Despite 1 in 10 people worldwide (an estimated 850 million people) having chronic kidney disease (CKD), treatment and prevention efforts to stem this potentially fatal condition are far from adequate in rich countries, and often near non-existent in developing countries. CKD kills an estimated 1.2 million people each year, while acute kidney injury (AKI) is thought to cause a further 1.7 million deaths.
On this year’s World Kidney Day, advocates led by the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF) are raising awareness of the serious and disabling silent epidemic of CKD. Latest estimates from the Global Burden of Disease Studies (2017) show CKD as the 12th leading cause of death worldwide, ahead of tuberculosis (13th), HIV (14th) and malaria (21st). It was also the 6th fastest growing cause of death between 1990 and 2017.
The theme for World Kidney Day 2019 is “Kidney Health for Everyone Everywhere” and is about encouraging countries to invest in health care to help treat the millions affected. In countries with adequate access to health care, more must be done to substantially increase diagnosis and treatment of CKD. The epidemic is described as silent because, in most cases, by the time symptoms occur, the disease is at a very advanced stage.
“We want to make screening for kidney diseases a primary healthcare intervention including access to diagnostics such as urine and blood tests,” says Professor Philip Kam Tao Li, Co-chairman of WKD Joint Steering Committee for ISN, based at Prince of Wales Hospital, Chinese University of Hong Kong.
“Screening of high-risk individuals and early diagnosis and treatment is cost-effective to prevent or delay end-stage kidney diseases requiring dialysis or transplantation. However, where these services are needed, countries must have transparent policies governing equitable and sustainable access,” adds Professor Guillermo Garcia, Co-chairman of WKD Joint Steering Committee for IFKF, based at University of Guadalajara Health Sciences Center, Mexico.
Prof Li, who is also President of the Asian Pacific Society of Nephrology, says: “We are also advocating to ensure kidney patients receive basic health services they need such as blood pressure and cholesterol control and other essential medications to delay CKD disease progression without suffering financial hardship.”
The kidneys are vital organs in our bodies, removing waste and excess water and controlling the blood pressure and acidity of our body. CKD is the gradual loss of the kidneys’ abilities to perform these essential functions and can be caused by high blood pressure, diabetes, obesity, smoking and other risk factors. One in three people in the general population is at increased risk of CKD. And although an estimated 10% of people worldwide have CKD, estimates suggest 9 in 10 of those are unaware of their condition.
In some high-income countries, studies have shown levels of CKD to be much higher than this global average3 – for example, one in four people in Belgium and Saudi Arabia have CKD, while in Poland, Germany, the UK, and Singapore, it is around 1 in 6 people. Yet low levels of awareness of CKD, and failure to adequately screen people at risk is a problem common to all countries.
One-third of the global population is at increased risk of CKD because they have one or more of the risk factors associated with the condition. These include high blood pressure, diabetes, obesity, smoking, being aged 60 years or over, having established a cardiovascular disease, having a family history of kidney failure, being from a high-risk ethnic group or having a history of AKI. Infections, dehydration or damage from medications or ingesting toxic drugs are all causes of AKI.
“The global silent epidemic of CKD can only grow, since risk factors such as obesity, diabetes, smoking and high blood pressure continue to grow in many regions, along with population aging.” Says Professor Deidra Crews of the WKD Joint Steering Committee, based at Johns Hopkins University School of Medicine, Baltimore, MD, USA.
“A more recent potential contributor to the burden of CKD is environmental toxic exposure, including air pollution4. We would encourage anyone with one or more risk factors for CKD to have their kidney health checked by their doctor, including both blood and urine tests. It may save their life.”
Tests for CKD measure the rate at which the kidneys filter the blood (known as glomerular filtration rate [GFR]), and also other factors such as protein in the urine. High levels of protein in the urine indicate the kidneys are no longer working normally. And even if these tests all come back clear, doctors recommend repeat screening every year if risk factors are still present.
However, World Kidney Day is not just about awareness: the experts behind the initiative are keen to emphasize that simple lifestyle changes can have a huge impact on CKD development and progression. Professor Garcia concludes: “Simple lifestyle advice including a healthy diet low in salt and high in fiber, more physical activity, stopping smoking, and good control of diabetes and high blood pressure if present can slow the rate of progression of CKD by up to 50% and in some cases reverse kidney damage.”