Overcoming Renalism: A Roadmap Towards Equitable Kidney Care

Renalism, the exclusion of CKD patients from diagnostic and therapeutic interventions due to concerns about kidney injury, remains a barrier to equitable healthcare. Originally identified in cardiovascular disease (CVD) care, renalism extends to hypertension management, oncology, critical care, and emerging treatments such as COVID-19 therapies. Despite their elevated cardiovascular mortality risk, CKD patients are underrepresented in clinical trials and often denied life-saving interventions like percutaneous coronary interventions (PCIs) and intensive blood pressure management due to concerns about AKI, often overestimated without proper risk stratification. Both industry-sponsored and investigator-initiated trials frequently exclude CKD patients, especially those with advanced disease or on dialysis, due to challenges such as higher adverse event rates, increased mortality risk, difficulty demonstrating treatment benefits, and logistical burdens. Concerns over nephrotoxicity, drug dosing, and necessary dose adjustments further complicate their inclusion. This exclusion limits evidence-based treatment options, reinforcing disparities in care and compromising health equity, a fundamental pillar of the United Nations’ Sustainable Development Goals (SDGs). Addressing renalism requires a collaborative effort from clinicians, researchers, regulatory agencies, and the pharmaceutical industry. Expanding CKD representation in clinical trials, spanning critical care, oncology, and emerging therapies, will help counteract therapeutic nihilism and improve patient outcomes. By fostering inclusivity in research and clinical decision-making, the medical community can move toward universal health equity and optimized care for all, including the vulnerable CKD population.