When I first began practicing internal medicine, and later functional medicine, I was taught to focus heavily on cardiovascular and metabolic diseases. Kidney health, however, was often treated as an afterthought — something to monitor only after a patient’s labs showed clear dysfunction.

Over time, I came to realize this is a dangerous oversight. Chronic Kidney Disease (CKD) is far more prevalent — and underdiagnosed — than most clinicians realize. According to the CDC, 14% of adults in the U.S. have CKD, yet 9 out of 10 of them don’t know it. Globally, nearly 10% of the population is affected.

CKD is a silent epidemic. It often progresses for years without symptoms. By the time overt dysfunction appears, much of the kidney damage is irreversible — and patients face increased risks for cardiovascular disease, frailty, cognitive decline, and premature death.

Fortunately, by applying a root-cause functional medicine lens and optimizing our detection strategies, we can identify CKD in its early stages — when intervention can slow, halt, or even reverse progression.

Let’s explore why CKD is often missed, which key biomarkers reveal it earlier, and how functional medicine practitioners can design truly preventive care plans.

Why Chronic Kidney Disease Is Often Missed

1️⃣ It’s Clinically Silent Until Late Stages

In early CKD, patients typically feel well. There are no symptoms until kidney function declines significantly — often not until Stage 4 or 5 (out of 5 stages).

2️⃣ Over-Reliance on Creatinine and eGFR Alone

• Serum creatinine is influenced by muscle mass, age, sex, and ethnicity.
• eGFR calculations based on creatinine may overestimate kidney function in frail or elderly patients, or underestimate it in athletes with high muscle mass.

3️⃣ Albuminuria Often Not Checked

Urine Albumin-to-Creatinine Ratio (ACR) is an early and sensitive marker of kidney damage — but it’s not routinely included in standard screening.

4️⃣ Lack of Repeat Testing

CKD diagnosis requires ≥2 abnormal results ≥3 months apart. Without consistent monitoring, early CKD can be missed or dismissed.

5️⃣ At-Risk Groups Are Not Flagged Proactively

Risk is elevated in:

• Adults over age 65
• Women (higher CKD prevalence but often slower progression to ESRD)
• Black adults (20% prevalence)

Those with hypertension, diabetes, metabolic syndrome, cardiovascular disease, or a history of nephrotoxic medication use

Functional Medicine Approach to Early Detection of CKD

Functional Testing for Kidney Health

✅ Comprehensive Metabolic Panel (CMP) — creatinine, BUN, eGFR
✅ Urine Albumin-to-Creatinine Ratio (ACR) — for albuminuria
✅ Urinalysis (UA) with microscopy — assess for hematuria, proteinuria, casts, specific gravity
✅ Cystatin C — an alternative filtration marker, especially useful when creatinine is unreliable (elderly, low muscle mass, high muscle mass)
✅ Phosphorus and Parathyroid Hormone (PTH) — particularly important in Stage 3+ CKD
✅ Renal Ultrasound — evaluate for structural abnormalities (scarring, cysts, obstruction); indicated when:

• eGFR is <60, OR
• ACR >300 mg/g, OR
• UA shows hematuria or persistent proteinuria, OR
• There is a declining eGFR trend or unexplained abnormal labs, even if eGFR is in the 60–89 range (such as eGFR 70 with albuminuria or hematuria), OR
• There is clinical suspicion or family history of polycystic kidney disease (PKD).

Interpreting Results Functionally

• A borderline eGFR (60–89) plus albuminuria and/or abnormal UA indicates early CKD — not “normal.” Unfortunately, most labs do not flag eGFR unless it is less than 60.

• Trends are more important than isolated results — monitor eGFR, ACR, and UA findings over time to detect progression.

• Renal ultrasound provides essential information about structural abnormalities and is an important tool when:

• eGFR is <60,

• ACR is elevated,

• UA is abnormal,

• There are unexplained trends or clinical suspicion — even if eGFR is still in the 60–89 range (such as eGFR 70 with proteinuria or hematuria), or

• Family history or suspicion of PKD.

• Low-grade inflammation and insulin resistance are key drivers of CKD progression and should be addressed proactively.

Root Causes That Drive CKD Progression

Functional medicine offers a deeper map of the why behind CKD, moving beyond basic staging:

Functional Interventions to Support Kidney Health

Optimize Metabolic Function

• Improve insulin sensitivity
• Normalize blood pressure
• Target weight optimization

Reduce Inflammatory Burden

• Lower oxidative stress
• Address systemic inflammation with diet, targeted supplements, and lifestyle

Balance Uric Acid

• Use dietary approaches and nutraceuticals to achieve optimal levels

Support Mitochondrial and Endothelial Function

• Use nutrients (CoQ10, omega-3s) and lifestyle practices to enhance vascular health and perfusion

Avoid Nephrotoxins

• Educate patients on NSAID risks
• Monitor for heavy metal exposure
• Use careful contrast protocols in imaging

Final Thoughts

Understanding how CKD silently progresses — and what drives that progression — helps us:
✅ Detect kidney disease earlier, before irreversible damage occurs
✅ Shift care from reactive to proactive, personalized, root-cause strategies
✅ Empower patients with education and preventive actions

Just as with trauma, early detection and functional root-cause care can dramatically alter the trajectory of CKD. Kidney function loss is not inevitable with aging. With proper testing, nutritional and metabolic optimization, and avoidance of drivers of progression, patients can maintain excellent kidney health for life.

Want to Master Functional Medicine for Complex Conditions?

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✅ Master advanced lab testing and interpretation
✅ Learn proven strategies for complex cases — including early CKD detection and metabolic disease reversal
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Disclaimer
The information in this article is for educational purposes only and is not intended as medical advice. Please consult a qualified healthcare provider for individualized care.

-Yousef Elyaman, MD, IFMCP

Founder of FMP Essentials

References

1. CDC. Chronic Kidney Disease: Data and Research. https://www.cdc.gov/kidney-disease
2. National Kidney Foundation. About Chronic Kidney Disease (CKD). https://www.kidney.org/atoz/content/about-chronic-kidney-disease
3. Jadoul M, Aoun M, Masimango Imani M. The major global burden of chronic kidney disease. Lancet Glob Health. 2024 Mar;12(3):e342-e343. doi: 10.1016/S2214-109X(24)00050-0
4. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl (2011). 2022 Apr;12(1):7-11. doi: 10.1016/j.kisu.2021.11.003
5. Kidney Disease: Improving Global Outcomes (KDIGO). 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl (2024). 14(1). Available at: https://kdigo.org/guidelines/ckd-evaluation-and-management/
6. Stenvinkel P, et al. Inflammation in end-stage renal disease: the hidden enemy. Nephrol Dial Transplant. 2004 Dec;19(12):2746-9. doi: 10.1093/ndt/gfh409
7. Kanbay M, et al. Uric acid in metabolic syndrome: From an innocent bystander to a central player. Eur J Intern Med. 2016 Jan;29:3-8. doi: 10.1016/j.ejim.2015.11.019