This edition covers:
- Why kidney disease should be treated as a core cardiometabolic condition
- How lifestyle support that improves blood pressure, glycemic control, and weight can meaningfully reduce kidney disease risk.
- The role of scalable, between-visit care programs in addressing risks and closing equity gaps in kidney disease prevention and management
Kidneys are pretty cool if you think about them. We’re born with two, yet we only need one to survive. Meaning if one kidney gets damaged, we have a spare; or if someone’s kidneys aren’t working, you can donate one of yours (provided you start with two well-functioning kidneys). But there’s a lot more to kidneys than most people realize; they’re one (or two) of the most complex organs in our bodies, and national estimates report roughly 37 million US adults are living with chronic kidney disease (CKD)—but 90% don’t know it.
You might be wondering, why is a diabetes, weight and heart health provider like Omada talking about kidney disease?
Because kidney, cardiovascular and metabolic health are deeply interconnected. The American Heart Association’s Cardiovascular-Kidney-Metabolic (CKM) Health Initiative explicitly frames heart disease, kidney disease, diabetes, and obesity as part of a shared syndrome requiring coordinated care.
The complexity of kidney function and care is what initially caught my attention while working as a registered dietitian in clinical practice. As a lifelong “science nerd,” I was amazed by the endless amount to learn and think about when it came to kidney health.
Most of my day-to-day work back then was with people living with CKD who were on dialysis, a life-sustaining treatment for end-stage renal disease where the dialysis machine essentially works as an external kidney for the patient. Dialysis is an intensive treatment, with Medicare expenditures reaching roughly $45 billion per year.
These patients were also often living with multiple, overlapping conditions; diabetes, hypertension, and other cardiovascular complications. Juggling three or more chronic conditions at one time is often and increasingly the norm, not the exception, and management at this late stage is complex, emotionally and medically.
As a researcher at Omada, I live and breathe the data and outcomes behind between-visit care for weight loss, prediabetes, diabetes, and hypertension. The everyday behavior changes and supports that help people manage these conditions, such as healthier eating, more movement, taking medications as prescribed, staying connected to care, and receiving care between visits, can also protect kidney health. Recognizing these shared roots creates an opportunity to identify CKD earlier, focus more attention on those at highest risk, and take practical steps that lower its overall impact.
What is Chronic Kidney Disease?
Before we dive into CKD, let’s break down the main functions of our kidneys:
The kidneys are remarkably complex organs that do far more than most people realize. Their most well-known function is filtering waste and managing fluid balance, basically the body’s Brita system, but better because you don’t have to remember to buy replacement filters every two months. However, the body’s dynamic duo does so much more. It also helps regulate blood pressure, support bone health through vitamin D metabolism, and plays a key role in red blood cell creation through production of a hormone called erythropoietin.
With CKD, kidney function is impaired. It’s often caused over time by elevated blood sugar levels and high blood pressure (both of which are common complications of obesity) causing damage to the functional units and blood vessels of the kidney, and leading the organ to become a much less effective filter. In turn, excess fluid and other complications can lead to increased cardiovascular and other multi-system complications.
CKD is diagnosed when the kidneys are damaged or not working as well as they should for at least three months. Without obvious symptoms, the primary way to detect CKD is through blood and urine tests.
- Blood tests measure a waste product called creatinine to estimate glomerular filtration rate (eGFR), basically an indicator of how well the tiny functional units of the kidney called glomeruli are filtering waste in the blood. A higher creatinine level means a lower eGFR, suggesting reduced kidney function.
- Urine tests measure the albumin-to-creatinine ratio (uACR). Albumin is a type of protein, and higher amounts of albumin in the urine (a higher uACR) can be a sign of kidney damage, especially for people at higher risk.
Awareness of kidney health screening is rising, as seen in this star-studded ad. Even among people with more advanced stages of the disease (stages 3–5), only about one in four know they have CKD. That means the majority of people with CKD are walking around without a diagnosis and without structured support to slow progression. This lack of awareness is especially troubling because it tends to hit vulnerable communities the hardest.
How to Reduce the Risk of CKD
Dr. Linda-Marie Lavenburg*, a triple board-certified physician in internal medicine, nephrology, and obesity medicine, says there are a few key steps we can take to manage CKD as part of routine care.
"You can also discuss with your healthcare provider if you ever notice blood in your urine. Additionally, while there are exciting new medications, which I often recommend to slow the progression of kidney disease, I always encourage the use of nutrient-rich foods and regular physical activity to counteract inflammation and manage other health conditions related to kidney disease.”
*Dr. Lavenburg is an external subject matter expert.
The good news is many of the same steps that protect the heart and help manage blood sugar also protect the kidneys:
- Keep blood pressure and blood sugar in target ranges using a combination of lifestyle and medications when needed.
- Eat a balanced, kidney-friendly diet emphasizing plants, whole grains, lean proteins, and limit excess sodium and ultra-processed foods (with personalization as CKD advances).
- Exercise regularly in ways that are sustainable and enjoyable; physical activity improves blood pressure, insulin sensitivity and weight management.
- Avoid or limit non-steroidal anti-inflammatory drugs (NSAIDs) when possible and talk with your clinician about medications that may affect the kidneys.
For those who already have CKD, these fundamentals still matter, and there is also a growing toolbox of medications designed to slow kidney function decline and reduce cardiovascular events:
- SGLT-2 inhibitors were first used to improve glucose control but are now recognized for their kidney-protective effects, reducing the risk of CKD progression and acute kidney injury in high-risk patients.
- GLP-1 receptor agonists can help to promote kidney health. Yes, the meds of the moment have CKD relevance as well! GLP-1s have been shown to promote weight loss, improve cardiometabolic risk, and may reduce albuminuria and other outcomes relevant to kidney health, especially in people with obesity or type 2 diabetes.
These medications do not replace lifestyle change; they complement it. The future of kidney care lies in integrating behavior change, medications, and team-based support.
Health Equity and CKD: Another Opportunity for Impact
Another key consideration to make a real impact on kidney health is ensuring equitable care. Working in dialysis units, where I got to know patients and their unique needs as they came into the clinic multiple times each week for treatment, I saw first-hand that the face of CKD was not evenly distributed. There are known disparities in CKD incidence and outcomes with disproportionate representation from marginalized communities, driven not only by clinical factors like diabetes and hypertension, but also by social determinants such as neighborhood environment, access to healthy food, and systemic inequities in care.
These inequities do not appear suddenly at the point of dialysis; they accumulate across the entire disease spectrum—from the earliest stages of risk to the need for transplantation or end-stage kidney disease care.
Addressing CKD Risk and Progression with Lifestyle Programs
During my postdoctoral training with kidney medicine specialists, I worked on a trial that analyzed a multifaceted population health intervention. The intervention incorporated early identification of high-risk patients, timely nephrology input and pharmacist-led medication management. It also included CKD-specific education to slow progression and reduce the risk of reaching end-stage kidney disease. This trial showed promise, and the receptive response by providers and patients alike to an intervention of this nature also highlighted one of the biggest realities in CKD: it often goes unrecognized, which means we miss valuable opportunities to act.
