Kidney Health for Everyone Everywhere - from Prevention to Detection and Equitable Access to Care

The global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5th most common cause of years of life lost globally by 2040. Aggravatingly, CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume up to 3% of the annual healthcare budget in high-income countries. Crucially, however, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventions – be it primary, secondary or tertiary. This complementing article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney and urinary tracts, as well as exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimization and glycemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD,management of co-morbidities such as uremia and cardiovascular disease is a highly recommended preventative intervention to avoid or delay dialysis or kidney transplantation. Political efforts are needed to proliferate the preventive approach. While national policies and strategies for noncommunicable diseases might be present in a country, specific policies directed toward education and awareness about CKD screening, management and treatment are often lacking. Hence, there is an urgent need to increase the awareness of the importance of preventive measures throughout populations, professionals and policy makers.

Kaynakça

[1]International Society of Nephrology. 2019 United Nations High Level Meeting on UHC: Moving Together to Build Kidney Health worldwide. Retrieved 20 July 2019, https://www.theisn.org/images/Advocacy_ 4_pager_2019_Final_WEB_pagebypage.p df.

[2]Foreman KJ, Marquez N, Dolgert A, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet. 2018; 392(10159): 2052-90.

[3]Essue BM, Laba TL, Knaul F, et al. Economic burden of chronic ill health and injuries for households in low- and middleincome countries. In: Jamison DT, Gelband H, Horton S, et al., eds. Disease Control Priorities Improving Health and Reducing Poverty,. 3 ed. Washington, DC: World Bank; 2018: 121-43.

[4]Vanholder R, Annemans L, Brown E, et al. Reducing the costs of chronic kidney disease while delivering quality health care: a call to action. Nat Rev Nephrol. 2017; 13(7): 393-409.

[5]Luyckx VA, Tuttle KR, Garcia-Garcia G, et al. Reducing major risk factors for chronic kidney disease. Kidney Int Suppl. (2011) 2017; 7(2): 71-87.

[6]Luyckx VA, Tonelli M, Stanifer JW. The global burden of kidney disease and the sustainable development goals. Bull World Health Organ. 2018; 96(6): 414-22D.

[7]Tonelli M, Muntner P, Lloyd A, et al. Risk of coronary events in people with chronic kidney disease compared with those with diabetes: a population-level cohort study. Lancet. 2012; 380(9844): 807-14.

[8]Kalantar-Zadeh K and Fouque D. Nutritional Management of Chronic Kidney Disease. N Engl J Med. 2017;377(18):1765-76.

[9]United Nations General Assembly. Political declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases. 2018, Retrieved from https://www.un.org/ga/search/view_doc.as p?symbol=A/73/L.2&Lang=E[10]Lopez AD, Williams TN, Levin A, et al. Remembering the forgotten noncommunicable diseases. BMC Med. 2014;12:200.

[11]Center for Disease Control (CDC) and Prevention. “Picture of America” (www.cdc.gov/pictureofamerica). At a Glance - Executive Summary. 2017;2019.

[12]Levey AS, Schoolwerth AC, Burrows NR, et al. Centers for Disease Control and Prevention Expert Panel. Comprehensive public health strategies for preventing the development, progression, and complications of CKD: report of an expert panel convened by the Centers for Disease Control and Prevention. Am J Kidney Dis. 2009;53(3):522-35.

[13]Saran R, Robinson B, Abbott KC, et al. US Renal Data System 2018 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2019;73(3S1):A7-A8.

[14]Kovesdy CP, Furth SL, Zoccali C, World Kidney Day Steering Committee. Obesity and Kidney Disease: Hidden Consequences of the Epidemic. J Ren Nutr. 2017;27(2):75- 77.

[15]Tantisattamo E, Dafoe DC, Reddy UG, et al. Current Management of Acquired Solitary Kidney. Kidney International Reports. 2019;4(9):1205-18.

[16]Webster AC, Nagler EV, Morton RL et al. Chronic Kidney Disease. Lancet. 2017;389(10075):1238-52.

[17]Koppe L and Fouque D. The Role for Protein Restriction in Addition to ReninAngiotensin-Aldosterone System Inhibitors in the Management of CKD. Am J Kidney. Dis. 2019;73(2):248-57.

[18]Rifkin DE, Coca SG and Kalantar-Zadeh K. Does AKI truly lead to CKD? J Am Soc Nephrol. 2012;23(6):979-84.

[19]Torres VE et al, Tolvaptan in patients with autosomal dominant polycystic kidney disease. N Engl J Med 2012;367(25):2407- 18.

[20]Verhave JC, Troyanov S, Mongeau F et al. Prevalence, awareness, and management of CKD and cardiovascular risk factors in publicly funded health care. Clin J Am Soc Nephrol. 2014; 9: 713–19.

