The kidneys are the organ where the modern food system comes to settle its accounts. They filter blood, regulate blood pressure, balance minerals, and run a small endocrine clinic on the side. They also sit downstream of every soda, every sleeve of ultraprocessed crackers, and every metabolic insult the modern diet delivers, and they keep score quietly for thirty years before they speak up. The receipts are in.

In 1990, Global Burden of Disease investigators counted 378 million adults with chronic kidney disease. By 2023 it was 788 million. CKD is now the world’s ninth leading cause of death and killed 1.48 million people in 2023, roughly one every twenty seconds. The organ that runs silently until it can’t is failing in about one of every seven adults on the planet.

That is the setup. Now The Lancet has called for fast implementation of the WHO’s first chronic kidney disease resolution, adopted at the 78th World Health Assembly in May 2025 and, according to the International Society of Nephrology, championed by Guatemala. The resolution tells member states to integrate kidney care into national strategies, push earlier detection, strengthen primary care, and expand access to kidney replacement therapy. Read quickly, that sounds like uncontroversial public health. Read slowly, and what the resolution does not say starts to do the talking.

The real driver of kidney failure is this. The GBD investigators rank the top risk factors as metabolic ones: type 2 diabetes, high blood pressure, obesity, and high body mass index, all of which sit downstream of a diet that is now global, ultraprocessed, and sugar-saturated. A pooled systematic review and meta-analysis found a 24 percent higher incident CKD risk in adults eating the most ultraprocessed food versus the least, with each additional daily serving adding roughly 5 percent. Sugar-sweetened beverages do it more directly, through fructose-driven hyperuricemia, hypertension, and the metabolic cascade that ends at the nephron. Swapping one daily serving of ultraprocessed food for something minimally processed drops CKD risk by about six percent. The upstream story is a story about food.

Ultraprocessed food and CKD risk
24 percenthigher incident CKD risk, highest vs lowest ultraprocessed food intake
A pooled meta-analysis found this elevation – the upstream cause the WHO resolution declines to name. Source: UPF and CKD meta-analysis, PMC (2023)

Now look at the steps that the Lancet editorial and the resolution’s published summaries actually emphasize: strategic rebalancing of kidney investments, expanded screening, expanded access to therapy, and integration into the noncommunicable disease agenda. What neither document pushes anywhere a reader can find it is a forceful call to confront the industries that built the metabolic disaster sitting upstream. The resolution asks for no soda taxes, no curbs on ultraprocessed food marketing, and no restrictions on the sweetened beverages the dedicated CKD literature has been flagging for years. A resolution about kidneys that refuses to name sugar is a resolution that refuses to name kidneys.

The omission sharpens when you look at what is queued up to catch the patients on the other side. The SGLT2 inhibitor class, led by AstraZeneca’s Farxiga and Boehringer Ingelheim and Eli Lilly’s empagliflozin, has quietly rebranded from a diabetes drug into a kidney drug. Novo Nordisk’s FLOW trial enrolled 1,767 patients with type 2 diabetes and CKD across 28 countries, showed a 24 percent reduction in major kidney events over 3.4 years, and opened a second blockbuster indication for semaglutide. AstraZeneca and Boehringer are now pushing combination SGLT2-plus-endothelin-antagonist regimens into phase 3, and DelveInsight counts more than 75 companies racing molecules through the CKD pipeline, with a market sized into the tens of billions through 2034. Kidneys are where cheap calories become expensive medicine, and the second business is now lining up to harvest the first.

The drugs work, and the biology is the part of this story that genuinely lit me up. SGLT2 inhibitors don’t just lower blood sugar; they take pressure off the glomerulus by resetting how the proximal tubule signals back to the macula densa, which dials down the hyperfiltration that grinds nephrons into scar over decades. GLP-1 receptor agonists run their kidney-protective effect partly through weight loss and partly through anti-inflammatory and hemodynamic pathways that have nothing to do with glycemic control. If you already have CKD, you want access to these drugs. The pharmacology is unambiguously good news for sick people.

But that is the clinical story for people who are already sick. The WHO resolution is a public health document about 788 million people, most of whom are not yet on dialysis and most of whom would never have reached the nephrologist’s office if their kidneys had not been steeped in fructose, sodium, and ultraprocessed everything for thirty years. To call a kidney resolution historic and then write it as a detection-and-treatment-access plan, while leaving the food system untouched, is to confuse a treatment problem with a prevention problem in exactly the way that benefits the manufacturers of treatments.

This is the agency that spent COVID misdirecting the world on lab leak, on natural immunity, on transmission, and on myocarditis. The history matters here because it sets a pattern: when the WHO writes a major public health document, the part it tends to leave out is the part that would discomfort an industry with money in Geneva. A kidney resolution that names treatment but not the food companies, that names screening but not sugar, fits the pattern. The National Kidney Foundation pressed the same concern at the assembly, asking for prevention to sit beside detection. The Lancet editorial calling for fast implementation does not press the question at all.

A serious kidney resolution would look different. Hard global targets for sugar-sweetened beverage taxation. Marketing restrictions on ultraprocessed food aimed at children. National commitments to halve incident type 2 diabetes by 2040. A parallel mandate to make SGLT2 inhibitors and GLP-1s genuinely affordable in low- and middle-income countries, where the burden lands hardest and where North Africa and the Middle East are running an 18 percent age-standardized CKD prevalence, the highest in the world.

I am not against the drugs. I am against the framing that calls the kidney crisis a drug-access problem when the data say plainly it is a food and metabolic problem with a drug rescue at the back end. If a global resolution is going to call itself historic, it has to look the upstream cause in the face. This one doesn’t, and a Lancet editorial telling member states to move faster on what is already on the page only deepens the omission.

Sources

  1. The Lancet, “Editorial: The next steps for chronic kidney disease” (2026-06-13)
  2. International Society of Nephrology, “Historic win for kidney health as WHO adopts global resolution” (2025-05-23)
  3. The Lancet, GBD 2023: global, regional, and national burden of chronic kidney disease in adults, 1990–2023
  4. Nephrology Dialysis Transplantation, updated global CKD burden: one death every 20 seconds (2025)
  5. ADA Meeting News, FLOW trial: semaglutide kidney and cardiovascular outcomes in type 2 diabetes with CKD
  6. FiercePharma, AstraZeneca ramps Farxiga push in CKD label expansion
  7. Pharmaphorum, AstraZeneca and Boehringer SGLT2 combination data for CKD
  8. DelveInsight via Barchart, CKD pipeline expanding to 75-plus companies
  9. PMC, ultraprocessed food and CKD systematic review and dose-response meta-analysis (2023)
  10. PubMed, sugar- and artificially-sweetened beverages and CKD risk, systematic review and dose-response meta-analysis
  11. National Kidney Foundation, World Health Assembly kidney advocacy