Salvatore Viscomi, MD, is the chief executive officer of Carna Health.

Salvatore Viscomi, MD

Crisis Point: The Cause and Calamity, Neighborhood Disadvantage and Kidney Disease

Clinicians often think of healthcare as having a problem and a solution, but what if there was more going on underneath the surface?

When it comes to the rising threat of developing 

, there's more at stake than the values we can measure in a lab. This Crisis Point focuses on the detrimental problem of neighborhood disadvantage as the cause and the calamity of kidney disease.

Neighborhood disadvantage is a place-based measure, defined as 1/5th of a population living below the federal poverty line, and with indices such as the Area Deprivation Index (ADI). Measurable data from the US Census Bureau identified 24 million Americans living in disadvantaged neighborhoods, with a disproportionate amount of racial and ethnic families residing within these communities. For example, only 4.3% of white Americans live in a disadvantaged neighborhood compared to 20.9% of black Americans.

These inequities don’t just present through poverty, housing instability, educational opportunities, employment, and access to resources. Neighborhood disadvantage trickles down the line, impacting an individual’s health through daily exposure to unfavorable conditions, including processed food, air pollution, and dehydration. As a result, the pathways to exposure to kidney disease can be represented by acute kidney injury (AKI), with repeated episodes accelerating CKD progression, and they can also be chronic, causing slow debilitating decline over the years.

“I really think that it asks nephrologists and other care providers to treat an individual's social context as part of their care plan,” said Maya Clark Cutaia, PhD, RN, in an interview with 

“We all walk in every day with those things on our backs. You may not see it, but we walk in with our history, our culture, our trauma, you know, our joys, whatever. And if we can take those real-world contexts and apply them to what we want to do next. It'll inform how we treat a patient.”

Statistically, 18.8 to 40 million Americans live within food deserts, characterized by a reliance on gas stations and convenience stores, limited or no access to fresh fruits and vegetables, and poor transportation options and unsafe spaces for exercise.

Having limited access to nutrient-dense options can take a major toll on kidney health. Often, the most affordable and easy choices in disadvantaged neighborhoods are chips, fried food, and sodas, of which the additives and high-sugar levels can build in the kidneys and contribute to inflammation. This differentiates from nephrologists’ kidney-friendly diet recommendations, which are a plant-based protein diet focused on whole foods and vegetables, while taking into account the risk of muscle loss for patients on dialysis.

Previous research has linked food deserts and disadvantaged communities with an increased risk of obesity. In kidney disease, obesity has been seen as both a 

 of further injury and disease progression. Thus, individuals living in disadvantaged communities face environmental factors that minimize their health and exacerbate poor outcomes, adding further barriers to care, especially 

Structural barriers in disadvantaged neighborhoods, such as distance to transplant centers, transportation burdens, and lack of local primary care physicians reflect systemic flaws in the catering of the healthcare system towards advantaged communities.

A majority of patients in these communities either lack awareness or the time to receive routine wellness checks related to the often silent disease of CKD. By the time a patient presents with symptoms of kidney deterioration, they’re often passed the point of early stages and require more in-depth treatment, according to experts. The issue of access and resources will not ultimately resolve itself once a patient presents with symptoms that need treatment.

Patients experiencing CKD in the later stages, especially end stage kidney failure (ESKD) will require dialysis, or in severe cases, transplantation. However, the barriers to care that existed in the beginning stages of their illness become even more pronounced once they require help.

“Neighborhood disadvantage puts people out of the running,” said Clark-Cutaia about the entire continuum of kidney care.

According to a recent study, neighborhood disadvantage is linked to a significant lack of access to waitlisting and kidney transplantation, especially living donor kidney transplantation. This reality can be seen as a representation of the double-sided nature of neighborhood disadvantage and kidney health as the root of the problem and a barrier to a solution.

To combat neighborhood disadvantage and its downstream effects, it is important to meet patients where they are. As clinicians, that means creating a presence in communities through churches, mosques, workplaces, farms, or by connecting with community leaders to build trust in the healthcare system.

Awareness and access can play a major role in improving patient outcomes. For example, on-site education and screening to reduce transportation/time burdens, along with mobile units for blood and urine testing can bypass systemic barriers and help patients get the preemptive help they need.