[21]Chow KM, Szeto CC, Kwan B, et al. Public lacks knowledge on chronic kidney disease: Telephone survey. Hong Kong Med. J 2014; 20(29: 139–44.

[22]Ene-Iordache B, Perico N, Bikbov B et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISNKDDC): A cross-sectional study. Lancet Glob Health. 2016; 4(5): e307–e319.

[23]Li PKT, Weening JJ, Dirks J, et al. A report with consensus statements of the International Society of Nephrology 2004 Consensus Workshop on Prevention of Progression of Renal Disease. Kidney Int Suppl. 2005;(94):s2-7.

[24]Vassalotti JA, Stevens LA, Levey AS. Testing for chronic kidney disease: A position statement from the National Kidney Foundation. Am J Kidney Dis. 2007; 50(2): 169–80.

[25]Levey AS, Atkins R, Coresh J et al. Chronic kidney disease as a global public health problem: Approaches and initiatives – a position statement from Kidney Disease Improving Global Outcomes. Kidney Int. 2007; 72(3): 247–59.

[26]Crowe E, Halpin D, Stevens P. Guideline Development Group. Early identification and management of chronic kidney disease: summary of NICE guidance. BMJ. 2008;337:a1530.

[27]Li PKT, Chow KM, Matsuo S, et al. Asian Chronic Kidney Disease (CKD) Best Practice Recommendations – Positional Statements for Early Detection of CKD from Asian Forum for CKD Initiatives (AFCKDI). Nephrology (Carlton). 2011;16(7):633-41.

[28]Fink HA, Ishani A, Taylor BC, et al. Screening for, monitoring, and treatment of chronic kidney disease stages 1 to 3: A systematic review for the U.S. Preventive Services Task Force and for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2012;156(8): 570–81.

[29]Li PKT, Ng JK, Cheng YL, et al. Relatives In Silent Kidney disease Screening study (RISKS): a Chinese cohort study. Nephrology (Carlton). 2017;22 Suppl 4:35- 42.

[30]Samal L, Linder JA. The primary care perspective on routine urine dipstick screening to identify patients with albuminuria. Clin J Am Soc Nephrol. 2013;8(1):131-35.

[31]George C, Mogueo A, Okpechi I, et al. Chronic kidney disease in low-income to middle-income countries: the case for increased screening. BMJ Glob Health. 2017;2(2):e000256.

[32]Gonzalez-Quiroz M, Nitsch D, Hamilton S, et al. DEGREE Study Steering Committee. Rationale and population-based prospective cohort protocol for the disadvantaged populations at risk of decline in eGFR (CODEGREE). BMJ Open. 2019;9 :e031169.

[33]Boulware LE, Jaar BG, Tarver-Carr ME, et al. Screening for proteinuria in US adults: A cost-effectiveness analysis. JAMA. 2003; 290(23): 3101–14.

[34]Go DS, Kim SH, Park J, et al. Costutility analysis of the National Health Screening Program for chronic kidney disease in Korea. Nephrology (Carlton). 2019;24(1):56-64.

[35]Komenda P, Ferguson TW, Macdonald K et al. Cost-effectiveness of primary screening for CKD: A systematic review. Am J Kidney Dis. 2014; 63(5): 789–97.

[36]Hwang SJ, Tsai JC, Chen HC. Epidemiology, impact and preventive care of chronic kidney disease in Taiwan. Nephrology (Carlton). 2010;15 Suppl 2:3-9.

[37]Almaguer M, Herrera R, Alfonso J, et al. Primary health care strategies for the prevention of end-stage renal disease in Cuba. Kidney Int Suppl. 2005; 97: S4-10.

[38]Alamaguer-Lopez M, Herrera-Valdez R, Diaz J, et al. Integration of chronic kidney disease prevention into noncommunicable disease programs in Cuba. In G. GarciaGarcia, L. Y. Agodoa, & K. C. Norris (Eds.), Chronic Kidney Disease in Disadvantaged Populations 2017, London: Elsevier Inc., pp. 357-365.

[39]U.S. Department of Health and Human Services. Advancing American Kidney Health., 2019 accessed Sept 26, 2019 https://aspe.hhs.gov/pdf-report/advancingamerican-kidney-health

[40]U.S. Department of Health and Human Services. The Special Diabetes Program for Indians. Estimates of Medicare savings., 2019. Accessed Sept 26, 2019 https://aspe.hhs.gov/pdf-report/specialdiabetes-program-indians-estimatesmedicare-savings

[41]Bello AK, Nwankwo E, El Nahas AM. Prevention of chronic kidney disease: a global challenge. Kidney Int Suppl. 2005;98:S11-17.

[42]James MT, Hemmelgarn BR, Tonelli M. Early recognition and prevention of chronic kidney disease. Lancet. 2010; 375(9722), 1296-1309.

Kaynak Göster