An Unprepared World Replete With Chronic Kidney Disease
Survey of 125 countries reveals global inconsistencies in how this condition is recognized and monitored
The Global Kidney Health Atlas study reports that chronic kidney disease (CKD) isn’t getting the attention it deserves, despite the fact that CKD affects 1 in 10 people worldwide and untreated kidney failure claims 1 million lives each year.
The International Society of Nephrology (ISN) and other kidney health experts helped compile this report, which was published in the Journal of the American Medical Association and presented at the World Congress of Nephrology in Mexico City.
CKD prevalence varies across the globe: as high as 12% in Europe, the Middle East, East Asia, and Latin America; 11% in North America; 8% in Africa; and 7% in South Asia. The disease is emerging as a silent world epidemic as risk factors for CKD such as diabetes, obesity, high blood pressure, and smoking continue to rise, the authors cautioned.
“People in the earlier stages of CKD can be treated with blood pressure lowering drugs, diet, and lifestyle, and can maintain a good quality of life. It is vital therefore that all countries improve their rates of early diagnosis and treatment. However, our Atlas shows that, across countries of all incomes, many governments are not making kidney disease a priority,” said Adeera Levin, MD, FRCPC, ISU president and a professor of medicine at the University of British Columbia in Vancouver, B.C., in a statement.
“This makes no sense, as the costs for treating people with end stage kidney disease are enormous, along with the devastating effect it has on patients and their families,” added Levin.
To determine the status of kidney healthcare efforts around the world, investigators polled 130 ISN-affiliated countries. Overall, 96%, or 125 countries representing 93% of the world’s population, responded. Among the polled nations, huge differences existed with respect to screening technologies for detecting and managing CKD, the financing of kidney replacement therapies, governance and workforce capacity, and service delivery.
Although they commanded the highest dialysis and transplantation costs, just 29% of the wealthier countries viewed CKD as a high priority, compared with nearly 60% of the low-income countries. About a quarter of all of the respondents said they had an active CKD detection program, and less than half were able to assess acute kidney disease prevalence in their respective populations.
The study highlighted the underutilization of CKD monitoring tools in primary care environments. Only 21 of the surveyed nations reported the use of routine serum creatinine with estimated glomerular filtration rate. And, just nine (8%) of the countries offered routine proteinuria measurements. Investigators also found a nearly 1,000-fold difference among countries on availability of dialysis and transplantation therapies. In Japan, the treatment rate is 2,000 per million, whereas in Rwanda, the rate is 2.8 per million.
Workforce shortages also run rampant: In all but two countries, respondents reported shortages of nephrologists, specialist nurses, and health workers. Outside of specialty care, primary care physicians worldwide lack sufficient knowledge about the disease, according to the Atlas survey results.
In a surprising finding, “close to 50% of respondent countries reported not having access to evidence-based guidelines for CKD and acute kidney injury care,” despite the many internet and mobile platform tools available to distribute information, noted Sreedhar Mandayam, MD, MPH, and Wolfgang C. Winkelmayer, MD, MPH, ScD, in a related JAMA editorial.
The Atlas report “mandates a resounding opportunity to join forces globally, regionally, and locally toward improving kidney health now rather than waiting until kidney diseases become one of the top 10 global causes of death, a potential development that is quite foreseeable,” they observed.
The editorial mentions the work of the Kidney Disease: Improving Global Outcomes foundation, which is seeking to develop evidence-based clinical guidelines that could be implemented at the regional and local level.