To address social determinants of health, clincians should aim to implement earlier screening and referrals and to connect patients to social workers for food transporation and social support needs.

Ethically and clinically, health care practitioners have a responsibility to their patients to treat neighborhood disadvantage as a clinical value and to find solutions for these barriers to care the same way they would treat an erroneous lab measure.

 is the inaugural Evelyn Lauder Associate Dean for Nurse Practitioner Programs and Professor at the Hunter-Bellevue School of Nursing at Hunter College.

 is a NIHR Advanced Fellow and Associate Professor (Principal Research Fellow) in Nutrition and Dietetics in the Centre of Obesity Research at University College London (UCL) and programme co-lead of the MSc Dietetics (Pre-registration) course at UCL.

 is the Chief Medical Officer at Evergreen Nephrology.

 is the Chief Executive Officer and Founder of Carna Health.

 is a nephrologist and Professor of Public Health Sciences and Medicine, Division of Nephrology and Hypertension at Loyola University Chicago, and the Editor in Chief of 

 is a postdoctoral researcher at the Leverhulme Centre for Demographic Science at the University of Oxford.

 is the Dr. Robert H and Eva M Moyad Research Professor of Urology, Co-Chief of Dow Division of Health Services Research, Professor of Internal Medicine, and Professor of Urology at the Medical School at the University of Michigan.

Editor’s Note: Cutaia declares no relevant disclosures. Brown reports no relevant disclosures. Pflederer reports relevant disclosures with Evergreen Nephrology. Viscomi reports relevant disclosures with Carna Health, Dama Health, QuantaBrain, and others. Shahinian reports no relevant disclosures.

Christie-Mizell CA. Neighborhood Disadvantage and Poor Health: The Consequences of Race, Gender, and Age among Young Adults. 

International Journal of Environmental Research and Public Health

Neighborhood Atlas - Home. Wisc.edu. Published 2018. 

https://www.neighborhoodatlas.medicine.wisc.edu/

Niculae A, Gherghina ME, Peride I, Tiglis M, Nechita AM, Checherita IA. Pathway from Acute Kidney Injury to Chronic Kidney Disease: Molecules Involved in Renal Fibrosis. 

International Journal of Molecular Sciences

Rhone A. USDA ERS - Documentation. Usda.gov. Published January 5, 2025. 

https://www.ers.usda.gov/data-products/food-access-research-atlas/documentation

American Kidney Fund. Kidney-friendly eating plan | American kidney fund. www.kidneyfund.org. Published December 1, 2021. 

https://www.kidneyfund.org/living-kidney-disease/healthy-eating-activity/kidney-friendly-eating-plan

Bellasi A, Di Lullo L, Di Iorio B. Chronic Kidney Disease: The Silent Epidemy. 

Li Y, Menon G, Kim B, et al. Residential Neighborhood Disadvantage and Access to Kidney Transplantation. 

https://doi.org/10.1001/jamanetworkopen.2025.49679

Videos

7 experts come together to address neighborhood disadvantage and its impact on kidney health in the latest Crisis Point. 

Enhancing CKD Early Detection in High-Risk Populations Via Community Programs, AI, With Salvatore Viscomi, MD

In communities with increased levels of disadvantage, the asymptomatic nature of chronic kidney disease (CKD) poses a substantial risk.

To combat the lack of awareness surrounding CKD and its symptoms, Salvatore Viscomi, MD, Founder and Chief Executive Officer of Carna Health, suggests implementing Artificial Intelligence (AI) tools and community centers to enhance the availability of data for these populations.

"Education and awareness at the community level are critically important. Bringing diagnostics and testing into the community is essential, especially given the challenges people face — having to leave their homes, leave their jobs, and manage their family responsibilities," said Viscomi in an interview with HCPLive. "For many, it's simply not an option to just go in for a wellness check, even if they're aware of a family history. So for us, it's been really important to be present in the community, find community champions, and to start there: start with education and awareness."

