Putting patient perspectives into action to address the global burden of chronic kidney disease


Nisha Bhatt MD, Executive Director, Global Medical Affairs at AstraZeneca

Chronic kidney disease (CKD) is a serious, progressive condition and under-recognised public health problem, affecting nearly 840 million people worldwide.1 More than 9 million people living with CKD have progressed to kidney failure, requiring dialysis or a kidney transplant, at an estimated annual cost between $35,000 and $100,000 per patient.2,3 By 2040, CKD is expected to become the world’s 5th leading cause of mortality.4

A diagnosis of CKD can drastically affect the lives of both patients and their loved ones.5,6 When kidney function declines, other health conditions also worsen.7 The disease can lead to serious complications such as anaemia and hyperkalaemia, which are associated with increased risk of mortality.8,9 As no cure currently exists, there is a critical need for early detection and improved treatment options.9,10

The urgency to understand the challenges of living with chronic kidney disease

CKD can have a profound impact on a patient’s personal life, including social, economic and physical effects.6 As a treating nephrologist and now while working at AstraZeneca, I believe it is critical that we step up to address the direct and indirect burden CKD patients are facing more fully. However, to truly put patients first, we needed to hear from them directly. Developed by AstraZeneca, the CKD-Personal Impact Index, a global analysis of the impact of CKD on people living with this condition, is helping us better understand and measure the day-to-day impact of the disease and its complications beyond standard Quality of Life analyses.11

(CKD) is a huge lifestyle change for me and my wife isn't taking it very well. I'm a chef by trade and we love to eat... I love life more than I love food though.

Quote from a CKD patient from the CKD-Personal Impact Index findings

The CKD-Personal Impact Index

According to the CKD-Personal Impact Index, approximately half of patients with CKD report that their daily activities are highly impacted by the disease and its complications. This impact is even greater for patients on dialysis (58%) and those with a kidney transplant (82%). The impact of CKD on a patient’s daily activities comes on swiftly once diagnosed, with 71% of respondents reporting an impact within the first six months after diagnosis.11

CKD’s impact on overall quality of life is perceived similarly, with 56% of patients reporting it has an extreme impact on quality of life, which is again higher for those on dialysis (61% vs. 50%) and those with a kidney transplant (73% vs. 53%). Financial, employment and professional time factors were deemed to have the strongest influence on patients’ overall quality of life.11

Data was collected through a global social media landscape assessment, including blogs and social networks, in addition to in-depth telephone interviews and a quantitative survey. With participants from China, Brazil, Sweden, the US, and the UK, the CKD-Personal Impact Index evaluated both global and regional perspectives and revealed critical issues and unmet patient needs.11

I am quite scared of what the future will hold. Angry, but can’t tell you why I am really angry. Fear of what it is going to be like in the future and the impact on my husband and child.

Quote from a CKD patient from the CKD-Personal Impact Index findings

We believe that the insights we have uncovered through this analysis will help improve understanding of the disease burden and secondary complications, raise awareness of the deeper impact of CKD and lead the way to developing tangible and realistic solutions.

Most burdensome personal attributes of CKD by percentage of patients who participated in the research who reported a somewhat or extreme impact to the daily activity

AstraZeneca’s commitment in CKD

At AstraZeneca, we know that helping patients manage CKD includes incorporating a holistic approach to care, which includes discovering the commonalities between cardiovascular, renal and metabolic (CVRM) diseases, including CKD. We are exploring solutions across the full continuum of CKD care, from prevention and protection before a CKD diagnosis, to slowing disease progression and managing serious complications across all stages of disease after diagnosis. We aim not only to bring CKD and its associated complications to the medical forefront, but also offer patients new methods to improve their journey beyond one specific disease. The CKD-Personal Impact Index is an important tool in the pursuit of our ambition to transform CKD management and help people live longer, healthier lives. We want to give a voice to this silent disease by raising awareness of the patient experience and improving communication with patients, communities, clinicians, and policymakers.

DISCLAIMER: As noted above, the objective of this index is to highlight the day-to-day and overall quality of life impact of living with CKD for patients. It is recognised that patients with mild CKD and only mildly impaired renal function, as evidenced by their e-GFR, may actually be asymptomatic with no immediate impact on their day-to-day living and overall quality of life. This actual CKD-Personal Impact Index analysis did not state whether the patients evaluated had mild, moderate, or moderate to severe CKD. This index therefore has limitations because it does not examine how or at what stage of CKD said impact changes in robust detail but instead examines those quality of life impacts arising for all patients, using an aggregated analysis of all patients who participated in the research. Furthermore, the findings contained within the index herein are developed solely based on several bodies of data that represents patient reported outcomes. The findings are not based on a literature review or what we know to be true on the medical landscape of chronic kidney disease.


1. Jager, Kitty J et al. “A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases.” Kidney international vol. 96,5 (2019): 1048-1050.

2. Bikbov B et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet 2020; 395(10225):709–33.

3. Levin A et al, Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy’, The Lancet, 2017, volume 390 issue 10105, pages 1888-1917

4. Foreman K.J. 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: 2052-2090

5. Brunori F et al. The interview with a patient on dialysis: feeling, emotions and fears. G Ital Nefrol 2016; 33(2)

6. Nguyen NTQ et al. Chronic kidney disease, health-related quality of life and their associated economic burden among a nationally representative sample of community dwelling adults in England. PLoS ONE 2018; 13(11):e0207960

7. National Institute of Diabetes and Digestive and Kidney Diseases. What Is Chronic Kidney Disease? [cited 19 April 2021]. Available from: URL: https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/what-is-chronic-kidney-disease

8. National Kidney Foundation. Clinical Update on Hyperkalemia: A chronic Risk for CKD Patients and a Potential Barrier to Recommended CKD Treatment. New York: National Kidney Foundation; 2014 [cited 19 April 2021]. Available from: URL: https://www.kidney.org/sites/default/files/02-10-6785_HBE_Hyperkalemia_Bulletin.pdf.

9. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis 2006; 47(5 Suppl 3):S1-146.

10. National Health Service. Treatment: Chronic kidney disease; 2019/08/29 [cited 19 Apil 2021]. Available from: URL: https://www.nhs.uk/conditions/kidney-disease/treatment/.

11. AstraZeneca. Data on File. Z4-27321. 19 April 2021.

Veeva ID: Z4-32703
Date of Preparation: April 2021