Can predictive diagnostics transform the early detection of chronic kidney disease?

Chronic kidney disease (CKD) is often detected only after significant progression, while fragmented testing and limited specialist capacity can delay intervention.

In this Q&A, Dr. Salvatore Viscomi, Co-Founder and Chief Executive Officer of Carna Health explains how a combination of population screening, precision diagnostics, predictive analytics, and connected care pathways are being used to identify risk earlier, and help health systems move from diagnosis to targeted action.

How is the convergence of predictive analytics and precision diagnostics changing the way we identify cardiometabolic and chronic kidney disease (CKD) risk?

SV: Predictive analytics and precision diagnostics move cardio-kidney-metabolic care beyond diagnosis and toward risk-guided care pathways. Population screening often identifies people with lower-stage asymptomatic disease, and a precision test can then identify who is most likely to progress, so treatment and referral can be prioritized.

Carna Health’s partnership with Renalytix applies this approach by pairing its digital platform with the FDA-approved kidneyintelX.dkd test, which is intended for patients with type 2 diabetes and early-stage CKD. In clinical validation studies, the test showed a 72% relative improvement over eGFR and UACR alone in identifying patients at high risk of progressive kidney function decline.

In real-world use, patients flagged as high risk were 4.5 times more likely to be prescribed SGLT2 inhibitors, a guideline-recommended therapy that can slow kidney disease progression but remains underused, suggesting the tool can turn risk identification into clinical action. This allows health systems to manage CKD populations with the precision already applied in oncology and cardiology specialties.

What are the biggest barriers to earlier detection of chronic kidney disease and cardiometabolic conditions, and how can AI-enabled diagnostics help overcome them?

SV: CKD is largely silent until it is advanced, meaning many people do not know they have it until they require dialysis or a transplant. CKD shares risk factors with diabetes, hypertension and heart disease, making undiagnosed kidney disease a missed opportunity to identify broader cardiometabolic risk.

Traditional risk-based prevention programs often focus on people already diagnosed with diabetes or hypertension, leaving many at-risk patients without a path to mitigate disease progression. Even when kidney disease is identified, follow-up can depend on access to laboratory testing and nephrologists, who remain scarce in many regions.

In Carna Health’s prevention program enrolling nearly 35,000 people in Cameroon, about 50% had abnormal UACR results and the average participant age was 42, so much of the disease was sitting undetected in working-age adults. Among participants who received both blood and urine testing, blood testing alone would have missed 85% of the cases found through UACR.

AI-enabled diagnostics fit at the point where test results become decisions, combining point-of-care results with demographics, comorbidities and longitudinal trends to predict who is most likely to progress. This prioritizes follow-up to the highest-risk patients first, while automated alerts help ensure referrals are not lost.

The same decision support upskills nurses, pharmacists and primary care teams by giving them evidence-based guidance at the moment of care, so they can manage most patients directly through lifestyle counseling, medication adjustments and scheduled follow-up.

Since most countries lack enough specialists to care for everyone once their disease is identified, this frees nephrologists to focus on the patients with the greatest need.

Carna Health has implemented screening programs in diverse settings, including Cameroon and Bermuda. What have these projects taught you about closing gaps in access to testing?

SV: Cameroon and Bermuda differ widely in resources, yet both showed that enrollment improves when local health leaders take ownership of the program and bring awareness and testing directly into the community.

In Cameroon, partnerships with the Ministry of Health, local clinics and community health workers allowed screening to scale quickly, and early results prompted a $1 million government investment to expand it. A second phase adding 75,000 people to the ongoing program is launching in Q1 2027.

In Bermuda, 94% of the people found to have CKD had not been previously diagnosed, which shows that the awareness gap exists in high-income settings as well. The country’s Ministry of Health has since established a national CKD Integrated Care Pathway, which incorporates screening and monitoring of CKD and diabetes that are included as a core benefit of universal coverage.

Longitudinal monitoring has also shown value, as the Bermuda Diabetes Association reported that participants who returned after one or two years had improved kidney health after making lifestyle changes. Taken together, these programs show that closing access gaps depends on connecting testing to a clear pathway for what happens next.

Finally, the platform needed to upskill primary care resources in Cameroon, given the paucity of specialists, whereas in Bermuda, we need to engage the nephrologists to provide care to those referred to them from the prevention centers.

How do you see the role of laboratory professionals evolving as testing moves closer to patients at the point-of-care while still maintaining quality, accuracy, and clinical confidence?

SV: Point-of-care testing (POC) and laboratory medicine work side by side as testing moves closer to patients. Point-of-care devices deliver clinical results within minutes in community settings, while laboratory-based precision tests such as kidneyintelX.dkd add risk prediction for the patients who need a closer look.

Furthermore, Carna’s platform tries to ingest historical data when available from laboratories to better inform its prediction algorithms. Carna Health’s platform brings both kinds of results, along with clinical data, into a single patient record.

Laboratory professionals play an increasingly important role in this shift. Patients have long relied on them to help ensure accurate, reliable results, and that trusted expertise remains essential as testing moves closer to the point of care. Their experience in training frontline staff and overseeing quality across decentralized testing sites helps a result generated in a pharmacy or community clinic carry the same confidence as one produced in the lab.

Laboratory professionals also understand how results are recorded, verified and shared, which positions them to connect point-of-care data with electronic health records, since data scattered across EHRs, laboratory systems and claims make it difficult to follow a patient’s health over time. When every result sits in one trusted record, patients and clinicians can act on it with confidence, wherever the test was performed.

What does the future of connected, patient-centered healthcare look like to you?

SV: Connected care follows cardio-kidney-metabolic risk as one picture across every setting where a person receives care. Whether someone stops by a pharmacy or sees a specialist, each encounter adds to a single longitudinal record.

Machine learning applied to that record can flag undiagnosed risk and predict progression, and it can send clear guidance to both patients and providers. These conditions tend to progress along a single continuum, so the systems built to manage them need shared data and shared accountability across specialties.

Clinical guidelines, therapies, and analytics are now largely aligned, which leaves the remaining challenge as an operational one. Health systems that connect screening and precision testing to ongoing care management will be able to act before patients reach dialysis or other high-cost milestones, and frontline providers will have the information to manage patients in their own communities.

Dr. Salvatore Viscomi spoke with Sonia Nicholas, Managing Editor and Clinical Lead at SelectScience, as part of the CLINICAL24 campaign exploring the people, technologies, and innovations shaping modern clinical laboratories.