In the US, > 90% of people with early-stage kidney disease are unaware of their condition. As Viscomi notes, many patients remain asymptomatic and are not seeking routine wellness checks, and for those in disadvantaged communities, the barriers to doing so are compounded by competing daily responsibilities. Early-stage CKD is often described clinically as a "silent disease," making community-level outreach all the more essential. Viscomi also points to an often-overlooked factor, a deep-seated mistrust of the healthcare system that keeps many from engaging with conventional care at all.

The logistical burden of seeking care is more significant than many realize. A study conducted by a colleague of Viscomi's in the UK found that a routine blood and urine test for kidney disease required a five-hour round trip from home, and that was by car. For those relying on public transportation, the burden is even greater. Combined with the cost of missed work, childcare, and transportation, routine monitoring becomes prohibitive for many patients.

Access to specialists compounds the problem further. In many parts of the United States and around the world, nephrologists are scarce, making specialist care effectively out of reach for large portions of the population most at risk.

Diet and clean water present additional, deeply structural challenges. In many communities, healthy food is simply not affordable. Ffresh fruit and vegetables can cost significantly more than processed, calorie-dense alternatives. Clean water access is also a concern, particularly for outdoor workers in low- to middle-income countries, who may face a choice between water contaminated with pesticides and kidney-damaging toxins, or sugary high-fructose drinks. Viscomi links this directly to a rising incidence of CKD among young outdoor workers globally.

Data has emerged as a potential bridge between underserved populations and recent breakthroughs in kidney disease care, but only if that data reflects the communities most affected.

"Digital health tools, for example, could potentially benefit those who can afford them or have access to them," said Viscomi. "If you think about AI predictive analytics, which can be fantastic, there's a real problem if data is only being collected from populations that already have access to plenty of care, the populations not being included won't benefit from understanding their risk progression."

The same risk extends to emerging medications and self-testing technologies. GLP-1 medications, which carry both anti-inflammatory and renal protective properties, remain unaffordable or unavailable in most of the world.

Self-testing, widely seen as the future of healthcare, will likely reach disadvantaged populations last due to cost. Viscomi argues that this is shortsighted: the burden of disease is ultimately shared by everyone, making broad investment in accessible self-testing not just an equity issue, but an economic one.

For Viscomi, the solution begins with a fundamental shift in how care is delivered. Rather than expecting patients to navigate the barriers of transportation, cost, and specialist access, the model needs to go to them, through mobile units on farms, testing at local pharmacies, and screening programs at places of worship such as churches and mosques.

Editor’s Note: Viscomi reports relevant disclosures with Carna Health, Dama Health, QuantaBrain, and others.

Lundin A. Digital Health Platform Leverages AI and POC Testing for Improved CKD Diagnosis. Clinical Lab Products. Published February 4, 2025. Accessed March 10, 2026. https://clpmag.com/disease-states/kidney-disease/digital-health-platform-leverages-ai-and-poc-testing-for-improved-ckd-diagnosis/

Vassalotti JA, Diamantidis CJ, Cook DJ. Shared Viewpoint—Developing the Future of Kidney Care. 

https://doi.org/10.1007/s11606-021-07014-x

Salvatore Viscomi, MD on closing CKD health disparities through community testing, AI equity, and accessible care for underserved populations.

Heat Stress, Environmental Exposures, and the Growing Burden of CKDu

A silent epidemic is devastating communities of young, working-age adults around the world. Coined as 

chronic kidney disease of unknown origin (CKDu)

, it is emerging in agricultural workers, miners, and other laborers exposed to factors like extreme heat, dehydration, pesticides, and toxic environmental conditions.

According to the International Society of Nephrology, most patients affected by CKDu are males between the ages of 20 and 60 who often live in rural or agricultural settings and may be exposed to extreme working conditions, with many experiencing a rapid loss of kidney function.

“It's a complex answer. I think a lot of the risk factors are known in terms of if you're working in certain parts of the world and you're doing these things that put you at a high risk of CKDu.. but it's really multiple small, acute insults to the kidneys that accumulate over time,” Salvatore Viscomi, MD, chief executive officer of Carna Health, explained to 

Specifically, Viscomi cites clusters of CKDu seen among young individuals working in physically demanding, outdoor jobs, particularly agricultural laborers such as sugarcane cutters, as well as miners, military personnel, and bricklayers. Geographically, he says cases have been reported in Central America, Sri Lanka, Nepal, India, and Africa, with emerging instances in the United States, particularly in hot climates like California, Florida, and Texas, suggesting that CKDu is a global issue not confined to traditional hotspots.

