Primary prevention of chronic kidney disease

There are 850 million people in the world with chronic kidney disease (CKD), one of the fastest growing global causes of death that was the most important risk factor for fatal COVID-19. The remaining life expectancy of people with CKD on renal replacement therapy is up to 40 years less than in the general population. While healthy lifestyles and control of risk factors such as diabetes and hypertension can help protect against the development of CKD, the global burden of CKD continues to increase. Despite these poor results, recent clinical trials indicate that the concept of primary prevention of CKD must be developed. In post-hoc analyses of at least two clinical trials, SGLT2 inhibitors prevented the development of CKD in people without prior CKD but at high risk for CKD. We propose a working definition of primary prevention of CKD with the aim of preserving renal health, which should include the target population (who), the moment (when) and the intervention (what).