One Nephrologist’s Mission to Change How Patients Learn About Kidney Disease

Kidney disease remains one of modern medicine’s inconspicuous public health challenges. In the United States, 37 million adults are living with chronic kidney disease (CKD), yet 90% don’t realize they have it. Many who do receive a diagnosis may encounter the healthcare system only after irreversible nephron loss has already occurred.

Dr. Andrew Kowalski, MD, MPH, FASN, believes this longstanding reactive model doesn’t reflect what current evidence makes possible. His work as a nephrologist increasingly focuses on a question he believes medicine should have asked much earlier: How can clinicians prevent kidney failure instead of preparing patients for it?

The turning point came during a routine clinic visit. Dr. Kowalski recalls caring for a patient born with a single kidney who had already received every evidence-based therapy available. She asked a simple question: What more could she do to preserve her kidney function? “I gave the same answer I had given countless times, diet and exercise,” Dr. Kowalski says. “Driving home that day, I realized that if someone asked me exactly how to slow kidney disease, I didn’t really know how to answer.”

Soon after, he dove deeper into the nephrology literature, and what he found exposed a troubling gap. Dr. Kowalski found that meaningful prevention research already exists, much of it documented during his own fellowship training. Yet, he observed that none of it had made its way into clinical education. Physicians, he notes, were taught the newest medications and the finer points of treatment timing, but rarely anything about stopping before it accelerated.

He points out that nephrology continued to receive referrals predominantly in advanced disease, often when patients had already reached stage four CKD, and the following conversations naturally shifted toward dialysis preparation and transplantation before prevention could ever enter the picture. “Why wait until someone has roughly 20% kidney function left before we really intervene? We now have therapies and evidence showing we can change the trajectory much earlier,” Dr. Kowalski says.

Over the past decade, the emergence of SGLT2 inhibitors, GLP-1 receptor agonists, and newer mineralocorticoid receptor antagonists has transformed the therapeutic landscape. Yet Dr. Kowalski believes pharmacotherapy represents only one component of prevention. Reactive care, in his telling, is structurally embedded in how nephrology has operated for decades, but his larger concern lies in the persistent gap between medical knowledge and patient understanding.

“We assume patients understand the language we use. They nod because they’re intimidated, but many leave without truly understanding what’s happening inside their bodies,” Dr. Kowalski explains. His mission grew directly out of this recognition. He wanted to give patients a working understanding of their own condition rather than the vague reassurances he had spent years repeating.

He points out that patients often arrive believing they have “stable kidneys,” unaware that stability can exist alongside significant chronic impairment. Others, he adds, misunderstand laboratory values or receive conflicting advice regarding nutrition, exercise, supplementation, or medication adherence. According to him, these misunderstandings often postpone meaningful intervention during the period when renal preservation remains most achievable.

Dr. Kowalski also argues that conventional kidney assessment depends too heavily on biomarkers that require clinical interpretation. Serum creatinine, for example, can be influenced by muscle mass, which tends to decrease with age, potentially leading to a misleading estimation of kidney impairment. He instead emphasizes that proteinuria, inflammatory status, imaging findings, metabolic health, and individualized clinical context can collectively provide a far more comprehensive assessment of renal risk. “A single laboratory number never tells the whole story. You have to understand the patient behind the number,” he explains.

According to him, cardiovascular disease, diabetes, chronic inflammation, sarcopenia (muscle wasting), and CKD rarely develop independently. Instead, they reinforce one another through interconnected pathophysiological mechanisms. In his assessment, addressing inflammation, preserving muscle mass, optimizing metabolic health, and identifying high-risk patients earlier may substantially alter disease progression before dialysis becomes part of the conversation.

“Medicine often focuses on treating the destination,” he says. “I’d rather address the road that leads patients there.” This perspective also shaped Kidney Strong, the educational platform Dr. Kowalski developed after recognizing how little accessible, evidence-based kidney education existed outside the clinic.

The platform began with supplemental reading for his own patients. Now it has expanded into an extensive collection of educational articles, patient workbooks, published books, and the forthcoming Filter It Out podcast, where physicians and patients discuss kidney disease in accessible language while removing unnecessary medical jargon. He also plans to launch Kidney School, offering structured educational courses, webinars, and continuing resources for patients and healthcare professionals.

Importantly, Dr. Kowalski views these resources as extensions of clinical care. “Most patients tell me nobody has ever explained kidney disease this way. If they understand what’s happening, they can participate in their own care instead of simply reacting to it,” he says.

As he moves forward with bolstering CKD awareness, he hopes prevention becomes the defining philosophy of nephrology. Patient education, he insists, should function as preventive medicine instead of an afterthought delivered late in disease progression. Advances in genetics, biomarker research, precision medicine, and preventive therapeutics have already shifted what clinicians can offer patients. The next challenge, he argues, is ensuring patients understand those opportunities early enough to benefit from them.

“I want people to know they can ask questions early,” Dr. Kowalski says. “We now have enough evidence to change the course of kidney disease for many patients. Education may be one of the most powerful tools we have to make that happen.”