“The biggest challenge is awareness,” says Viscomi. “In some countries, as few as 2% of patients with CKD know they have the disease. Because early CKD is asymptomatic, people simply don’t think about it. We need to change that mindset.”

Chronic kidney disease is a silent but growing threat. By prioritizing early detection, advancing treatment options, and fostering collaboration among health care providers and patients, we can change the trajectory of this disease and improve the lives of millions.

This transcript was edited for clarity.