Ellie Clifford, Senior Account Manager at Incisive Health
Last month, a new commission by The Lancet highlighted the global burden of kidney disease and current disparities in access to kidney care. It calls for transparent decision-making processes and guidelines that promote access to therapies and interventions to delay progression of a particular form of kidney disease – chronic kidney disease (CKD). This World Kidney Day, patient organisations around the world are reiterating this very important message, while advocating for a new approach to the management of CKD that is often missed.
What is chronic kidney disease?
The kidneys play a vital role in maintaining optimal conditions for the body’s organs by removing waste, and balancing fluids, minerals and hormones. CKD is a long-term condition in which there is a gradual loss of kidney function over time. The condition affects 9.5% of the global population [1], yet fewer than 10% of people living with CKD are aware they have the disease [2]. If left undiagnosed, CKD can progress to kidney failure, which is deadly and patients require kidney replacement therapies in the form of dialysis or a kidney transplant to stay alive.
CKD rarely strikes alone
CKD is part of a collection of non-communicable diseases (NCDs), alongside cardiovascular diseases (e.g. heart failure and hypertension) and metabolic conditions (e.g. obesity and diabetes), which are interconnected. These conditions share risk factors such as physical inactivity, unhealthy diets, ethnicity, tobacco use and the harmful use of alcohol [3], and people are often affected by more than one of these conditions. For example, a recent study conducted in Hungary found that 70% of people with CKD had hypertension, 42% had diabetes and 21% had heart failure [4].
Yet current policies and strategies aimed at addressing NCDs fail to recognise the link between these conditions. For example, the United Nations (UN) political declaration on NCDs does not include any targets on CKD.
Reducing the overall burden of CKD requires a holistic, systemic approach that plays into the interrelated web of kidney, cardiovascular and metabolic diseases.
Immediate action is needed
We know that the prevalence of cardiovascular diseases and metabolic conditions is increasing rapidly. It’s no surprise, therefore, that the prevalence of CKD is also increasing – in fact, it’s set to become the world’s fifth leading cause of mortality by 2040 [5,6].
Annual health system costs associated with kidney replacement therapies (dialysis and transplant) are projected to increase from GBP 2.15 billion to GBP 2.60 billion in the UK, and from USD 72.72 billion to USD 94.41 billion in the US, between 2022 and 2026 [7].
If CKD is detected and treated early, progression to end-stage kidney disease can be delayed, reducing the need for kidney replacement therapies, thereby reducing the burden on patients, caregivers, health systems and economies.
What can policymakers do to address this issue?
Recognise the interconnectedness of CKD, cardiovascular disease and metabolic conditions. Charities in the UK, across Europe and much of the globe have been campaigning on this issue for some time.
Incorporate steps to prevent, diagnose early, treat effectively and support people living with CKD into national and global NCD action plans.
Test people with, or who are at risk of, cardiovascular and metabolic conditions for CKD, so that it can be caught in its early stages.
Policy opportunities to look out for
The call for a holistic approach to the management of kidney, cardiovascular and metabolic diseases is starting to gain traction, and there are some key upcoming platforms and dialogues to keep an eye on as we move through the rest of this year and into the next:
As part of the EU strategy to improve kidney care during the 2024-2029 mandate, the ‘PreventCKD’ project calls for policymakers to systematically include CKD in EU NCD prevention programmes, to reduce the incidence of CKD by 10% by 2029 [8].
The next UN High-Level Meeting on NCDs will take place in 2025, during which the NCD targets, which currently do not include any kidney targets, are expected to be updated and extended.
Current NCD strategies and policies do not reflect the whole story. It’s critical that CKD is recognised as an urgent public health priority, and that only by addressing it as part of the full cardiovascular, renal and metabolic collection can meaningful change be achieved, before the burden of these diseases becomes a health emergency.
References
1. Bello et al.. An update on the global disparities in kidney disease burden
and care across world countries and regions. 2024. Available from: https://www.thelancet.com/action/showPdf?pii=S2214-109X%2823%2900570-3 [Last accessed 12 March 2024]
2. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. 2020. Available from: https://www.thelancet.com/article/S0140-6736(20)30045-3/fulltext [Last accessed 12 March 2024]
3. Noncommunicable diseases. World Health Organisation. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases#:~:text=Tobacco%20use%2C%20physical%20inactivity%2C%20the,of%20the%20response%20to%20NCDs. [Last accessed 05 March 2024]
4. Zemplenyi et al.. Prevalence, Cardiometabolic Comorbidities and Reporting of Chronic Kidney Disease; A Hungarian Cohort Analysis. 2023. Available from: https://www.ssph-journal.org/articles/10.3389/ijph.2023.1605635/full [Last accessed 01 March 2024]
5. Jankowski et al.. Cardiovascular Disease in Chronic Kidney Disease. 2021. Available from: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.120.050686 [Last accessed 27 February 2024]
6. Foreman 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. 2018. Available from: https://pubmed.ncbi.nlm.nih.gov/30340847 [Last accessed 27 February 2024]
7. Mennini et al.. Inside CKD: Projecting the Economic Burden of Chronic Kidney Disease Using Patient-Level Microsimulation. 2022. Available from: https://www.valueinhealthjournal.com/article/S1098-3015(21)02136-7/fulltext [Last accessed 27 February 2024]
8. Kidney Manifesto. European Kidney Health Alliance. Available from: https://www.era-online.org/wp-content/uploads/2024/01/EKHA_Kidney-Manifesto2024.pdf [Last accessed 01 March 2024]