Preventing chronic kidney disease and maintaining kidney health: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Alberto Ortiz, Department of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz Universidad Autónoma de Madrid, Madrid, Spain; Red de Investigación Renal (RICORS2040) and PREVENTCKD consortium, Madrid, Spain.
José Manuel Arreola Guerra, Nephrology Department, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico; Instituto para la Atención Integral de Enfermedades Renales del Estado de Aguascalientes, Aguascalientes, Mexico.
Juliana C. Chan, Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Hong Kong, China; Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
Vivekanand Jha, George Institute for Global Health, University of New South Wales, New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
Holly Kramer, Departments of Public Health Sciences and Medicine, Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, Illinois, USA.
Susanne B. Nicholas, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Meda E. Pavkov, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Christoph Wanner, Department of Clinical Research and Epidemiology, Wuerzburg University Clinic, Wuerzburg, Germany; Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Leslie P. Wong, Rochester Regional HealthFollow
Michael Cheung, KDIGO, Brussels, Belgium.
Jennifer M. King, KDIGO, Brussels, Belgium.
Morgan E. Grams, Department of Medicine, New York University Langone School of Medicine, New York, New York, USA.
Michel Jadoul, Division of Nephrology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium.
Katherine R. Tuttle, Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA; Kidney Research Institute, University of Washington, Seattle, Washington, USA; Nephrology Division, University of Washington, Seattle, Washington, USA.

Department

Medicine

Document Type

Article

Publication Title

Kidney International

Abstract

To date, the primary focus of chronic kidney disease (CKD) care has been on managing disease progression, complications, and kidney failure. In contrast, maintaining kidney health and preventing CKD have received limited attention, despite their potential to save millions of lives, reduce health care costs, and lessen environmental burdens. The cardiovascular-kidney-metabolic (CKM) concept frames CKD as part of a complex, high-risk syndrome requiring global risk assessment and multifactorial intervention. CKD incidence along with CKM risk factors may be reduced by a healthy diet, physical activity, and a supportive environment. However, risk for CKD does extend beyond the cardiovascular-metabolic component, and residual risk persists despite healthy lifestyles and treatment of risk factors. Post hoc analyses of clinical trials suggest pharmacological interventions, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, may help to prevent or regress CKD in individuals with type 2 diabetes or obesity. Clinical trials are needed to validate these findings in broader high-risk populations. Personalized strategies to improve kidney health should include CKD risk prediction via targeted testing, genetic or biomarker assessments, shared decision-making, cost considerations, selection of therapeutics, and the potential for adverse effects. The overall goals of CKD prevention should prioritize a lifespan approach to risk evaluation along with safe, efficacious, and accessible interventions to maintain kidney health.

First Page

555

Last Page

571

DOI

10.1016/j.kint.2025.04.005

Volume

108

Issue

4

Publication Date

10-1-2025

Medical Subject Headings

Humans; Diabetes Mellitus, Type 2 (complications); Diet, Healthy; Disease Progression; Renal Insufficiency, Chronic (prevention & control, epidemiology, diagnosis); Risk Assessment; Risk Factors; Sodium-Glucose Transporter 2 Inhibitors (therapeutic use); Practice Guidelines as Topic

PubMed ID

40536455

Link to Full Text

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