World Kidney Day

World Kidney Day is being celebrated today in more than 80 countries and territories and 6 continents. WKD is a joint initiative of the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF) and is held every second Thursday in March.

What is Chronic Kidney Disease (CKD)?  CKD is present when individuals have an increase in excretion of albumin in the urine or a major decrease in kidney function. This may lead to complications such as high blood pressure, anaemia, and heart and blood vessel disease.

How common is chronic kidney disease?  More than 500 million persons worldwide - 10% of the adult population - have some form of kidney damage, and every year millions die prematurely of cardiovascular diseases linked to CKD.

What causes chronic kidney disease?  Globally the most common causes of CKD have been nephrotic or inflammatory diseases of the kidney, infections, obstruction in the urinary tract and inherited disorders like polycystic kidney disease. This is changing in both developed and developing nations towards diabetes and hypertension, which are also the most common causes of cardiovascular disease (CVD).

How is chronic kidney disease detected?  Simple laboratory tests are done on small samples of blood and urine to measure creatinine content and calculated GFR and albumin excretion.

What are the consequences of undetected chronic kidney disease?  The first consequence is the risk of developing progressive loss of kidney function leading to kidney failure and the need for dialysis or transplantation. The second is premature death from associated cardiovascular disease.

Individuals who appear to be healthy who are then found to have CKD have at least a tenfold risk of dying prematurely from CVD regardless of whether they develop kidney failure. CKD contributes towards morbidity from CVD in over 12 million individuals worldwide each year. These numbers are rapidly rising due to the global epidemic of type 2 diabetes.

What are the costs and consequences to society of the growing epidemic of CKD?  The costs of kidney failure (end-stage renal disease) are escalating. Worldwide, over 1.5 million people are currently kept alive through either hemo or peritoneal dialysis or transplantation, this number is forecasted to double within the next 10 years. The cumulative global cost for dialysis and transplantation over the next decade is predicted to exceed $1,000,000,000,000. This economic burden could strain healthcare budgets in developed countries. For lower income countries it is impossible to meet such costs.

More than 80% of individuals receiving renal replacement therapy (RRT) live in the developed world because in developing countries it is largely unaffordable. In countries such as India and Pakistan less than 10% of all patients who need it receive any kind of renal replacement therapy. In many African countries there is little or no access to RRT, meaning many people simply die.  In most undeveloped and third world countries, End Stage Renal Disease is a death sentence.

The economic burden for developing countries is particularly severe, partly because CKD generally occurs at a younger age. For example, in Guatemala, 40% of patients on RRT are under 40. In China, the economy will lose US$558 billion over the next decade due to effects on death and disability attributable to chronic cardiovascular and renal disease.

What can be done to detect, prevent and treat chronic kidney and cardiovascular disease?  Detection

Simple tests are now available for serum creatinine, calculated GFR and urine albumin that allow early detection of CKD.  The majority of individuals with early stages of CKD go undiagnosed, particularly in the developing world. The early detection of kidney impairment is essential and allows suitable treatment before kidney damage or deterioration manifests itself through other complications.

Prevention and delay

Screening must be high priority in subjects considered to be at high risk of kidney disease, namely:

• Patients with diabetes and hypertension.
• Individuals who are obese or smoke.
• Individuals over 50 years of age.
• Individuals with a family history diabetes, hypertension and kidney disease.
  

Current kidney protective treatments should now be extended to those with early stages of renal failure.  Key preventative measures have been defined and proven successful in protecting against both renal and cardiovascular disease, such as:

• Reduction of high blood pressure -the lower the blood pressure, the lower the GFR decline.
• Control of glucose, blood lipids and anemia.
• Smoking cessation.
• Increased physical activity.
• Control of body weight.

Treatment

ACE inhibitors are effective in preventing progressive renal function decline. Angiotensin-II-antagonists lower albuminuria and prevent progressive renal failure.

 

There are currrently more than 98,000 individuals in the United States awaiting an organ transplant and 74,873 of them are awaiting a kidney.  With these numbers being so high and the fact that they are rising every year, it is unfortunate but true that someone needing a kidney will touch your life.  You may not be able to do anything about that person, but you can certainly give a gift to someone esle.  Please, take the time to sign up for your states organ donation registry and make sure that your feelings are known to your family. 

Those that await a donation wish no ill happenings to anyone, but they do hope, they actually beg, that you make a provision that if something tragic does befall you, that you take the proper ssteps to make sure that you can save at least one life in your passing. 

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