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World Kidney Day 2026: Are We Detecting CKD Early Enough — And Using Available Cardiorenal Therapies?

Chronic kidney disease (CKD) affects an estimated 9%–10% of the global population, with more than 850 million people worldwide living with kidney disease. Yet in real-world practice, many patients are still diagnosed only after substantial kidney damage has occurred.

On World Kidney Day 2026, new guideline updates, emerging trial data, and early innovations in transplantation are raising an important question:

Are we identifying and managing CKD early enough in everyday clinical practice?

Three developments are shaping the current CKD landscape.

 

Key Development 1: Many CKD Patients Are Still Diagnosed Late

A real-world analysis of more than 29 million U.S. patients with documented CKD from the LINQ Real-World Data Explorer (10-year lookback) found that Stage 3 was the most common stage at diagnosis, while fewer than 2 million patients were identified at Stage 1.

The KDIGO 2024 guideline emphasizes earlier identification of CKD and recommends annual assessment of eGFR and albuminuria in people with diabetes beginning at the time of type 2 diabetes diagnosis.

 

Key Development 2: Guideline-Recommended Therapies Continue to Expand

KDIGO 2024 recommends assessing CKD risk in individuals with:

  • hypertension
  • diabetes
  • cardiovascular disease

Treatment guidance includes:

  • SGLT2 inhibitors for adults with CKD and eGFR ≥20 mL/min/1.73 m², particularly those with albuminuria or heart failure
  • GLP-1 receptor agonists with cardiovascular benefit for adults with type 2 diabetes and CKD who remain above glycemic targets despite metformin and SGLT2 inhibitor therapy

These recommendations reflect a growing emphasis on earlier cardiorenal risk reduction across the course of disease.

 

Key Development 3: New Evidence and Emerging Approaches Are Expanding the CKD Landscape

FLOW Trial (NEJM 2024)

Among 3,533 patients with type 2 diabetes and CKD, investigators reported:

  • 24% relative risk reduction in the composite kidney outcome
  • 1.16 mL/min/1.73 m² per year slower decline in eGFR
  • 20% reduction in all-cause mortality

At baseline, 15.6% of participants were receiving SGLT2 inhibitors.

 

IgA Nephropathy: Updated KDIGO 2025 Guidance

KDIGO 2025 introduces a framework that separates:

  • therapies targeting IgA immune complex formation
  • therapies addressing downstream nephron injury

The guideline also lowers the proteinuria target to <0.5 g/day, ideally <0.3 g/day.

However, the guideline notes that long-term evidence demonstrating prevention of dialysis over a patient lifetime remains limited.

 

Xenotransplantation: Early Clinical Experience

Early clinical experience with genetically modified porcine kidney transplantation has been reported in compassionate-use cases. In one report, a porcine kidney with 69 genomic edits demonstrated immediate graft function in a living recipient, allowing discontinuation of dialysis.

With more than 100,000 patients currently on the U.S. kidney transplant waitlist, xenotransplantation is being explored as a potential future strategy to address organ shortages.

 

Join the Discussion

Q1: Real-world data suggest many patients are still diagnosed with CKD only after significant kidney damage has occurred.

In your experience, what is the biggest barrier to identifying CKD earlier in routine clinical practice?

Q2: Cardiorenal therapies are increasingly recommended for patients with CKD and type 2 diabetes.

How has the expanding role of these therapies changed the way you approach CKD management in your practice?

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  • 2d
    The underuse of UACR and the relatively poor coverage of glp-1 agonists and sglt-2 inh.
  • 1w
    Unfortunately, the answer is no. Failure to recognize early CKD and an indifference to therapeutic options to prevent progression is the norm these days.
  • 1w
    Biggest barrier is non compliant patients with lack of follow up.
    Therapy have changed the way I practice however insurance coverage is the biggest barrier to prescribing the newer medications.
  • 2w
    Q1. A great barrier to identifying CKD earlier seems to be the lack of awareness and education among both patients and providers. CKD is silent and less "glamorous" than screening for conditions like colorectal or breast CA so it is often neglected. Screening for CKD through blood and urine testing should be mandatorily covered by insurance/medicare and a priority as a part of health care maintenance.
    Q2. As others have commented, insurance and cost are often a barrier to newer therapies as well as access to nephrologists. Early use of ACEIs and ARBs is still crucial. Some patients are waiting to see what long term adverse effects might be connected with GLP-1s and SGLT-2s.
  • 3w
    Q1: Patients don't follow-up and often do not want to provide a urine sample. We have a harder time with patients leaving a urine sample vs blood sample. Even if patients come to see their PCP they don't go to the lab and/or they don't repeat labs in an appropriate amount of time.
    Q2: insurance and cost can be a barrier to the newer therapies (more so with GLP-1s in my practice than SGLT2i). Access to a nephrologist continues to be a barrier at my organization.
  • 3w
    Q1: Patients don't come in as often with routine checks where we can get blood work, they often come in for more acute care issues so it's hard to assess a baseline for them.
    Q2: There's been better coverage for CKD and DM2 meds and the expansion of SGLT-2s going generic has been helpful. GLP-1s are getting covered at times but still a bit lacking. Kerendia has also been a great medication for CKD.
  • 3w
    Q1- CKD is largely asymptomatic in early stages. Patients with Stage 1–2 CKD rarely have symptoms compelling enough to prompt a kidney-focused workup. Without an overt clinical signal, neither patients nor providers may recognize the urgency of screening. May be an out of site, out of mind issue until it is preventing a greater issues.

