Pranav Garimella, MBBS, MPH, is chief medical officer of the American Kidney Fund.

Pranav Garimella, MBBS, MPH

The US Preventive Services Task Force finalized its research plan on chronic kidney disease screening in 2023 and has not yet issued a draft recommendation. As the Task Force considers how kidney disease screening should be approached in primary care, a nephrology perspective can help illustrate the importance of earlier detection and how screening could translate into clinical practice. 

"Screening for kidney disease should become a routine part of preventive care for adults, especially those at high risk before symptoms develop," said Pranav Garimella, MBBS, MPH, chief medical officer of the American Kidney Fund.


US adults are estimated to be living with chronic kidney disease (CKD).


of US adults with CKD do not know they have it.


In a study of more than 513,000 adults with type 2 diabetes, the 1-year median testing rate was 89.5% for estimated glomerular filtration rate (eGFR) compared with 52.9% for urine albumin-to-creatinine ratio (uACR).

 uACR can identify kidney damage even when eGFR remains relatively preserved, making both tests important for detecting CKD.

Nearly 9 in 10 US Adults With CKD Don't Know They Have It, With Pranav Garimella

The question is particularly relevant given ongoing gaps in 

detection. Modeling published in 2023 found that screening adults aged 35 to 75 for albuminuria, paired with available treatments, could prevent dialysis or kidney transplant in up to 658,000 people and would be cost-effective.¹ Nearly 1 in 3 adults with severe CKD remain unaware of their disease,² while just 5% of respondents to a 2025 American Kidney Fund survey recalled ever receiving a uACR test.³

In the following interview, Garimella discusses what a USPSTF recommendation on kidney disease screening could look like in practice, including who should be tested and how kidney screening could fit into routine preventive care.

Q&A: How a USPSTF kidney screening recommendation could work

HCPLive: If a recommendation is issued, what should it look like in practice: who is tested, how often, and with which tests?

 Screening for kidney disease should become a routine part of preventive care for adults, especially those at high risk before symptoms develop, using both eGFR and uACR. Modeling data published in 2023 found that screening adults aged 35 to 75 with a urine albumin test, paired with today's treatments, would be cost-effective and could keep thousands of people off dialysis.

Testing in people with diabetes and hypertension deserves a specific note. The Task Force guidance treats their kidney testing as part of managing those conditions, noting that guidelines for those groups already exist. While true, these guidelines have not closed the gap: about half of people with type 2 diabetes did not receive a uACR in a year. A recommendation covering other at-risk adults, such as those with cardiovascular disease, a family history of kidney disease, obesity or older age, would be valuable.

Ideally, kidney health becomes part of routine preventive care, monitored the way clinicians already monitor blood pressure, blood sugar and cholesterol, rather than something first addressed after advanced disease appears.

HCPLive: What message would you give the task force about kidney disease prevention, and what impact do you hope it has?

 About 1 in 3 adults with severe CKD do not know they have it, and many patients who start dialysis today first learned of their kidney disease when they became ill and needed dialysis urgently.

We have simple blood and urine tests that identify kidney disease, and treatments that slow progression and reduce serious complications. We need to identify people at risk, test them appropriately, confirm the diagnosis and connect patients to treatment and ongoing care. Because kidney disease is intertwined with diabetes, cardiovascular disease and obesity, protecting kidney health should be part of protecting cardiovascular and metabolic health, not treated in isolation.

My hope is that this review gives primary care clinicians and patients a clearer pathway to identify kidney disease when there is still the most opportunity to preserve kidney function and prevent or delay kidney failure.

HCPLive: Is there anything else you would like the task force or nephrology community to know?

 The fact that there are specialists serving alongside primary care clinicians on the Task Force is meaningful. Our understanding of the relationship among kidney, cardiovascular and metabolic health has advanced substantially, and we have more tools available to intervene earlier. My hope is that preventive cardiology's embrace of CKM means more high-risk patients will be identified and started on guideline-directed therapy, and that benefits kidney health too.

AKF's 2025 national survey found that although 68% of respondents reported having an annual physical in the prior year, only 51% said their kidneys were checked. Just 5% recalled ever having a uACR test, while more than half were unsure whether they had ever received one.

We have an opportunity to make kidney health a more routine part of preventive care. Clear, evidence-based guidance from the USPSTF could help primary care clinicians identify who should be tested, which tests to use and what should happen after an abnormal result.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools. Garimella has relevant disclosures with Otsuka and the PKD Foundation.

