Prevention of CKD onset and progression is a critical public health priority. The ISN Global Kidney Health Roadmap (Levin et al., Kidney International, 2023) identified CKD prevention, early detection, and equitable access to care as the three foundational pillars of the ISN’s strategic agenda for the decade. High-risk populations identified by the Chronic Kidney Disease Prognosis Consortium (CKD-PC), as published in Lancet (Gansevoort et al., 2013), include individuals with diabetes, hypertension, obesity, family history of kidney disease, and prior AKI.
The International Society of Nephrology has promoted CKD prevention through World Kidney Day, co-organized annually with the International Federation of Kidney Foundations, and through community-based screening initiatives documented in the ISN GKHA. The Kidney Failure Risk Equation (KFRE), published by Tangri et al. in JAMA (2011) and validated across 31 multinational cohorts in Annals of Internal Medicine (2016), has been endorsed by ISN as a risk communication tool enabling evidence-based referral and treatment intensification decisions.
Lifestyle modification forms the cornerstone of primary CKD prevention. The DASH diet, evaluated in the PREMIER trial and subsequent analyses in the Clinical Journal of the American Society of Nephrology (Rebholz et al., 2016), demonstrated significant associations between dietary adherence and slower eGFR decline and lower albuminuria. Plant-based dietary patterns have been reviewed by ISN-affiliated investigators in Kidney International (Chen et al., 2019), suggesting favorable effects on uremic toxin generation and CKD progression.
Pharmacological prevention strategies include RAAS inhibitor use in patients with proteinuric CKD and, increasingly, SGLT2 inhibitors for eligible patients based on the CREDENCE, DAPA-CKD, and EMPA-KIDNEY trial data. The uric acid-lowering hypothesis for CKD prevention was tested in the CKD-FIX trial (Badve et al., New England Journal of Medicine, 2020), which found that allopurinol did not significantly slow eGFR decline compared to placebo in CKD patients with or without gout.
ISN has emphasized that prevention programs must address social determinants of kidney health. The Social Determinants of Health and Kidney Disease initiative described in Kidney International (2023) documents how food insecurity, housing instability, and healthcare access barriers disproportionately affect populations at highest CKD risk. The International Society of Nephrology has supported development of culturally adapted screening tools and community health worker training programs to expand preventive nephrology reach in underserved communities.