    Q2- The emergence of SGLT2 inhibitors and GLP-1 receptor agonists as guideline-recommended cardiorenal therapies has fundamentally reframed how CKD is managed in the context of type 2 diabetes. Rather than treating kidney disease and cardiovascular risk as parallel concerns, clinicians are increasingly expected to address both simultaneously through a sequenced, evidence-based regimen. The FLOW trial's demonstration of significant reductions in kidney outcomes and all-cause mortality underscores the urgency of initiating these therapies earlier in the disease course — yet real-world data suggest uptake remains inadequate. Moving forward, closing the gap between what guidelines recommend and what patients actually receive will require not only greater prescriber awareness, but also earlier nephrology involvement and better care coordination across the specialties that manage this high-risk population.
  • 3w
    Q1-My perspective is the treatment for CKD must have prevention of CKD as number one goal. In my rural area, the modifiable risks factors of obesity, hypertension and diabetes have unmeds need of optimization before progression to CKD. The biggest barrier is poverty and lack of insurance as many younger patients use the ER for health needs and never see a primary care physician for preventative care.
    Q2-I always refer to nephrology early for CKD management for evaluation for other therapies. Cost of some of these drugs can be a barrier to the patient every receiving them though.
  • 3w
    in CKD diagnosis the most important aspect to diagnose early is to identify the microalbuminuria with the albumin creatinie ratio in the HTN , Obese , CVD and Diabetic pts to detect in the CKD stage 1 disease and that is where early interventions with Ace inh/A2RB , SGLT-2 inhibitors or GLP-1 agonist in appropirate pts can be started to prevent the progression of CKD
  • 3w
    Q1. Having patients that are remotely aware of their health challenges is by itself a challenge because ignorance is not conducive to longterm health.
    Q2. Offering to CKD/T2DM patients the options available and encouraging participation with recommended therapeutic's or risk increasingly damaged renal function.
  • 3w
    Q1: Early referral to Nephrology from primary care is a big barrier for our practice.
    Q2: I am more aggressive in treating patients with elevated UACR, I wish the coverage for the GLP1 and SGLT2 drugs was better, that seems to be a big barrier for me in my area.
  • 3w
    Utilization of GFR as a means of determining renal function is an inaccurate way. Cystatin C is under utilized. 24 hour urine collection is overwhelming to patients. Tend to use GLP-1 and SGLT2 medications but many patients are faced with high out of pocket expenses and have issues with side effects
  • 3w
    Honestly, when it comes to cardiovascular disease, hypertension and diabetes there is absolutely no excuse how any doctor, nurse practitioner or physician assistant could allow a patient to end up on dialysis, barring some other issue of an autoImmune nature or other factor. I have practiced Family Medicine for 35 years and I have never had a patient go to dialysis, lose toes. Heart attacks and strokes are almost nonexistent; can’t remember the last one. If you are struggling with these issues in your practice, you need to reevaluate the way you look at people and the way you advise, educate and manage your patients.
  • 3w
    Biggest barrier for patients is understanding the disease and progression. Early detection is the key. Conveying the importance of screenings
  • 3w
    It's difficult for patients to be told they are at Stage 3 CKD when they first hear about a kidney issue. Universally they ask why they did not know about this sooner. I try to be much more proactive in screening because of this.
  • 3w
    I screen and treat patients much sooner than I use to, thus many times preventing progression of the disease
  • 3w
    Early detection and treatment is key.
  • 3w
    New and improved treatment and medication and early detection is definitely helpful and recommended.
  • 3w
    Early detection and starting treatment early is definitely helpful as above treatment is documented and recommended.
  • 3w
    Patients not coming in or not getting their labs done continues to be an obstacle to early detection. New therapies are very exciting, but cost and insurance coverage continue to obstruct treatment. EHRs should be leveraged to provide more proactive notifications of CKD and potential therapies.
  • 3w
    New medications are great to treat this problem, yet coverage is the biggest problem for my pats.
  • 3w
    I see many patients that have not had simple routine labs done in several yrs. And certainly no urine for microalbumin. People want their meds refilled without coming in for visits or having labs done. Yes it is easier to just refill, but education about a disease's renal impact and expectations regarding monitoring, including labs need to be set from the start, then stuck to. Early recognition & intervention for any medical issue is the ideal we should all strive for.
  • 3w
    Incorporating the new guidelines will take some time. Insurance coverage for these meds will need to improve over time as well, as affordable access remains an issue
  • 3w
    Biggest barrier in identifying CKD is patient not following up with pcp when they suppose too. Some insurance dont cover labs routinely, expanding role of cardiorenal therapy help with ckd and get diabetes under control and have better compliance rate for patients
  • 3w
    We need to incorporate other measures of renal function routinely in high risk individuals where creatinine may not be as accurate. We have had so many breakthroughs in treatment of CKD in the past decade, we should be initiating these as soon as possible
  • 3w
    Another barrier to care is the fact that when you tell people that they have early kidney disease--they are in denial as they are asymptomatic and you don't see them until they are ill--when dehydration can cause further acute damage. People are reluctant to take medications for their kidney disease because there is so much misinformation out there--especially about ace's and statins.
  • 3w
    The greatest barrier is the kidney disease is asymptomatic until it's later stages. The greatest barrier is getting lab tests done and urine specimens.
    The generic medications are easy to prescribe, ie ACEI/ARB, but the SGLT2 and GLP1a remain difficult to prescribe 2/2 to cost and insurance coverage.
  • 3w
    LACK OF PEOPLE SEEING THEIR PHYSICIANS ON A REGULAR BASIS ESPECIALLY DURING AND SINCE COVID.