Cusick M, Owens DK, Goldhaber-Fiebert J, Tisdale R. Population-Wide Screening for Chronic Kidney Disease: A Cost-Effectiveness Analysis. 

. 2023;176(6):788-797. doi:10.7326/M22-3228

Centers for Disease Control and Prevention. Trends in Kidney Disease Awareness among U.S. Adults with CKD Stages 3-5. Chronic Kidney Disease Surveillance System. Accessed September 25, 2026. 

https://nccd.cdc.gov/CKD/detail.aspx?QNum=Q98

American Kidney Fund. New survey reveals misconceptions and urgent gaps in public understanding of kidney disease. Published August 27, 2025. Accessed September 25, 2026. 

https://www.kidneyfund.org/article/new-survey-reveals-misconceptions-and-urgent-gaps-public-understanding-kidney-disease-majority

Articles

Routine CKD screening in primary care is positioned as a high-value preventive service, particularly for asymptomatic, high-risk adults. Evidence from cost-effectiveness modeling suggests albuminuria screening in adults aged 35–75, paired with contemporary therapies, could avert dialysis or transplant for hundreds of thousands. Persistent detection gaps remain, including low uACR utilization and substantial unawareness even in advanced CKD. Integrating eGFR and uACR into routine preventive workflows—aligned with broader cardiometabolic risk management—could enable earlier diagnosis, confirmatory testing, and timely linkage to guideline-directed care.

Pranav Garimella discusses what a potential USPSTF kidney screening recommendation could mean for high-risk adults and primary care.

The Case for Routine Kidney Screening, With Pranav Garimella, MBBS, MPH

An estimated 37 million US adults, or 14% of the adult population, have 

, and about 87% of adults with CKD do not know they have it.¹

On September 17, 2026, the US Department of Health and Human Services announced 8 new members of the US Preventive Services Task Force (USPSTF).² The USPSTF previously published its final research plan for CKD screening in July 2023 but has not yet released a draft recommendation.³

In a statement released September 17, the American Kidney Fund noted that the new USPSTF roster does not include a nephrologist and said preventive care recommendations should reflect current evidence on kidney disease detection and treatment.⁴

Testing gaps persist even among patients with established risk factors. In a study of 513,165 adults with 

 receiving primary care across 24 US health care organizations, the 1-year median testing rate was 89.5% for estimated glomerular filtration rate (eGFR) but just 52.9% for urinary albumin-to-creatinine ratio (uACR).⁵ Albuminuria can signal kidney damage even when eGFR remains relatively preserved, making uACR an important part of kidney assessment.

CKD is defined by abnormalities of kidney structure or function that persist for more than 3 months, helping distinguish chronic disease from a single abnormal test result.³ Earlier identification can create opportunities to initiate treatment and address cardiovascular and metabolic risk before more advanced kidney disease develops.

 spoke with Pranav Garimella, MBBS, MPH, chief medical officer of the American Kidney Fund, about the current state of CKD detection and the evidence he believes should inform the USPSTF’s ongoing review of kidney disease screening.

Q&A: Improving chronic kidney disease detection and screening

HCPLive: Where does kidney disease stand in the US today, and what does that mean for people at risk?

 Kidney disease is both common and significantly underdiagnosed. About 14% of US adults, roughly 37 million people, are living with chronic kidney disease, and nearly 9 in 10 do not know they have it. Kidney disease can progress for years without noticeable symptoms, and by the time someone feels sick, significant damage may already have occurred.

We also increasingly understand kidney disease as part of a broader health picture. Cardiovascular-kidney-metabolic, or CKM, syndrome recognizes the interconnected nature of heart disease, kidney disease, diabetes and obesity. Nearly 90% of US adults meet criteria for at least early-stage CKM syndrome. Identifying kidney disease earlier is therefore an opportunity to protect kidney function and to address a patient's broader cardiovascular and metabolic risk.

For people at risk, that means we cannot wait for symptoms. Earlier identification creates an opportunity for treatment that can slow CKD progression and reduce the risk of heart attack, stroke and kidney failure.

HCPLive: From a nephrology perspective, what should the task force keep in mind about how kidney disease is detected and who is at greatest risk?

 Kidney health should be assessed with two tests in everyone: an estimated glomerular filtration rate, or eGFR, which measures how well the kidneys filter the blood, and a urine albumin-to-creatinine ratio, or uACR, which detects albumin in the urine as a sign of kidney damage. 

