World Kidney Day 2020: The onset and progression of CKD are often preventable

Prof. Philip KT Li

Honorary Professor of Medicine, Chinese University of Hong Kong and President of Hong Kong College of Physicians, and represents ISN on the WKD Joint Steering Committee 

Dr.Guillermo García García

Research Professor, University of Guadalajara Health Sciences Center, and Director of Nephrology, Hospital Civil de Guadalajara, Mexico, and represents IFKF on the WKD Joint Steering Committee

Preventive interventions – put in place in every country – could be the most suitable means of reducing the prevalence of chronic kidney disease (CKD) and the costs associated with it.

One in three people in the general population (an estimated 850 million people) is at increased risk of CKD. Worldwide, an estimated 10% of people have CKD, and estimates suggest nine in ten of those are unaware of their condition. The global burden of CKD is rapidly increasing with a projection of becoming the fifth most common cause of years of life lost globally by 2040.

Preventable costs of chronic kidney diseases

The costs of dialysis and transplantation consume 2–3% of the annual healthcare budget in high-income countries. This money is being spent on less than 0.03% of the total population of these countries. To reduce costs, the focus should then be put on preventing CKD. 

Cost-effectiveness can be increased by adopting secondary prevention measures for higher-risk populations such as those with diabetes mellitus and hypertension and those with rapid CKD progression. 

Education and political engagement, the first steps toward prevention 

“Primary prevention should focus on the modification of CKD risk factors and addressing structural abnormalities of the kidney and urinary tracts. There should also be a focus on exposure to environmental risk factors and substances that inhibit, damage or destroy the cells and/or tissues of the kidneys (nephrotoxins),” explains Professor Philip Kam Tao Li, Co-chairman of World Kidney Day Joint Steering Committee for the International Society of Nephrology (ISN).

“In contrast, in persons with pre-existing kidney disease, secondary prevention, including blood pressure optimisation, glycemic control and avoiding a high-protein high-sodium diet should be the main goal of education and clinical interventions,” adds Professor Guillermo Garcia Garcia, Co-chairman of WKD Joint Steering Committee for the International Federation of Kidney Foundations (IFKF).

Prof Li, who is also Immediate Past President of the Asian Pacific Society of Nephrology, says: “Educational and political efforts are needed to push the ‘prevention’ approach.” 

We need to raise awareness across all of society

CKD prevention should be understood across all parts of society: from the general public to nephrologist practitioners and decision-makers. Populations should be made aware of the risks through global communication campaign, while online learning platforms can empower patients.

On the flipside, practitioners who receive cross-speciality training will increasingly identify and treat at-risk patients. Politicians can do their share by prioritising integrated NCD programmes and support good practice. Good practice includes screening at-risk populations, improving universal access to essential diagnostics of early CKD, increasing the availability of affordable basic technologies and essential medicines, and task shifting from doctors to front-line healthcare workers to more effectively target progression of CKD. 

World Kidney Day on Thursday, 12 March 2020

Led by the ISN and the IFKF, the theme for World Kidney Day 2020 is: “Kidney Health for Everyone Everywhere – from Prevention to Detection and Equitable Access to Care.” It highlights the importance of preventive interventions – be it primary, prevention of CKD onset, or secondary or tertiary, i.e. prevention of worsening early CKD or progression of more advanced CKD to end-stage kidney disease, respectively.