Kidney Health for Everyone Everywhere – from Prevention to Detection and Equitable Access to Care
Burden of kidney disease
Kidney disease is a non-communicable disease (NCD) and currently affects around 850 million people worldwide. One in ten adults has chronic kidney disease (CKD). The global burden of CKD is increasing, and is projected to become the 5th most common cause of years of life lost globally by 2040. Chronic kidney disease is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume 2–3% of the annual healthcare budget in high-income countries; spent on less than 0.03% of the total population of these countries. In low-income and middle-income countries, most people with kidney failure have insufficient access to lifesaving dialysis and kidney transplantation.
Crucially, kidney disease can be prevented and progression to end-stage kidney disease can be delayed with appropriate access to basic diagnostics and early treatment. However, while national policies and strategies for NCDs in general are present in many countries, specific policies directed toward education and awareness about kidney disease as well as CKD screening, management and treatment are often lacking. There is a need to increase the awareness of the importance of preventive measures throughout populations, professionals and policy makers.
What we call for
This year World Kidney Day continues to raise awareness of the increasing burden of kidney diseases worldwide and to strive for kidney health for everyone, everywhere. Specifically, the 2020 campaign highlights the importance of preventive interventions to avert the onset and progression of kidney disease.
What is a preventive intervention?
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 kidney disease before the disease process begins (2) Secondary Preventionsuggests preventive measures that lead to early diagnosis and prompt treatment of kidney disease to prevent more severe problems developingand (3) Tertiary Preventionindicates managing kidney disease after it is well established in order to control disease progression and the emergence of more severe complications.
Specifically, primary prevention of kidney disease requires the modification of risk factors, including diabetes mellitus and hypertension, unhealthy diets, structural abnormalities of the kidney and urinary tracts, and/ or nephrotoxicity levels. Preventative primary interventions include promoting of healthy life styles including physical activity and healthy diets, screening for patients at higher CKD risk with the aid of urine and blood tests and keeping screening data in a CKD registry.
In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimization and glycemic control, is the main goal of education and clinical interventions which can be achieved by low salt and protein, as well as plant-based diets and pharmacotherapy.
In patients with advanced CKD, management of co-morbidities such as uremiaand cardiovascular disease is of high priority.
Such preventive measures of CKD are becoming ever more important, with rising levels of cases worldwide. As CKD is associated with high costs, preventive measures addressing root causes, especially in the form of primary prevention, have significant value. Raising awareness and educating individuals on the most important risk factors and preventative measures for kidney disease is hence important so as to reduce the burden of kidney disease. In order for the importance of the “Prevention approach” of kidney disease and kidney failure to be recognized, promotion programs for health care professionals including nephrology fellowship programs and non-specialist training; effective and efficient education and awareness programs for the general population and partnerships for patient empowerment are key.
In 2020, World Kidney Day calls on everyone to advocate for concrete measures in every country to promote and advance kidney disease prevention, including:
- Renewed focus on primary care, awareness raising and education including patient empowerment and cross-specialty training
- Integration of CKD prevention into national NCD programs for comprehensive and integrated services, which are essential in improving the early detection and tracking of CKD at country level
- Whole-of-government, whole-of-society, health in all policies, multisectoral collaboration to promote prevention of kidney disease
Uremia – condition of having high levels of urea in the blood. Urea is a by-product of protein breakdown and is a primary component of urine.