The AKF’s first CMO says most people don’t know they have kidney disease until it’s too late.
Dr. Pranav Garimella has spent his career at the intersection of nephrology, research and public health. A board-certified nephrologist, Director of Acute Dialysis Services at UC San Diego Health and the American Kidney Fund’s first-ever Chief Medical Officer, Dr. Garimella brings clinical depth and urgency to one of the most underdiagnosed health crises in the country. With AMKD Awareness Day on April 28, he sat down with rolling out’s Health IQ to talk about kidney disease, the communities most at risk and what every person needs to know.
What are the most important things people should understand about their kidneys right now?
Our kidneys are critical. They filter hundreds of liters of blood a day and keep working around the clock. Unlike heart attacks and strokes, there is no one singular moment when most people lose kidney function. It goes down slowly and silently, which is why it is such a big epidemic. Most people do not know they have kidney disease.
However, it is easy enough to detect. A simple blood and urine test can identify kidney disease, stage it and help determine what therapies can slow or stop its progression.
What should a person do if they have kidney disease in their family?
Not all kidney disease runs in families, but if you have first-degree relatives who have had kidney disease, kidney failure, dialysis or a transplant, it is important to understand whether you carry the risk. Talk to your doctor about getting a blood creatinine or cystatin test, which gives you a filtration rate or GFR, and a urine test. Know your kidneys and know your risk.
Why is regular testing so important?
Things change. Five years is a long time. Medications change, clinical status changes and damage can be completely silent. If you have high blood pressure or diabetes, even if your prior test was normal, check at least once a year. The urine test that picks up protein is just as important as the blood test. If protein is caught early, there are treatments that can slow progression. Ask for that test and get it done.
What should people know about foamy urine?
A urine test can identify protein, and when protein appears in large quantities, it causes foamy urine. This can happen even when your filtration rate looks completely normal. That foam is telling you something. If you have foamy urine along with a family history of kidney disease, diabetes or other risk factors, talk to your doctor. A simple dipstick test done right in clinic can tell you if protein is present and how much.
How much water should people actually be drinking?
There is no magic rule of eight glasses a day. It does not exist. The kidneys regulate urine output on their own. Drink to thirst. Watch your urine. If it is dark and concentrated, you may need a little more fluid. But there is no magic number and no one-size-fits-all answer.
What are your top four things people can do to protect their kidneys?
The No. 1 cause of kidney failure is still diabetes. If you have a family history or have diabetes yourself, aggressive blood glucose control is the biggest modifiable risk factor we have.
Blood pressure control is critical. Make sure your medications are appropriate for your kidney function and that your pressure is well managed.
The heart, the vascular system and the kidneys are all connected. Managing obesity and heart disease matters for kidney health too. It is about taking care of the whole person, not treating each condition separately.
And lastly, if you have a family history of kidney disease or a genetic predisposition, get that blood and urine test. That is the easiest way to catch kidney disease before it becomes kidney failure.
Black communities are disproportionately affected by kidney disease. What is driving that?
Kidney disease does not affect everyone equally. The African American community makes up about 33% of all dialysis patients today, roughly three times the general population prevalence. There are genetic predispositions, but the social determinants of health play an undeniable role.
Food deserts, lack of healthy eating choices, how neighborhoods were designed, access to high-salt and high-calorie foods that lead to the conditions that cause kidney disease. There are also pharmacy deserts, where people travel long distances just to access medications. Even if a physician prescribes the right treatment, if the patient cannot get it, it does not serve them.
Access to food, clean drinking water and living situations free of environmental toxins all matter. Prescribing medication once disease has started is not the goal. Preventing disease is, and that requires understanding what is causing it.
How should care partners approach getting a loved one to seek help?
Do not put blame on someone for not doing something. There are many reasons people may be afraid of going to a physician. Care partners can play a huge role in modifying lifestyle risk. If you are cooking together as a family, using less salt for everyone has a real impact on blood pressure.
The message I would want care partners to share is that this is not about blame. This is about providing help they can use to improve their health. Kidney disease is not a death sentence. We can actually prevent kidney failure now. Getting the tests and moving toward treatment is what the community should be aiming for.
How important is staying active for kidney health?
We were not designed to be stationary. Movement is critical for kidney health and for longevity. Whether it is cardio, resistance training or a walk after a meal, it all matters. Many patients with kidney disease lose muscle mass, become frail and stop moving, which puts them at greater risk for complications.
Beyond formal exercise, non-exercise activity counts too. Gardening, moving around the house, doing things that bring joy and keep the body in motion. People on dialysis who stay active have better outcomes. Keep moving.
What is AMKD and why is awareness around it so important right now?
AMKD stands for ApoL1-mediated kidney disease, and AMKD Awareness Day is April 28. This disease disproportionately affects people of West African ancestry due to specific genetic risk factors. Just having those genes does not mean someone will develop the disease, but it is important to know.
As of 2025, we now have an ICD code for AMKD, meaning we can formally identify and track these patients in medical records the same way we do for diabetes. We have a cause, a way to identify who these patients are and the ability to provide targeted therapies and clinical trials. The hope is that in the next three to five years, we will have treatments that can meaningfully slow disease progression.
Most people do not know they have it. Families can have multiple generations affected and never connect the dots. But it is detectable early. Catching protein on a urine test early can prevent kidney failure down the line.
Why should Black communities consider participating in clinical trials?
Clinical trials did not always treat everyone equally, and there is real and justified mistrust in the medical community, especially from minority populations. That history needs to be acknowledged directly. The current clinical trial setup has rigorous equity and transparency standards that were not always present before.
If people from affected communities do not participate, we are left with trials done in different populations and treatments extrapolated from data that may not apply. Without representation, we cannot provide truly personalized care to the people who need it most. Participation across diverse populations is how the medical community generates the data that actually helps the communities who are disproportionately affected.