CKD can be diagnosed from albuminuria even when eGFR is normal, so the urine test can detect early disease the blood test misses. Yet the urine test is the one most often skipped. A 2021 study in Diabetes Care of more than 500,000 primary care patients with type 2 diabetes found that about 9 in 10 had an eGFR in a year, but only about half had a uACR. That means disease is being missed at the stage when patients have the greatest opportunity to protect their kidney health.

An abnormal result should be repeated to confirm CKD rather than diagnosed from a single test, because CKD requires abnormalities lasting more than three months. That confirmation step also guards against overdiagnosis and labeling, and the Task Force's plan appropriately includes the potential harms of screening.

The groups at highest risk are people with diabetes and high blood pressure, which we have long recognized. In addition, those with obesity, cardiovascular disease, older adults and people with a family history of kidney disease are at high risk for CKD. Importantly, risk is also not shared equally, with Black Americans being more than four times as likely as white Americans to develop kidney failure, and Hispanic and Native American people being more than twice as likely.

HCPLive: What do you hope the task force's evidence review captures, and how can the nephrology community contribute?

 When the Task Force last reviewed CKD screening in 2012, it found the evidence insufficient to make a recommendation in asymptomatic adults. The landscape has changed considerably since, both in our understanding of kidney disease and in the treatments available. Drugs such as SGLT2 inhibitors, finerenone and GLP-1 receptor agonists have shown in large trials that they can slow kidney disease progression and reduce cardiovascular events even in early stages.

The evidence review should examine whether screening accurately identifies CKD, what happens after identification, and whether earlier detection lets clinicians start treatments that improve outcomes. Since kidney disease does not affect every community equally, evaluation of screening should account for populations that bear a disproportionate burden of CKD and kidney failure.

The nephrology community can contribute by continuing to provide current research, clinical experience and implementation data. As the Task Force resumes its work, the public comment period on the draft evidence review and recommendation will be an important opportunity for kidney experts to identify gaps and add clinical context.

Centers for Disease Control and Prevention. 

Chronic Kidney Disease in the United States, 2026

US Department of Health and Human Services. Secretary Kennedy Announces New Appointments to US Preventive Services Task Force. Published September 17, 2026.

US Preventive Services Task Force. Chronic Kidney Disease: Screening. Final Research Plan. Published July 13, 2023.

American Kidney Fund. American Kidney Fund Statement on USPSTF Roster Updates. Published September 17, 2026.

Bailey RA, Wang Y, Marcovina S, et al. Chronic kidney disease testing among primary care patients with type 2 diabetes across 24 US health care organizations. 

. 2021;44(9):2009-2016. doi:10.2337/dc20-2715.

Chronic kidney disease affects roughly 37 million US adults and remains profoundly underrecognized, with nearly 90% unaware of their diagnosis despite years of asymptomatic progression. Persistent gaps in risk-based testing—particularly underuse of uACR relative to eGFR—limit early detection when intervention may be most impactful. CKD should be framed within cardiovascular-kidney-metabolic (CKM) syndrome and its disproportionate burden in Black, Hispanic, and Native American populations. Updated screening deliberations should incorporate modern therapeutics and balance benefits against overdiagnosis via confirmatory testing.

As the USPSTF considers evidence for updated CKD screening guidance, Garimella discusses gaps in kidney disease detection and what the review should capture.

Recent trial data have broadened the case for GLP-1 receptor agonists in kidney disease, pointing to a possible role beyond the drug class's original diabetes indication. 

Translating that evidence into everyday practice hasn't necessarily kept pace, says Pranav Garimella, MD, chief medical officer at the American Kidney Fund, who points to cost, clinician unfamiliarity, and gaps in patient identification as ongoing barriers to access.

GLP-1s Move Beyond Diabetes as Core Kidney-Protective Therapy

What Does the Evidence Show for GLP-1 Receptor Agonists in Kidney Disease?

 In more than 3,500 participants with type 2 diabetes and CKD, semaglutide cut kidney-specific outcomes by 21% and slowed annual eGFR decline versus placebo.[1]

 A 22% reduction in the composite kidney endpoint among non-diabetic participants with cardiovascular disease and obesity.[1]

 Semaglutide cut a marker of kidney protein loss by roughly half over 24 weeks in people with overweight or obesity.[1]

"GLP-1 [receptor agonists] no longer belong just in the treatment of diabetes," Garimella has said, describing them as integral to preventing both heart failure and kidney disease progression. He frames them as complementary to RAS inhibitors, SGLT2 inhibitors, and nonsteroidal mineralocorticoid receptor antagonists (MRAs)—and, in select patients without significant proteinuria who have obesity, sleep apnea, or elevated heart failure risk, as a potential alternative to nonsteroidal MRAs. His approach broadly tracks the 2024 KDIGO CKD guideline, which pairs RAS/SGLT2 inhibitor therapy with emerging support for nonsteroidal MRAs and GLP-1 receptor agonists.

