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

Pranav Garimella, MBBS, MPH

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

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

Crisis Point: The Silent Rise and Growing Threat of Chronic Kidney Disease

CKD’s Emergence as A Public Health Crisis: How We Got Here and How to Turn the Tide

CKD is estimated to affect 35 million adults in the US alone, but despite its widespread impact, it often flies under the radar. For 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.

Several changes will be necessary to change the trajectory of CKD and mitigate the public health crisis it poses. Among these is the need for heightened public awareness. Given the silent nature of CKD, early detection and treatment are difficult to obtain if patients are not aware of the disease and their risk for it.

Effective interventions for CKD are most effective when the disease is caught early, preventing the need for dialysis or transplantation. While kidney disease is not reversible, it is treatable. Most recently, the US Food and Drug Administration approved semaglutide (Ozempic) to reduce the risk of kidney disease worsening, kidney failure, and death due to cardiovascular disease in adults with 

Part 1 of this episode of Crisis Point 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.

 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

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

Brooks A. FDA Approves Semaglutide (Ozempic) for Type 2 Diabetes, Chronic Kidney Disease. 

. January 28, 2025. Accessed March 5, 2025. 

https://www.hcplive.com/view/fda-approves-semaglutide-ozempic-type-2-diabetes-chronic-kidney-disease

In part 1 of this episode of Crisis Point, 3 nephrology experts and a patient advocate discuss CKD’s emergence as a public health crisis.

Understanding Semaglutide for Diabetes and CKD, with Pranav Garimella, MBBS, MPH

The growing influence of GLP-1 receptor agonists (GLP-1 RAs) has reshaped treatment strategies across multiple specialties, from endocrinology to cardiology and 

. Initially developed for glycemic control in 

, these agents have expanded their clinical reach, demonstrating benefits in weight loss, 

On January 28, 2025, the US Food and Drug Administration approved Novo Nordisk’s semaglutide (Ozempic) for adults with type 2 diabetes and 

. The decision was based on results from the phase 3b FLOW kidney outcomes trial demonstrating semaglutide’s statistically significant and superior 24% relative risk reduction of kidney disease worsening, end-stage kidney disease, and death due to cardiovascular disease compared with placebo when added to standard of care.

Initially approved in 2017 to improve blood sugar, along with diet and exercise, in adults with type 2 diabetes, semaglutide was granted an additional indication in 2020 to reduce the risk of major cardiovascular events such as heart attack, stroke, or death in adults with type 2 diabetes and known heart disease. Now, the GLP-1 RA is also approved for adults with type 2 diabetes and CKD.

According to the US Centers for Disease Control and Prevention, approximately 1 in 3 adults with diabetes has CKD. It is the leading cause of kidney failure, accounting for 44% percent of new cases.

“Any drug or any intervention that can help stem the progression to end-stage kidney disease is an incredibly important tool,” Pranav Garimella, MBBS, MPH, chief medical officer of the American Kidney Fund, told 

. “Historically, we had limited medications to stem the progression of kidney disease and diabetes. This has changed over the last decade, and we're hopeful that as we have more tools in our armamentarium, we will decrease the progression of kidney disease to kidney failure and transplantation in this high-risk population.”

Garimella went on to explain the significance of now having a treatment that has a cardiovascular effect, noting clinicians will be more likely to treat these patients with drugs that target organ damage across the entire vascular bed rather than just controlling diabetes.

“We used to have RAAS inhibitors. Then there were the SGLT2 inhibitors, and now we have GLP-1 agonists. We are really strengthening how we treat the progression of kidney disease, and the foundations of it have just gotten stronger with the addition of semaglutide,” Garimella said. “We are incredibly thankful for all the innovation that's being done and having something that can actually prevent complications and death. We now need to find a way to implement this and get it across to patients who need it most.”

. January 28, 2025. Accessed January 30, 2025. 

US Centers for Disease Control and Prevention. Chronic Kidney Disease. Accessed January 30, 2025. https://www.cdc.gov/diabetes/diabetes-complications/diabetes-and-chronic-kidney-disease.html

National Kidney Foundation. Diabetes and Chronic Kidney Disease. Accessed January 30, 2025. https://www.kidney.org/diabetes-and-chronic-kidney-disease

Garimella describes the overlap between diabetes and kidney disease, explaining the significance of semaglutide’s new indication for these patients.

Pranav Garimella, MBBS, MPH

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