    ABSOLUTELY THESE PEOPLE ARE STARTED ON HYPERGLYCEMIC MEDS BECAUSE OF THE RISK REDUCTION, PREVENTION OF DX PROGRESSION AND OVERALL MORTALITY AND QUALITY OF LIFE IMPROVEMENT. UNLESS THERE IS A CONTRAINDICATION OR INTOLERANCE THAN THERE IS NO REASON WHY THESE MEDICATIONS SHOULDN'T BE ADDED TO THE PTS DAILY/WEEKLY REGIMEN.
  • 3w
    We need insurance companies to be more pro active in earlier lab testing to help detect changes in kidney function with no co payments to encourage patients to get tested earlier and more often.
  • 3w
    My biggest barrier in my FQHC clinic is patients getting labs done and scheduling appropriate follow up. I have so many patients with labs ordered, but they face so many barriers (transportation, insurance, etc) to getting them done. I have started patients on SGLT2 and GLP1 much earlier in treatment courses due to the added heart and kidney protection.
  • 3w
    I am vigilant to use the proper classification of CKD in their chart.
  • 3w
    other maladies CKD at the outset may have no associated symptoms which might motivate the patient to seek medical care
    Q2.We now have at our disposal drugs such as SGLT2s which may alter/has been demonstrated to alter the course of CKD
  • 3w
    the meds seem to be covered by insurance
  • 3w
    same
  • 3w
    nothing, I was doing a great job before
  • 3w
    Adding these meds more to their medical regimen.
  • 3w
    I think they are being utilized more but providers are still getting used to using them.
  • 3w
    Primary care providers need to do a better job of monitoring patient's renal function and sending them to nephrology as indicated. Also, certain med combinations and abx doses should be adjusted but this will be overlooked if they do not even have a dx of CKD in their chart.
  • 3w
    very exciting to have meds that work on a broad spectrum and slow progression, we should probably do more specific subtyping, genetic testing like with natera etc to fine tune and better stratify our patients
  • 3w
    A big reason is that early kidney disease usually has no symptoms. It’s often missed unless simple blood and urine tests are done regularly. A less obvious issue is that patients may see different doctors over time so small changes in kidney function do not always get noticed early.

