monitoring needs, targeted action on kidney disease prevention should become integral to the global policy response (1). The global kidney health community calls for the recognition of kidney disease and effective identification and management of its risk factors as a key contributor to the global NCD burden and the implementation of an integrated and people’s centered approach to care. Definition and classification of CKD prevention According to the expert definitions including the Center for Disease Control and Prevention (11), the term ‘‘prevention’’ refers to activities that are typically categorized by the following three definitions: 1) Primary Prevention implies intervening before health effects occur in an effort to prevent the onset of illness or injury before the disease process begins; 2) Secondary Prevention suggests preventive measures that lead to early diagnosis and prompt treatment of a disease to prevent more severe problems and includes screening to identify diseases in the earliest stages; and 3) Tertiary Prevention indicates managing disease after it is well established in order to control disease progression and the emergence of more severe complications, which is often by means of targeted measures such as pharmacotherapy, rehabilitation, and screening for and management of complications. These definitions have important bearing on the prevention and management of CKD, and accurate identification of risk factors that cause CKD or lead to faster progression to renal failure as shown in Figure 1 are relevant in health policy decisions and health education and awareness related to CKD (12). Primary prevention of CKD The incidence (new cases) and prevalence (cumulative pre-existing cases) of CKD have been rising worldwide (13). This primary level of prevention requires awareness of modifiable CKD risk factors and efforts to focus healthcare resources on those patients who are at the highest risk of developing new onset or de novo CKD. Measures to achieve effective primary prevention should focus on the two leading risk factors for CKD including diabetes mellitus and hypertension. Evidence suggests that an initial mechanism of injury is renal hyperfiltration with seemingly elevated glomerular filtration rate (GFR), above normal ranges. This is often the result of glomerular hypertension that is often seen in patients with obesity or diabetes mellitus, but it can also occur after a high dietary protein intake (8). Other CKD risk factors include polycystic kidneys or other congenital or acquired structural anomalies of the kidney and urinary tracts, primary glomerulonephritis, exposure to nephrotoxic substances or medications (such as nonsteroidal anti-inflammatory drugs), having one single kidney, e.g., solitary kidney after cancer nephrectomy, high dietary salt intake, inadequate hydration with recurrent volume depletion, heat stress, exposure to pesticides and heavy metals (as has been speculated as the main cause of Mesoamerican nephropathy), and possibly high protein intake in those at higher risk of CKD (8). Among non-modifiable risk factors are advancing age and genetic factors such as apolipoprotein 1 (APOL1) gene Braz J Med Biol Res | doi: 10.1590/1414-431X20209614 Prevention of kidney diseases 2/10 that is mostly encountered in those with sub-Saharan African ethnicity, especially among African Americans. Certain disease states may cause de novo CKD such as cardiovascular and atheroembolic diseases (also known as secondary cardiorenal syndrome) and liver diseases (hepatorenal syndrome). Table 1 shows some of the risk factors of CKD. Among measures to prevent emergence of de novo CKD are screening efforts to identify and manage persons at high risk of CKD, especially those with diabetes mellitus and hypertension. Hence, targeting primordial risk factors of these two conditions including metabolic syndrome and overnutrition is relevant to primary CKD prevention as is correcting obesity (14). Promoting healthier lifestyle is an important means to that end including physical activity and healthier diet. The latter should be based on more plantbased foods with less meat, less sodium intake, more complex carbohydrates with higher fiber intake, and less saturated fat. In those with hypertension and diabetes, optimizing blood pressure and glycemic control has shown to be effective in preventing diabetic and hypertensive nephropathies. A recent expert panel suggested that persons with solitary kidney should avoid high protein intake above 1 g/kg body weight per day (15). Obesity should be avoided, and weight reduction strategies should be considered (14). Secondary prevention in CKD Evidence suggests that among those with CKD, the vast majority have early-stage of the disease. i.e., CKD stages 1 and 2 with microalbuminuria (30 to 300 mg/day) or CKD stage 3B (eGFR between 45 to 60 mL min–1 (1.73 m2 ) –1 ) (16). In these persons with preexisting disease, the ‘‘secondary prevention’’ of CKD has the highest priority. For these earlier stages of CKD, the main goal of kidney health education and clinical interventions is how to slow disease progression. Uncontrolled or poorly controlled hypertension is one of the most established risk factors for faster CKD progression. The underlying pathophysiology of faster CKD progression relates to ongoing damage to the kidney