While occupation is a clear risk factor, Viscomi stresses that genetics, environmental toxins, and lifestyle factors may also contribute. For example, he says pesticides that accumulate in water sources and nephrotoxic herbal remedies common in parts of Africa play a role, also pointing to the use of medications such as ibuprofen by laborers to manage pain, which can compound kidney damage.

“The first thing is awareness that this exists,” Viscomi said. “I think many people, many physicians, are unaware of this phenomenon.”

In addition to being aware of potential risk factors, Viscomi emphasizes the importance of practical interventions like hydration, shade, and avoidance of peak heat hours. Workplace-based screening with point-of-care testing could also allow for early detection and targeted interventions, helping to prevent progression to kidney failure.

Looking ahead, Viscomi highlights the need for more research into risk stratification and pathophysiology, as well as the potential role of digital health tools to monitor hydration and body heat. He reiterates that while advanced technology may help, the most effective interventions may be the simplest, including providing shade, hydration, and awareness to those most at risk.

Editors’ note: Viscomi is CEO of Carna Health.

International Society of Nephrology. What is CKDu? Accessed September 3, 2025. 

https://www.theisn.org/initiatives/what-is-ckdu/#distribution-in-the-world

Claudel SE, Chan M, Scammell MK, et al. Challenges and Opportunities: Studying CKDu in the United States. 

Salvatore Viscomi, MD, warns CKDu is a growing global health crisis, driven by heat stress, toxins, and occupational risks in vulnerable populations.

Crisis Point: Curbing the Chronic Kidney Disease Epidemic

Our mini-docuseries has returned, taking a comprehensive look at public health crises affecting the United States today, with global implications tomorrow. If the crisis point is the moment where a crisis will worsen or begin to get better, the question remains: where are we now?

CKD’s Emergence As A Public Health Crisis: Next Steps for Halting the Silent Spread

In recognition of National Kidney Month, this episode addresses the growing burden of 

 and its emergence as the biggest public health crisis of our time.

CKD is estimated to affect 35 million adults in the US alone, but despite its widespread impact, it often flies under the radar. In many patients, the disease progresses silently and goes undetected until it reaches advanced stages when symptoms appear but treatment options are limited. While there has been no single cause of the CKD crisis, the growing prevalence of risk factors like diabetes, hypertension, and obesity has intensified the threat posed by CKD, setting the stage for a surge in cases that could overwhelm healthcare systems and disrupt countless lives.

Current estimates suggest 9 out of 10 people with kidney disease are unaware they have it, and 1 in 3 of those with severely reduced kidney function but who are not yet on dialysis are unaware they have kidney disease.

In addition to the need for better public awareness to facilitate early detection and treatment of CKD, patient-focused multidisciplinary care is also essential for improving outcomes. The burden of CKD cannot fall on nephrologists alone. Addressing this crisis requires a collaborative effort across the entire health care system but must be tailored in a way that ensures complete, equitable care for the patient.

Be sure to check out part 1 of this episode, which delves into the complex challenges surrounding CKD, exploring the various factors contributing to its growth, the importance of early detection and intervention, and the need for heightened public awareness.

In part 2, the conversation shifts to the importance of collaborative, multidisciplinary care that maintains a focus on patients’ wants and needs as well as the future of CKD care.

Brief descriptions of the speakers featured in this project are provided below:

, chief medical officer of the American Kidney Fund

, 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

, chief executive officer of Carna Health

, a patient advocate who was diagnosed with CKD during pregnancy, eventually requiring dialysis and a kidney transplant

 to see other episodes on improving health equity in eye care, disparities in cardiovascular health, insulin access in the United States, physician burnout across healthcare, and the ongoing obesity crisis.

American Kidney Fund. Quick kidney disease facts and stats. Accessed March 5, 2025. 

https://www.kidneyfund.org/all-about-kidneys/quick-kidney-disease-facts-and-stats

In part 2 of this episode of Crisis Point, 3 nephrology experts and a patient advocate discuss strategies to address the CKD crisis.

Salvatore Viscomi, MD

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