    Many doctors are starting treatment earlier because newer medications can protect both the heart and kidneys, rather than waiting for the disease to worsen. Less obviously, this shift also means patients are often on more medications so side effect management becomes paramount and a bigger part of care.
  • 3w
    Early detection would be great, it’s challenging as there are so many barriers in healthcare these days. Referrals, insurance, ect
  • 3w
    One issue is labs not reporting egfr levels until it’s stage 3. Patients are surprised and providers look negligent. Primary prevention with ACE/ARBs, sglt2, mras, and glp1s should help reduce ckd in the future.
  • 3w
    It’s true early CKD is missed too often and aggressive management of risk factors is not done to prevent further deteriorations PCPs need to be more proactive.
  • 3w
    I think continuing to encourage non-medical specialties to look at GFR vs just looking at sCr when reviewing routine labs (pre-op screenings, ED visits) will help improve early recognition.
  • 3w
    Early detection of CKD and start of treatment for a good therapeutic outcome

  • 3w
    We’ve come a long way and I think earlier detection is very much possible with earlier screening based on KDIGO guidelines ; SGLT2i have changed the way we approach CKD and hopefully aldosterone synthase inhibitors will be added soon to our practices
  • 3w
    More tendebcy to use glp1 and glp2 earlier and more often
  • 3w
    There are also immune disease that may contribue to this , and personally my husband is one of them. He did not get correctly diagnosied until very late 30s. barrier would be not able to connect the dots between frequent kidney stone, protein in urine. etdc
  • 3w
    Definitely too late, with too few MACRs ordered. Yet SGLT2 and GLP1 are very commonly used, much less for MRA. Barrier is just understanding treatments and CVD connection.
  • 3w
    Patient education is important in early detection of renal dysfunction .
  • 3w
    JOEL WASHINSKY
    Start cardiorenal therapies as early as possible to help prevent significant proteinuria and significant
    cardiorenal disease.
  • 3w
    I routinely screwed my patience. I have started using both SGLT2 and GLP ones for their benefits on multiple comorbidities.
  • 3w
    I routinely screen all my patients with Diabetes, HTN, CHF, obesity and smokers with 3-6 monthly eGFR and urine albumin creatinine ratio. I start SGLT 2s at stage 2 CKD and Ozempic in Type 2 diabetics; I add Kerendia if I don't see a satisfactory improvement in either eGFR or albuminuria.
  • 3w
    Prevention and slowing progression is key. We now have excellent medications that for this goal. Screening early and prescribing meds early to avoid further kidney damage is a priority.
  • 3w
    It’s so important to diagnose kidney disease early to help progression be reduced to chronic kidney failure
  • 3w
    I agree that we are detecting CKD early and initiating cardioprotective treatments such as SGLT2i, GPL1 and Kerendia sooner. We are dramatically seeing improvement and stabilization of CKD in our patient population.
  • 3w
    Start cardiorenal therapies as early as possible to help prevent significant proteinuria and significant
    cardiorenal disease.
  • 3w
    Early intervention and detection. Lifestyle modification.
  • 3w
    Early detection and prevention on CKD
  • 3w
    1) the biggest barrier to identifying CKD earlier in routine clinical practice is lack of time and limited resources
    2)it has shifted chronic kidney disease (CKD) management from a reactive, blood-pressure-centric model to a proactive, "four-pillar" guideline-directed medical therapy (GDMT) approach. The goal has evolved from merely slowing progression to actively preserving organ function and improving both renal and cardiovascular survival in patients with Type 2 Diabetes (T2D) and CKD
  • 3w
    Early intervention and prevention is most important in CKD .!
  • 3w
    obviously importatnt to screen and to use imaging, particularly ultrasound, when appropriate
  • 3w
    Very important to screen early for this conditions, start early treatment, prevent morbidities, complications, improve cardiovascular outcomes.
  • 3w
    Most patients do get screened early, but their CKD is just not recognized. In order to identify early-stage CKD, urinalysis needs to be done. Some patients present to the office unable to give a urine sample during their "lab time", and then it gets missed. I certainly prescribe SGLT-2 inhibitors and GLP-1 agonists earlier now, though unfortunately insurance coverage and the need for prior authorization often results in patients never starting these classes of medications.
  • 3w
    The biggest barrier is having these patients referred already with an element of CKD since they were not screened or screened but either not referred or aggressively treated. In he diabetes population aggressive use of SGLT2 inhibitors, along with glucose control, and blood pressure control are standards of care
  • 3w
    Silent killer. Many don't know they are hypertensive or having symptoms of kidney disease until way late in the illness
  • 3w
    1. Not looking for it. More screening earlier. 2. I personally screen earlier and start these agents much earlier than i did years ago.
  • 3w
    Early screening, optimal treatment of risk factors, and lifestyle factors are all items that need to be addressed. These are all generally low cost, high return strategies.
    Prevention of the problem to begin with will eliminate the need for high cost, branded medications.

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