For National Kidney Month, Dr. Salvatore Viscomi offers insight into the rising burden of chronic kidney disease and how the healthcare system can pivot to improve screening.

I’m Salvatore Viscomi. I’m the co-founder and CEO of Carna Health, the digital health platform for chronic diseases, with our first product to manage chronic kidney disease. I’m a physician. I trained at Brigham and Women’s in Harvard Medical School, and I stayed there for 14 years before leaving in 2018 to take a more entrepreneurial path.

It’s astounding that at least 90% of people with chronic kidney disease are unaware, and it’s not just in certain parts of the world. That’s consistent throughout the world. We found in places like Turkey that 98% of people with chronic kidney disease are unaware. In the US, 90% are unaware, and it’s hard to know why.

I think the kidneys have done a poor job marking themselves as an organ compared with other organs. Heart disease and breast cancer have had successful champions.

Also, chronic kidney disease was 36 on the rank list for mortality not too long ago. In 2040, it’s going to be number 5, so it’s increasing as a problem. Because it didn’t start off as such a high priority problem, that may be part of it.

There was a time when there weren’t as many treatments, so people just expected to progress and dialysis or transplant were the only solutions. Today, we have many more solutions that can stop or slow the progression, but awareness is a key problem for this disease because it’s asymptomatic, so people won’t know they have it. Sometimes people think, “well, I have two kidneys, so if one fails, I have the other one as backup,” and it doesn’t work that way. For chronic kidney disease, they generally both deteriorate simultaneously.

This is a problem that we’re solving by being present. Everywhere that we enter a new country, there’s an awareness campaign. We do the heavy lifting on that and work with our partners. Part of our mission is not only to diagnose and manage disease, but also to raise awareness that you or someone in your family may have this.

Climate change is a really important part of healthcare and healthcare sustainability. For chronic kidney disease, it’s quite interesting. In the last decade, with the warmer climate, we’ve seen an increase in the number of younger people in certain occupations that are having kidney injury over and over again, which results in chronic kidney disease and then crashing into dialysis. This is not going away.

It’s an important element that was happening in certain geographies more than others, but the US is now reporting cases in Texas and Florida as well. So we need to be aware of this. We need to be aware of the risk factors for heat-induced kidney injury. What occupations are at risk? What are the genetic risk factors as well?

At the same time, the treatment for chronic kidney disease has been dialysis for the most part, and dialysis is not friendly to the climate. There are a lot of CO2 emissions and water waste. More people are on dialysis; the numbers are staggering and increasing year after year. This is responsible, in part, for heat stress as well. It’s a vicious cycle that we need to stop on both ends. One, we need to have less dialysis, so there are fewer CO2 emissions, and we need to identify people at risk so we can implement interventions so that these fairly young people don’t end up with permanent kidney damage.

If you think about it, there’s probably about a billion people in the world with chronic kidney disease. There’s not nearly the number of nephrologists to manage the disease. The nephrologists are really important, not to manage each patient with chronic kidney disease, but to provide oversight in each part of the world where they work, because the disease and risk factors vary from place to place. Nephrologists play an important role, but we need primary care. We need the people on the front lines to be aware of this disease, to very easily identify people who should be screened, to provide accessible testing that doesn’t require a laboratory, to have real-time results so patients can be engaged at the time they’re seeing their provider.

Also, primary care doctors manage so many diseases and so many problems, many of which are acute. Chronic kidney disease is often not top of mind as an asymptomatic disease. We need to be able to upskill these clinicians—it could be nurses, pharmacists, technicians, or doctors—to know who to screen. And once that patient’s been screened and identified as having the disease, what are the treatment options? We need to help doctors manage diseases that they often would not be able to, when there is not an opportunity to refer to a nephrologist because they’re few and far between.

For example, we’re doing a program in Cameroon, a population of over 20 million people, and there are about 20 nephrologists for the entire country. That’s not unusual. That’s typically the case in many places of the world. So we need to find other solutions, and the solutions have to be within our primary care system.

We feel that chronic kidney disease is a neglected area, and there’s an opportunity for it to be recognized, particularly in light of the increasing prevalence and double-digit growth every year, the increasing mortality, and the unsustainability of dialysis. There’s an opportunity to identify people at risk. It’s not only people with diabetes, but also people with high blood pressure and a family history.

We know that there are genetic prepositions in Asia and Africa, in people of African descent. We need to be smarter about not just saying “yes” or “no,” but saying, “hey, there are 40 million Americans with chronic kidney disease. How do we make sure they’re identified? How do we make sure they’re aware of their disease? How do we make sure they’re engaged and we’re monitoring them serially?”

It’s also an opportunity to understand the disease better. If you’re longitudinally measuring people, you will understand the risk of progression, which is something that we don’t necessarily understand. It’s really important to start with screening. It’s a very easy blood and urine test. It doesn’t require any sort of invasive procedure. It’s not expensive, not a CT scan, not an MRI, not a stem cell therapy. It’s very affordable. So there’s no reason for us to not be screening populations for this very, very common disease that is devastating to patients and the healthcare system. It’s a strain and an economic burden.

There are a lot of lessons from around the world. Every place is different. You start with a pilot, so you understand how your technology works in a population. What are the cultural differences, in terms of the language that you’re using in the patient app and the physician portal?

We’ve learned that we need to be sensitive to how populations, doctors, and available resources are different in different parts of the world. There are places where certain drugs that may be the gold standard are not available or affordable. Every program has to have the basics: a patient app, a physician portal reporting module, and basic testing for creatinine and UACR. But everything else needs to be curated for the population in front of you.

We’ve been able to do that. We’ve been able to learn on the ground and to understand what levers need to change to make the program work. We went to one of the highest per-capita places in the world, in Bermuda, and were successful. We’ve also done this in Cameroon. We’re about to launch in the Philippines, Turkey, the UAE—very, very different types of populations in terms of risk factors and the availability of nephrologists and dialysis. But the one thing that’s common is the lack of awareness and the high prevalence of disease.

I think everyone should spend some time Googling chronic kidney disease. You’ll be shocked to find out how big a disease this is, affecting a billion people in the world, and that many people, including doctors, don’t think about it enough. Also, look up Carna Health, because we are trying to make a difference. We’re trying to disrupt the trajectory of a disease that’s been neglected, where people have been offered only dialysis. We want to give people an opportunity to live longer, healthier lives with their families, with something that’s very easily preventable.

Thanks for listening. Stay tuned for next week’s episode. To hear more, follow PeerPOV: The Pulse on Medicine on Apple Podcasts, Spotify, or Amazon Music.

This transcript has been edited for readability.