What Barriers Limit GLP-1 Receptor Agonist Use in Kidney Disease?

Garimella pointed to four first-line barriers still limiting access:

 "The ability to get these for all patients across all payers remains a challenge," he told HCPLive, noting that coverage criteria can differ by indication—diabetic kidney disease, heart failure, or obesity—so documenting the specific indication at prescribing matters.

 GLP-1s were historically viewed as diabetes-only drugs prescribed mainly by primary care and endocrinology. "Now we know that these medications can prevent kidney disease progression [and] heart disease progression, and so cardiologists and nephrologists are using them more often," Garimella said.

 Clinicians need to correctly flag patients with CKD alongside diabetes, obesity, or heart failure—including as a complementary option for patients who need to come off a drug class that's raising their potassium levels.

 Not every patient tolerates the maximal dose. "We may need to back off to the best-tolerated dose, or even take patients off of it," Garimella said, adding that setting this expectation early keeps patients on therapy long enough to see benefit.

How Should Clinicians Discuss Weight Loss With GLP-1 Patients?

Garimella pushes back on the stigma that can surround weight-loss discussions in clinic. Central adiposity drives cardiac, kidney, and metabolic dysfunction, he said, so he frames GLP-1 therapy around long-term outcomes rather than the scale: "I show patients that this is doing more than just changing the numbers on the scale... The overarching goal is to connect that medication with the outcomes—not just the weight loss in the short term, but really those long-term outcomes that we're trying to prevent."

What's Next for GLP-1 Receptor Agonists in Kidney Disease?

GLP-1 receptor agonists are approaching standard therapy in the CKD toolkit, Garimella said, with wider use across disease states and combination therapies likely as data accumulates and FDA indications expand. Open questions remain: which patients benefit most versus those where risk outweighs benefit, how long therapy should continue, and how to manage patients who regain weight after stopping. Evidence is also thin in medically complex populations. "We don't know what the true benefits of GLP-1 receptor agonists are in patients who've received kidney transplants," he said, noting many still have diabetes, proteinuria, obesity, heart failure, or sleep apnea. "That is an area that is ripe for research still in the GLP-1 space."

: Garimella reports no relevant disclosures.

Cooper ME, van Raalte DH. GLP-1 agonists in the treatment of chronic kidney disease in type 2 diabetes and obesity. J Clin Invest. 2025;135(21):e194749. doi:10.1172/JCI194749

GLP-1 Receptor Agonists Reshape CKD Treatment Sequencing, With Pranav Garimella, MD. HCPLive. Published July 30, 2026. Accessed July 31, 2026. 

https://www.hcplive.com/view/glp-1-receptor-agonists-reshape-ckd-treatment-sequencing-with-pranav-garimella-md

Videos

Pranav Garimella, MD, on how nephrologists and cardiologists can apply GLP-1 receptor agonist evidence to CKD treatment decisions.

a nephrologist and the Director of Acute Dialysis Services and the Polycystic Kidney Disease (PKD) Center of Excellence at UC San Diego Health and Chief Medical Officer of the American Kidney Fund

a nephrologist at Florida Kidney Physicians and Director of the FKP Glomerulonephritis Center of Excellence in Boca Raton, Florida.

an assistant Professor in the Division of Nephrology at the University of California, San Francisco (UCSF) and the medical director of the nephrology-based kidney stone prevention center at UCSF.

 care has entered a new era, but what does this mean for nephrologists managing patients today?

After decades with few disease-modifying options beyond blood pressure control and renin-angiotensin system blockade, clinicians now have multiple therapies targeting different pathways involved in kidney disease progression. The challenge in 2026 is no longer simply whether effective treatments exist, but how best to identify patients who need them and implement them in practice.

“I think a lot of nephrologists have been sort of swayed to sleep by 20 to 25 years of really no groundbreaking developments in how we manage chronic kidney disease,” said Marc Richards, MD. “We've gone from that to now potentially 3 new classes of agents on the market, and potentially more, that can delay progression of kidney disease in our patients and prevent progression to end-stage kidney disease.”

