Kidney disease must be included on the global health agenda – added to the other major non-communicable diseases (NCD) of heart disease, stroke, cancer, diabetes and chronic lung disease, nephrology professional bodies say.

An international consensus, published in Nature Reviews Nephrology [link here], said the absence of either acute kidney injury (AKI) or chronic kidney disease (CKD) from the WHO list of major NCD causes of premature mortality was unacceptable.

“Failure to spotlight kidney disease will undo or substantially slow progress towards the 2015 United Nations Sustainable Development Goal 3.4 of reducing premature mortality from NCDs by a third by 2030,” it said.

The heavy-hitting consensus statement comes from the International Society of Nephrology, European Renal Association and American Society of Nephrology and has been endorsed by Asian Pacific Society of Nephrology, African Association of Nephrology, Latin American Society of Nephrology and Hypertension and the World Heart Federation.

It argues that the burden of disease is already substantial with a global prevalence >10% and concerningly, is growing.

In particular, it emphasised the inequitable burden of disease in low-income and lower-middle-income countries (LICs and LMICs).

Population growth, ageing populations and increasing CKD risk factors, namely diabetes, hypertension and obesity, will drive the burden of kidney disease higher, it said.

As well, environmental risks and climate instability will contribute to the increased risk of kidney disease globally.

“For example, persistent exposure to high temperatures, particularly for agricultural and outdoor workers in LICs and LMICs who lack access to adaptation interventions, increase heat stress, which exacerbates the risk of kidney disease,” the statement said.

“Furthermore, large population studies suggest that rises in fine particulate matter in the air are associated with an increased risk of AKI, as well as CKD prevalence and progression.”

Public health needs

Dr Anna Francis

The statement, co-authored by Dr Anna Francis from the Queensland Children’s Hospital, said kidney diseases disproportionately affect the poor and disadvantaged, globally and within each country.

“Moreover, kidney disease not only has a profound negative impact on patients owing to its debilitating symptom burden but it also increases their risk of developing other major NCDs, restricts their ability to work and care for family members, and is cripplingly expensive for individuals, families, health systems and governments.”

Yet the impact of kidney disease was under recognised.

“The ISN, American Society of Nephrology and European Renal Association and nephrology communities worldwide unite in calling for kidney health to become a core part of the global health agenda.”

“Specifically, prioritisation by the WHO will help to raise awareness and demand for care, develop and implement guidelines and standards, improve implementation of locally appropriate surveillance and monitoring mechanisms, coordinate international efforts, and allocate resources more efficiently.”

It added that prioritisation of kidney disease will also “foster investment towards the development of sorely needed new therapies.”

It said urgent public health needs for people with, or at risk of, kidney disease include:

• Improved access to diagnostic and treatment services
• Better prevention strategies
• Affordable, scalable and sustainable models of care
• Greater awareness and education including in primary care
• Addressing social determinants of kidney health
• Increased funding for research and development
• International cooperation and coordination
• Greater engagement with patient communities

An accompanying editorial in the journal [link here] said kidney dysfunction was now the seventh leading risk factor for death.

“Indeed, the number of years of life lost (YLL) — a measure of premature mortality — attributed to CKD is predicted to rise by 100% between 2016 and 2040, a notably sharper growth than that estimated for any of the other major NCDs,” it said.

“This mortality burden is not equally distributed as members of minority groups and those living in poverty have the lowest access to kidney replacement therapy (KRT) and the poorest outcomes.”

It said a disproportionate amount of the healthcare budget (2–4%) is spent on the 0.1–0.2% of the population with kidney failure in many high-income countries.

As well, the proportion of patients in LICs who need KRT but cannot access it can be as high as 98%.

“Yet despite kidney disease being common, deadly and costly, public awareness of it remains low. This lack of awareness reflects a failure of global public health agendas to adequately acknowledge the burden of kidney disease and undermines efforts to mitigate risk factors and improve early diagnosis.”

“Greater global recognition of kidney disease as a driver of premature mortality will encourage the widespread prioritisation of strategies that aim to prevent the development and progression of kidney disease, and support the development of more affordable and effective treatments.”

International consensus statement published in @NatRevNeph calls for urgent action to address CKD on the global public health agenda. Read “Chronic Kidney Disease and the Global Public Health Agenda: An International Consensus” ➡️ https://t.co/jX6Mi8QSHA pic.twitter.com/Pp6teeW1dE

— Int Society of Nephrology (@ISNkidneycare) April 4, 2024