We must make an impact on CKD worldwide
Time is crucial for the almost 850 million people – around 1 in 10 people worldwide – living with CKD[1], [2], [3]. Every day that someone remains undiagnosed, CKD is allowed to progress silently[4].
Fewer than 10% of people with CKD are aware of their disease which, without intervention, can lead to dialysis, kidney transplant or death[5], [6]. However, early diagnosis can be life-changing – delaying diagnosis by a year may lead to a 40% increase in risk of progression to late-stage disease, with a 63% higher likelihood of kidney failure requiring dialysis or transplant[7].
CKD is expected to become the world’s fifth leading cause of mortality by 2040[8]. It often affects people with hypertension, cardiovascular disease and diabetes[9], [10], with diabetes accounting for 30% of all CKD populations[11], [12].
“We need to promote comprehensive kidney disease care programmes that include screening of those who already live with hypertension and diabetes” stresses Marisol Robles of the Mario Robles Foundation, Mexico’s advocacy group for Kidney Health. Readily available and affordable treatments exist5, and blood and urine tests can be used to measure kidney function[13], however, we are not using these early enough to help patients.
“CKD is a leading cause of death, yet it does not receive the level of attention and resources that other diseases do. It’s important for policymakers to understand that dialysis is not inevitable” LaVarne Burton, CEO of the American Kidney Fund warns.
This is why, in 2023, we formed the Global Patient Alliance for Kidney Health with 29 patient advocacy organisations. Our goals are to elevate the patient voice on the benefits of early diagnosis in global and regional policy forums, engage with policymakers at the national level, and call to prioritise early-stage and screening policies.
Dialysis and transplantation are costly and devastating for patients, caregivers, health systems and the environment
“Treating kidney disease at the point of kidney failure has a devastating effect on patients and caregivers. Patients are confronted with the reality that they need dialysis or a transplant to stay alive”, explains Carrie Thibodeau, National Director, Programs and Public Policy, The Kidney Foundation of Canada. “Most often dialysis involves a 4-hour treatment in hospital or a dialysis centre multiple times a week, and many patients are unable to work due to the time commitment and physical toll.”
Caregivers who may be informal carers, spouses, friends, or other family members are also affected. They can spend an average 9.25 hours and 2.8 hours per week on informal care for dialysis patients and transplant patients respectively[14]. They can also experience carer-associated depression and anxiety[15], [16].
CKD comes with economic costs – annual associated costs of dialysis and kidney transplantation range from USD 35,000 to USD 100,000 per patient[17]. And there is also an environmental impact, with dialysis consuming over 169 billion litres of water and generating 1 billion kilograms of waste yearly globally[18], [19].
CKD is not currently recognised by governments as an urgent health priority.
While treatment options have expanded, adoption of policies has lagged behind.
We call on policymakers to elevate CKD as a critical health priority and implement policies to:
1) Detect and diagnose patients at earlier stages, and
2) Enable immediate access to care and recommended treatments to slow CKD progression and prevent kidney failure.
For this to be achieved, CKD must be incorporated into non-communicable disease policy approaches alongside cardiovascular and metabolic conditions and brought to the forefront of global public health agendas.
“We need a complete paradigm shift, from kidney failure to kidney health” says Chris Forbes of Kidney Health Australia.
To drive this urgency, we’ve launched the Make the Change for Kidney Health campaign to call for policy change using mounting evidence on the benefits of early intervention on CKD. By taking action together, we can help make a difference to the lives of hundreds of millions. The time for policymakers to act is now.
Note: The Make the Change for Kidney Health campaign is co-created with the Global Patient Alliance for Kidney Health as well as funded and produced by AstraZeneca.
[1] Jager KJ, Kovesdy C, Langham R, et al. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Nephrol Dial Transplant. 2019;34(11):1803-1805.
[2] Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements. 2022 Apr 1;12(1):7-11.
[3] Sundström J, Bodegard J, Bollmann A, et al. Prevalence, outcomes, and cost of chronic kidney disease in a contemporary population of 2· 4 million patients from 11 countries: The CaReMe CKD study. The Lancet Regional Health–Europe. 2022 Sep 1;20.
[4] Economist Impact: Chronic kidney disease: driving change to address the urgent and silent epidemic in Europe. March 2023. Available at: https://impact.economist.com/projects/chronic-kidney-disease/ Last accessed February 2024.
[5] GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709-733.
[6] Economist Impact: Chronic kidney disease: driving change to address the urgent and silent epidemic in Europe. March 2023. Available at: https://impact.economist.com/projects/chronic-kidney-disease/ Last accessed February 2024.
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[9] U.S. Department of Health and Human Services. Chronic Kidney Disease in the United States, 2023. 2023. Available at: https://www.cdc.gov/kidneydisease/pdf/CKD-Factsheet-H.pdf. Accessed February 2024.
[10] Stevens PE, O’Donoghue DJ, de Lusignan S, Van Vlymen J, Klebe B, Middleton R, Hague N, New J, Farmer CK. Chronic kidney disease management in the United Kingdom: NEOERICA project results. Kidney Int. 2007 Jul;72(1):92-9.
[11]Jitraknatee J, Ruengorn C, Nochaiwong S. Prevalence and Risk Factors of Chronic Kidney Disease among Type 2 Diabetes Patients: A Cross-Sectional Study in Primary Care Practice. Sci Rep. 2020;10(1):6205.
[12] Centers for Disease Control and Prevention. Diabetes and Chronic Kidney Disease. 2022. Available at: https://www.cdc.gov/diabetes/managing/diabetes-kidney-disease.html. Accessed February 2024.
[13] National Kidney Foundation. Quick Reference Guide on Kidney Disease Screening. N.d. Available at: https://www.kidney.org/kidneydisease/siemens_hcp_quickreference. Accessed February 2024.
[14] Deloitte Access Economics. Changing the chronic kidney disease landscape: The economic benefits of early detection and treatment. 2023:62. Available at: https://www.deloitte.com/au/en/services/economics/analysis/changing-chronic-kidney-disease-landscape.html. Accessed February 2024.
[15] Adejumo OA, Iyawe IO, Akinbodewa AA, et al. Burden, psychological well-being and quality of life of caregivers of end stage renal disease patients. Ghana Med J. 2019;53(3):190-196.
[16] Shah KK, Murtagh FEM, McGeechan K, Crail SM, Burns A, Morton RL. Quality of life among caregivers of people with end-stage kidney disease managed with dialysis or comprehensive conservative care. BMC Nephrol. 2020 May 4;21(1):160.
[17] Levin A, Tonelli M, Bonventre J, et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. The Lancet. 2017;390(10105):1888-917.
[18] Vanholder R, Annemans L, Bello AK, et al. Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney. Clinical kidney journal. 2021;14(7):1719-30.
[19] Wieliczko M, Zawierucha J, Covic A, et al. Eco-dialysis: fashion or necessity. International Urology and Nephrology. 2020;52:519-23.