Historically, CKD care focused largely on controlling blood pressure, managing diabetes, and slowing kidney damage with renin-angiotensin system (RAS) blockade. However, the treatment landscape has expanded with therapies targeting multiple pathways involved in kidney disease progression, proteinuria, cardiovascular risk, and metabolic dysfunction.

“The modern management of CKD relies on the integration of foundational and newer nephroprotective therapies,” Richards said.

From Supportive Care to Disease-Modifying Therapy

The expanding CKD treatment landscape reflects a shift toward evidence-based therapies that target specific mechanisms involved in disease progression.

CKD Treatment Toolbox: Key Kidney-Protective Therapies in 2026


Longstanding foundational therapy, particularly for patients with proteinuric CKD and hypertension.


Reduce kidney disease progression and cardiovascular risk and are now considered foundational therapy across broad CKD populations.

Nonsteroidal mineralocorticoid receptor antagonists (MRAs)


Target aldosterone-related pathways and are particularly used in patients with proteinuric CKD, with evidence expanding beyond diabetic kidney disease.

 semaglutide, liraglutide, tirzepatide (dual GIP/GLP-1 agonist)



Provide cardiovascular and metabolic benefits and are increasingly incorporated into cardio-kidney-metabolic risk reduction strategies.

“Now our data is exploding,” Richards said. “We have evidence with ACE inhibitors and ARBs for proteinuric kidney disease states. We have SGLT2 inhibitors becoming a standard of care. We now have the nonsteroidal MRAs that are on the market, both in diabetic and—now we're learning—non-diabetic kidney disease, that could benefit our patients. Data is emerging with GLP-1 agonists.”

RAS inhibitors, including angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), remain foundational therapies for patients with CKD, particularly those with proteinuric disease.

“RAS inhibitors such as ACE inhibitors or angiotensin receptor blockers have a long and safe history of being the first-line therapy for treatment of diabetes and kidney disease, and even high blood pressure,” Richards said. “That remains unchanged.”

Over the past decade, sodium-glucose cotransporter-2 (SGLT2) inhibitors have become another cornerstone of CKD management, with evidence supporting kidney and cardiovascular benefits across broad patient populations.

“Over the last decade, we've now added SGLT2 inhibitors that have the added benefit of preventing heart failure and cardiovascular disease, and even progression of kidney disease,” Richards said. “They now form the cornerstone of treating all chronic kidney disease.”

Nonsteroidal mineralocorticoid receptor antagonists (MRAs), including finerenone, have further expanded treatment options, particularly among patients with proteinuric kidney disease.

“The nonsteroidal mineralocorticoid receptor antagonists are added on, especially in people who have proteinuric kidney disease,” Richards said.

The Cardio-Kidney-Metabolic Connection Expands CKD Care

Another major shift in CKD management has been the recognition that kidney disease cannot be treated independently from cardiovascular and metabolic health.

Glucagon-like peptide-1 (GLP-1) receptor agonists, once primarily viewed as glucose-lowering therapies, are increasingly being incorporated into CKD care because of their cardiovascular and metabolic benefits.

“Over the last few years, the biggest shift is that GLP-1 agonists have gone from being viewed as just glucose-lowering drugs to drugs that now treat the broader cardio, kidney, metabolic syndrome,” said Pranav Garimella, MD.

“That’s really critical because we’ve come to realize that we can’t treat these organs in silos anymore,” he continued. “The kidneys, the heart, and the metabolic system are intricately tied together.”

Garimella said GLP-1 receptor agonists should now be considered part of the broader CKD treatment toolkit.

“GLP-1s no longer belong just in the treatment of diabetes, but they are integral to preventing heart failure and kidney disease progression,” he said.

However, he emphasized that GLP-1 receptor agonists should be viewed as complementary to existing kidney-protective therapies rather than replacements for foundational treatments.

For example, a patient with CKD, hypertension, diabetes, and proteinuria may benefit from RAS blockade followed by an SGLT2 inhibitor and potentially a nonsteroidal MRA. In contrast, a patient with CKD, obesity, sleep apnea, and increased cardiovascular risk may derive additional benefit from GLP-1 receptor agonist therapy.

“The GLP-1s are seen now as complementary,” Garimella said.

Emerging Targets: The Role of Aldosterone in CKD

Beyond currently established therapies, researchers continue to investigate additional pathways involved in CKD progression, including aldosterone signaling.

Richards said aldosterone has become an increasingly important therapeutic target because of its effects on cardiovascular and kidney health.

