Chronic Kidney Disease:
A neglected public health crisis that can be prevented

John Bowis, Former Minister of Health, UK.

WRITTEN BY

John Bowis, Former Minister of Health, UK.

Today, an estimated 850 million people worldwide live with chronic kidney disease (CKD)1. This is approximately twice the number of people with diabetes2. Still, the magnitude of CKD is not reflected in public health policies that are still lagging, especially when compared to other non-communicable diseases (NCDs)3.

It is a silent and progressive disease that thrives when undetected. The overall prevalence of undiagnosed CKD is especially high in its early stages, when effective management could be initiated to slow or avert the worsening of kidney function4. However, it is not uncommon for people to lose up to 90% of their kidney function before getting any symptoms.5

Yet, the ever-increasing spread of CKD is far from inevitable. The good news is: accurate and inexpensive tests are already available to hunt down CKD. Policymakers could adopt an integrative approach for targeting at-risk populations in a systematic prevention plan that consolidates programmes already in place for other NCDs. Indeed, the strategy for early CKD screening should prioritise people with common and important CKD risk factors such as hypertension and diabetes6. Such a comprehensive vision is necessary as NCDs often exist in clusters with common risk factors. What are we waiting for to make a real change on how we manage CKD and provide better outcomes for patients?


CKD is also a leading cause of health expenditure worldwide, and its burden weighs heavily on individuals and healthcare systems alike.7

With kidney failure, annual costs of dialysis and kidney transplantation alone range between USD 35,000 and USD 100,000 per patient8.

Moreover, the social and psychological impact of CKD is severely underestimated3. Patients living with kidney diseases can experience significant physical limitations, loss of quality of life, emotional and cognitive disorders, social isolation and premature death3. CKD also leaves a lasting mark on the environment as all treatments have a considerable carbon footprint and cause substantial pollution3. Because CKD’s damage is as multidimensional as extensive, identifying it at the earliest stages is definitely an equity imperative.

With approximately 10% of the world’s population living with CKD, it is currently the third fastest-growing major cause of death worldwide9,10. The need for immediate action is now more urgent than ever. It is, therefore, imperative to work for alleviating the barriers to life-saving primary CKD prevention.


On 10 March, I had the pleasure to take part in the Chronic Kidney Disease Summit, hosted by the Swedish Pavilion at EXPO Dubai 2020. In partnership with AstraZeneca, this platform brought together policymakers, healthcare workers, and health stewards from the kidney community to bridge the policy gap on CKD.

The COVID-19 pandemic painfully exposed the vulnerability of healthcare systems and CKD patients are at the heart of this storm. CKD is one of the most prevalent risk factors for severe COVID-1911. These circumstances should be a wake-up call to change the paradigms underpinning the failures of our healthcare system in the face of the pandemic. To build back more resilient post-COVID-19 systems, we must learn from CKD. The blind spots of its management are an eye-opening example of our structurally short-sighted policy perspective. Katie Dain, Chief Executive Officer of the NCD Alliance, underlined our opportunity to act; “How can we accelerate action on CKD? We need to make sure it is reflected and prioritised within the global NCD policy response, within Universal Health Coverage responses, as well as now, within pandemic preparedness and response agendas.”

As such, one of CKDs’ most powerful lessons is the benefits of prevention over cure. Not only is it critical for patients, but it would also reduce the socio-economic and environmental costs of later invasive treatments, decrease cardiovascular death4, and prevent the healthcare system’s long-term overload in the aftermath of the pandemic. Dr. Fiona Adshead, Chair of the Sustainable Healthcare Coalition reminded us, “The most sustainable healthcare of all is prevention and early detection. It is quite clear that we can reduce the human cost, economic and the environmental costs by really focusing on that.” For this reason, it is time to treat healthcare policy with an investment mindset taking into account opportunity costs of early screening and prevention. 


Guidelines on evaluating and managing early CKD are available but have not been universally adopted in the absence of incentives or quality of measures for prioritising CKD care6

The paradigm shift we call on depends upon the engagement of all stakeholders. Implementation efforts for the early screening of CKD should engage policymakers, primary clinicians, and the community at large in an iterative process6.  As Chris Forbes, Chief Executive Officer of Kidney Health Australia, said we collectively can change the paradigm, from kidney failure to kidney preservation.

Finally, it is important to highlight the words of Jane DeMeis, a patient advocate who emphasized CKD is not a death sentence. Yet, the improvement of public policies requires a global effort to generate lessons learned and opportunities to share and disseminate strategies that are successful. From AstraZeneca’s commitment to diagnose 140 million patients by 2025 across the globe to evidence-based case studies from Thailand, China, Uruguay, and Egypt, I am certain the discussions that took place during this Chronic Kidney Disease Summit will pave the way for proactive policymaking and real change. 


References:

1.Jager KJ, 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.NCD Alliance [Internet]. Leaving no one behind: New partnership to promote a broader NCD agenda. [cited 2022 February]. Available from: https://ncdalliance.org/sites/default/files/resource_files/LeaveNoOneBehind_EndocrineReport_FINAL_for_website_0.pdf
3.Vanholder R, et al. Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney. Clin Kidney J [Internet]. 2021 [cited 2022 February] ;14(7):1719–30. Available from: http://dx.doi.org/10.1093/ckj/sfab070
4.International Society of Nephrology [Internet]. Early diagnosis of chronic kidney disease. [cited 2022 February]. Available from: https://www3.weforum.org/docs/WEF_CKD_discussion_paper_PHSSR.pdf
5.World Kidney Day. [Internet]. Chronic kidney disease. [cited 2021 Jun 7]. Available from: URL: https://www.worldkidneyday.org/facts/chronic-kidney-disease/#:~:text=A%20person%20can%20lose%20up,the%20urine%20and%20foamy%20urine.   
6.Shlipak MG, et al. The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int [Internet]. 2021 [cited 2022 February].;99(1):34–47. Available from: http://dx.doi.org/10.1016/j.kint.2020.10.012
7.Luyckx, et al. Sustainable Development Goals relevant to kidney health: an update on progress. Nature Reviews Nephrology. 2021 Jan;17(1):15-32. https://doi.org/10.1038/s41581-020-00363-6
8.Levin A, , et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet [Internet]. 2017;390(10105):1888–917. Available from: http://dx.doi.org/10.1016/s0140-6736(17)30788-2
9.National Kidney Foundation [Internet]. Global Facts: About Kidney Disease. [cited 2022 February]. Available from: https://www.kidney.org/kidneydisease/global-facts-about-kidney-disease#_ENREF_1
10.Neuen BL, Chadban SJ, Demaio AR, Johnson DW, Perkovic V. Chronic kidney disease and the global NCDs agenda. BMJ Glob Health 2017;2(2):e000380
11.ERA-EDTA Council, ERACODA Working Group. Chronic kidney disease is a key risk factor for severe COVID-19: a call to action by the ERA-EDTA. Nephrol Dial Transplant [Internet]. 2021 [cited 2022 February];36(1):87–94. Available from: http://dx.doi.org/10.1093/ndt/gfaa314


tags

  • Regulatory
  • Partnering
  • Corporate and financial

Veeva ID: Z4-43276
Date of preparation: March 2022