Mind the Gap in Kidney Care

Facts about Kidney Worldwide

At least 1 in 10 people worldwide is living with kidney disease.¹ According to the Global Burden of Disease study, in 2019,>3.1 million deaths were attributed to kidney dysfunction, making it the seventh leading risk factor for death worldwide (Figure 1).² However, global mortality from all kidney diseases may actually range between 5 and 11 million per year if the estimated lives lost, especially in lower-resource settings, from acute kidney injury and from lack of access to kidney replacement therapy for kidney failure (KF) are also counted.³ These high global death rates reflect disparities in prevention, early detection, diagnosis, and treatment of chronic kidney disease (CKD).⁴ Death rates from CKD are especially prominent in some regions, and particularly high in Central Latin America and Oceania (islands of the South Pacific Ocean), indicating the need for urgent action.⁵

CKD also poses a significant global economic burden, with costs increasing exponentially as CKD progresses, not only because of the costs of dialysis and transplantation, but also because of the multiple comorbidities and complications that accumulate over time.^6,7

Lack of CKD Awareness

A large proportion of CKD can be prevented through healthy lifestyles, prevention and control of risk factors, avoidance of acute kidney injury, optimization of maternal and child health, mitigation of climate change, and addressing social and structural determinants of health.³ Nevertheless, the benefits of some of these measures may only be seen in generations to come. In the meantime, early diagnosis and risk stratification create opportunities to institute therapies to slow, halt, or even reverse CKD.⁸ Concerningly, CKD awareness was strikingly low among individuals with kidney dysfunction, with 80% to 95% of patients being unaware of their diagnosis across world regions (Figure 2).^9-14 People are dying because of missed opportunities to detect CKD early and deliver optimal care! More importantly, CKD is a major risk factor for cardiovascular disease, and as kidney disease progresses, cardiovascular death and KF become competing risks.¹⁵ Indeed, the Global Burden of Disease study data from 2019 showed that more people died of cardiovascular disease attributed to kidney dysfunction (1.7 million people) than from CKD itself (1.4 million people).² Therefore, cardiovascular disease care must also be a priority for people with CKD.

Call to Action

The diagnosis in kidney care has been tolerated far too long. The biomarker diagnosis offers real convince and hopes that many people with CKD can survive without developing KF. The evidence of clinical benefit is overwhelming and unequivocal. Known barriers and global disparities in access to diagnosis must be urgently addressed (Figure 4). To achieve health equity for people with and at risk of kidney diseases, we must raise awareness from policy makers to patients and the general population, harness innovative strategies to support all cadres of health care workers, and balance profits with reasonable prices. If we narrow the gap between what we know and what we do, kidney health will become a reality worldwide.

Getein for Kidney

The theme of this year's World Kidney Day is Advancing Equitable Access to Care and Optimal Medication Practice, and Getein has been working hard to provide high-quality, yet affordable, diagnostic services. As one of the leading in vitro diagnostic companies in China, Getein always keeps the health and well-being of all human in mind and has developed a complete solution for kidney disease testing. It also has POCT, CLIA and clinical chemistry series instruments to help health care provider offering professional and timely diagnosis. Getein will also pay close attention to the global kidney disease burden and help reduce the burden of the medical system with professional products.

Reference

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2. Institute for Health Metrics and Evaluation (IHME). GBD compare data visualization. Accessed November 18, 2023. http://vizhub.healthdata.org/gbd-compare

3. Luyckx VA, Tonelli M, Stanifer JW. The global burden of kidney disease and the sustainable development goals. Bull World Health Organ. 2018;96:414–422D.

4. International Society of Nephrology. ISN Global Kidney Health Atlas. 3rd ed. Accessed November 18, 2023. https://www.theisn.org/initiatives/global-kidneyhealth-atlas/

5. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, of Disease Study 2017. Lancet. 2020;395:709–733.

6. 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;13:393–409.

7. Nguyen-Thi HY, Le-Phuoc TN, Tri Phat N, et al. The economic burden of chronic kidney disease in Vietnam. Health Serv Insights. 2021;14: 11786329211036011.

8. Levin A, Tonelli M, Bonventre J, et al. Global kidneyhealth 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet. 2017;390:1888–1917.

9. Stengel B, Muenz D, Tu C, et al. Adherence to the Kidney Disease: Improving Global Outcomes CKD guideline in nephrology practice across countries. Kidney Int Rep. 2021;6:437–448.

10. Chu CD, Chen MH, McCulloch CE, et al. Patient awareness of CKD: a systematic review and metaanalysis of patient-oriented questions and study setting. Kidney Med. 2021;3:576–585.e1.

11. Ene-Iordache B, Perico N, Bikbov B, et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study. Lancet Global Health. 2016;4:e307–e319.

12. Gummidi B, John O, Ghosh A, et al. A systematic study of the prevalence and risk factors of CKD in Uddanam, India. Kidney Int Rep. 2020;5:2246–2255.

13. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2022;102(5S):S1–S127.

14. Nicholas SB, Daratha KB, Alicic RZ, et al. Prescription of guideline-directed medical therapies in patients with diabetes and chronic kidney disease from the CURECKD Registry, 2019-2020. Diabetes Obes Metab. 2023;25:2970–2979.

15. Grams ME, Yang W, Rebholz CM, et al. Risks of adverse events in advanced CKD: the Chronic Renal Insufficiency Cohort (CRIC) study. Am J Kidney Dis. 2017;70:337–346.