“Now we have a focus on targeting aldosterone as a way of trying to help limit stress on the kidney or limit stress on the heart,” Richards said. “With older drugs like spironolactone and eplerenone, newer medicines like finerenone, and even looking into novel agents like aldosterone synthase inhibitors to even prevent aldosterone from being released in the first place.”

Aldosterone contributes to processes including hypertension, electrolyte abnormalities, and organ stress over time, making it an important pathway of interest for future CKD therapies.

Beyond eGFR: Moving Toward Personalized CKD Management

While the expansion of treatment options has changed CKD care, experts emphasized that effective management still depends on understanding the individual patient and their underlying disease drivers.

Matthew Breeggemann, MD, said evaluating CKD requires looking beyond a single kidney function measurement.

“I think for me it’s really helpful to get a really detailed history when you first meet them, and this would include the patient and the patient’s family, and just trying to fit those pieces of the puzzle together,” Breeggemann said.

A patient with diabetes may have straightforward diabetic kidney disease, he explained, while another patient may have diabetes along with hypertension, kidney stones, or other contributors that require a different management approach.

When assessing CKD severity, Breeggemann said clinicians should focus on trends over time rather than isolated values.

“I really want to see the trend,” he said.

He explained that one patient may have an eGFR of 50 mL/min/1.73 m² that remains stable for years, while another patient with the same baseline value may experience a rapid decline over a short period of time.

Beyond laboratory values, Breeggemann highlighted the growing role of precision approaches, including genetic testing and kidney biopsy.

“Our center also does perform a substantial amount of genetic testing for kidney disorders, and these findings have definitely led to a change in how we approach and manage some patients with CKD,” he said.

He also emphasized the importance of incorporating patient preferences into treatment decisions.

“We want to ensure that patients understand why we recommend what we recommend, and importantly, lastly, take into account the patient’s priorities for their own care to really make sure we’re working with them and honoring their treatment preferences,” Breeggemann said.

Recognizing AKI as a Driver of Long-Term Kidney Health

Another shift in kidney care has been the recognition that acute kidney injury (AKI) may have long-term consequences for kidney health.

Breeggemann said AKI should not be viewed simply as a temporary event that resolves once creatinine improves.

“An episode of acute kidney injury should not really be viewed as a simple transient condition, even when perhaps labs may improve and then thus suggest so,” he said.

AKI episodes can contribute to structural changes in the kidney, inflammation, cellular injury, and vascular damage, potentially increasing the risk of future CKD development or progression.

“It would be a mistake to just say, okay, great, nothing, no additional evaluation or monitoring is needed,” Breeggemann said.

He added that many patients who experience AKI may not receive consistent follow-up after discharge, despite their increased risk.

The Remaining Challenge: Translating Evidence Into Practice

Despite major advances in CKD treatment, experts said a significant challenge remains: ensuring that evidence-based therapies reach the patients who could benefit.

Breeggemann noted that implementation of new therapies often takes years.

“It takes approximately 17 years following a new medical intervention or therapy to be routinely used in clinical practice,” he said.

Barriers include delayed diagnosis, delayed referral to nephrology, insurance challenges, clinician familiarity, and coordination between specialties.

Garimella also highlighted clinician familiarity as an ongoing challenge as GLP-1 receptor agonists expand beyond diabetes care.

“Historically we viewed these medications as being exclusively diabetic medications,” he said. “However, now we know that these medications can prevent kidney disease progression; they can prevent heart disease progression.”

Looking ahead, Richards said continued research will be essential to further improve CKD care.

“Potentially the next great treatment is out there, but we just need to get patients into clinical trials to see if we can establish new standards of care to optimize management of our patients,” he said.

Editor’s Note: Richards reports no relevant disclosures; Garimella has relevant disclosures with Otsuka and the PKD Foundation.

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Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes. 

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Chronic kidney disease management has shifted from supportive measures toward multi-pathway, disease-modifying therapy. RAS blockade remains foundational for proteinuric disease, with SGLT2 inhibitors now broadly nephroprotective and cardioprotective across CKD populations. Nonsteroidal MRAs such as finerenone add incremental benefit, particularly in proteinuria, while GLP-1 receptor agonists are increasingly positioned within cardio-kidney-metabolic risk reduction as complementary agents. Optimal care emphasizes individualized phenotyping beyond single eGFR values, attention to AKI as a progression driver, and faster implementation of evidence into routine practice.

Nephrology experts discuss how CKD care has evolved in 2026, including SGLT2 inhibitors, finerenone, GLP-1 receptor agonists, and personalized treatment.