Lack of CKD Awareness Limits GLP-1 RA Kidney Protection in Over 9 Million US Adults

An estimated 9.1 million US adults with type 2 diabetes (T2D) meet kidney-related eligibility criteria for glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy, yet 82.3% are unaware they have chronic kidney disease (CKD), according to a National Health and Nutrition Examination Survey (NHANES) analysis.1

Unawareness remained near 80% to 85% across a decade, even as the candidate pool grew. Ozioma Akahara, MD, of Houston Methodist Hospital, and colleagues presented the findings at ASN Kidney Week 2026 in Denver, Colorado.1

In the FLOW trial, semaglutide reduced the risk of major kidney disease events by 24% in patients with T2D and CKD, leading to a US Food and Drug Administration kidney indication in 2025.1,2 Investigators noted the national size of the GLP-1 RA–eligible population, and whether these patients know they have CKD, had not been characterized. Up to 9 in 10 US adults with CKD are unaware of their disease, according to the authors.1

How Many US Adults With Type 2 Diabetes Qualify for Kidney-Protective GLP-1 RA Therapy?

The investigators pooled 4 NHANES cycles from 2013 to 2023, including 21,450 adults.1 CKD was defined as an eGFR < 60 mL/min/1.73 m² or a urine albumin-to-creatinine ratio (UACR) of ≥ 30 mg/g, with eGFR calculated using the 2021 race-free CKD-EPI equation. Among adults with diagnosed T2D, eligibility was assessed using both FDA-label/KDIGO criteria and strict FLOW trial criteria.1,3

CKD unawareness was defined as laboratory evidence of CKD without prior communication of kidney disease from a clinician. National estimates applied NHANES survey weights with Taylor-series linearized variance estimation. The FDA-label/KDIGO analysis included 1177 unweighted participants, and the strict FLOW analysis included 150.1

An estimated 9.09 million US adults (95% CI, 8.38–9.80 million), or 3.96% of the adult population, met FDA-label/KDIGO criteria. Of these candidates, 82.3% (95% CI, 79.1%–85.6%), or roughly 7.5 million adults, were unaware of their CKD. Only 17.7%, or about 1.6 million adults, reported having been told they had kidney disease.1

Did CKD Awareness Improve Across Subgroups and Over Time?

Under strict FLOW criteria, an estimated 0.94 million adults (95% CI, 0.74–1.13 million) were eligible.1 Even in this group with more advanced kidney disease, 59.7% (95% CI, 48.2%–71.3%) remained unaware of their CKD.

Unawareness was consistently high across demographic subgroups, ranging from 79% to 89%. The highest rates were observed among non-Hispanic Asian adults (89%) and adults younger than 65 years (86%). The investigators described the pattern as a system-level gap in detection and communication rather than one confined to specific populations.1

From 2013 to 2023, the candidate population grew from approximately 8.2 million to 10.4 million. Over the same period, CKD unawareness held flat at roughly 80% to 85% across all four survey cycles. The authors called for routine pairing of eGFR with UACR testing, since eGFR alone may miss albuminuric CKD.1

The investigators also recommended integrating CKD screening into diabetes care, coordinating nephrology and primary care management, and targeting education toward groups with the highest unawareness. They proposed tracking CKD awareness, treatment uptake, and kidney outcomes to measure progress.

References

1. Akahara OA, Nadeem S, Ayah OA, et al. Nine million candidates, four in five unaware: the CKD detection gap limiting kidney-protective GLP-1 receptor agonist therapy in US adults with type 2 diabetes. Poster presented at: ASN Kidney Week 2026; October 21-25, 2026; Denver, CO. doi:10.1681/ASN.20262zmkjgq7

2. Perkovic V, Tuttle KR, Rossing P, et al. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes. N Engl J Med. 2024;391(2):109-121. doi:10.1056/NEJMoa2403347

3. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2022;102(5S):S1-S127.