The prevalence of kidney disease and its associated morbidity and mortality continues to increase. We cannot tackle this crisis unless we make kidney disease a global public health priority.
Kidney disease is a common non-communicable disease that is more prevalent worldwide than other NCDs (cardiovascular diseases, cancer, chronic respiratory diseases, diabetes) currently prioritized by the World Health Organization (WHO). Sexually transmitted diseases (NCDs).1,2. Chronic kidney disease (CKD) is progressive and eventually leads to kidney failure, requiring renal replacement therapy (KRT), i.e. dialysis or transplantation, for survival. However, neither his KRT therapy is curative, and the mortality and morbidity associated with renal failure remains high. In this issue, Nature Reviews Nephrologya consensus statement led by the American Society of Nephrology, the European Society of Nephrology, and the International Society of Nephrology.3 WHO calls for prioritizing kidney disease as the main NCD cause of premature death.
The proportion of deaths from kidney disease has steadily increased over the past 20 years3. Renal insufficiency is now her seventh leading risk factor for death. However, further increases are expected in the coming years, necessitating greater focus on this NCD as a contributing factor to premature death. In fact, the number of years of death (YLL) attributable to CKD (a measure of premature mortality) is projected to increase by 100% between 2016 and 2040, which is higher than estimates for other major NCDs. This is also a remarkable rapid increase.Four (Figure 1). Mortality associated with renal failure is particularly high among patients undergoing hemodialysis. In the United States, the life expectancy of her 40-45 year old patients undergoing hemodialysis is about the same as the life expectancy of her 75-79 year old individuals in the general population (approximately 11 years).Five. 5-year relative survival rate for patients with renal failure (36%)6 This is much lower than what has been reported for patients with prostate, skin, breast, cervical, colon, or ovarian cancer (60% to 96%).7. This mortality burden is not evenly distributed, as members of minority groups and people living in poverty have the least access to KRT and the worst outcomes. In addition, CKD patients are at increased risk of developing other NCDs, including cardiovascular disease, and are at increased risk of infectious diseases, which is further exacerbated by a reduced response to vaccination.3. This comorbidity burden not only leads to high mortality rates but also results in disease complexity and high symptom burden.
CKD, chronic kidney disease. eq, equivalent. HIC, high-income country; KRT, renal replacement therapy; LIC, low-income country; L/MIC; low- and middle-income countries. LMIC, low- and middle-income countries. NCD, non-communicable disease. OECD, Organization for Economic Co-operation and Development. UMIC, upper middle income countries; WHO, World Health Organization. Oh, the years of life lost. Source data are listed in Supplementary Box 1.
The economic burden of kidney disease, especially the cost of KRT, is enormous. In many high-income countries, a disproportionate amount (2-4%) of the health budget is spent on the 0.1-0.2% of the population with kidney failure.3. In areas without universal health coverage, KRT out-of-pocket costs are prohibitive. For millions of people, treatment costs are unaffordable. Many households experience catastrophic medical expenditures, leading to treatment discontinuation. In low-resource settings, the proportion of patients who require KRT but cannot access it can reach 98% (Ref. 1). 8). This gap results in millions of preventable deaths each year.
The inequitable burden of kidney disease is also evidenced by the morbidity and mortality of acute kidney injury (AKI), which not only increases the risk of developing CKD but can also lead to kidney failure.Patients from low-income and lower-middle income countries typically have more severe AKI and higher mortality rates than patients from high-income and upper-middle income countries9. These patients include children with reversible kidney disease who died after failing short-term, life-saving KRT.Ten.
“Despite kidney disease being common, deadly, and costly, public awareness of kidney disease remains low.”
The high prevalence, morbidity, mortality, and costs associated with kidney disease support its priority at the public health stage. However, public awareness of kidney disease remains low, even though it is common, deadly, and costly. This lack of awareness reflects a global public health challenge that does not adequately recognize the burden of kidney disease, undermining efforts to reduce risk factors and improve early diagnosis. . Several treatments are currently available that can slow the progression of CKD. However, access to these interventions remains inequitable. Alternative approaches to expensive and inappropriate dialysis modalities are also needed to reduce morbidity and mortality worldwide. Increasing global recognition of kidney disease as a cause of premature death has led to widespread prioritization of strategies aimed at preventing the onset and progression of kidney disease, making treatments more affordable and effective. Legal development will be facilitated. Such strategies have the potential to improve and save millions of lives each year.
