The progression of chronic kidney disease (CKD) follows a heterogenous course with a minority of individuals progressing to kidney failure requiring dialysis or kidney transplantation1. When recognized early, progression in high-risk individuals can be reduced by managing upstream risk factors using disease modifying medications, managing blood pressure, and achieving adequate glycemic control2 . If treatment is delayed until nephrology referral, the therapeutic window for several disease modifying drugs is narrowed or closed, and dialysis can only be delayed, not prevented2.