Diabetes, hypertension key risks in chronic kidney disease, says expert

World Kidney Day is observed on March 13 and is a joint initiative of the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations – World Kidney Alliance (IFKF-WKA).

World Kidney Day (WKD) is a global campaign aimed at raising awareness of the importance of our amazing kidneys and promoting kidney health for all.

The objectives of the WKD are to highlight that diabetes and high blood pressure are key risk factors for chronic kidney disease (CKD), to encourage systematic screening of all patients with diabetes and hypertension for the CKD, to encourage preventive behaviours and to educate medical professionals about their key role in screening, early detection and reducing the risk of the CKD progression, particularly in high-risk populations. The WKD also stresses the important role of local and national healthcare systems.

The theme of the WKD 25 is “Are your kidneys OK?” Detect early, protect kidney health emphasises the importance of screening and early detection of the CKD to halt or delay the progression of kidney failure by lifestyle modification and early medical intervention.

The CKD is an immense public health problem. Today, it is estimated that more than 850 million people worldwide suffer from it. The Global Burden of Disease (GBD) study found that about one-third of the global burden of the CKD was contributed by India and China. By 2040, the CKD is projected to become the fifth leading cause of years of life lost, highlighting the urgent need for global strategies to combat kidney disease.

Although people of every age and race are affected by the CKD, people from disadvantaged populations may be at the higher risk of the condition and associated morbidity and mortality due to socio-economic factors and limited access to care. The CKD has many known causes, including high blood pressure (hypertension), diabetes mellitus, obesity, autoimmune diseases, kidney stones, kidney infections, kidney cysts and cigarette smoking, to mention a few. Diabetes stands as one of the most common causes of kidney disease contributing to one-third of all cases. High blood pressure contributes to just over a quarter of all cases of kidney failure. Environment factors such as climate change, geographical location, exposure to toxins, and dietary habit also contribute to CKD.

Genetic predisposition results in inherited kidney diseases like polycystic kidney disease. Signs of worsening kidney function are increased protein in the urine (proteinuria) or increased creatinine (a nitrogenous waste product of protein metabolism) in the blood.

It is important to monitor these markers over time and to use therapies to delay progression in order to manage the CKD and prevent further kidney damage. Lifestyle modifications include intake of healthy diet, regular physical activity, weight management and smoking cessation.

Despite these well-established preventive strategies, many people still progress through the CKD to kidney failure. Approximately 0.1% of the world’s population has kidney failure, and estimates suggest a higher prevalence in upper middle income countries (UMICs) (0.1%) and high-income countries (HICs) (0.2%), compared to low-income countries (LICs) (0.05%) or lower-middle income countries (LMICs) (0.07%). However, the proportion of people with kidney failure who are not receiving treatment in the form of dialysis or transplantation is much higher in LICs (98%) and LMICs (94%) than in UMICs (79%) and HICs (30%).

The treatment for kidney failure involves either dialysis or kidney transplantation. There are two modalities of dialysis: Peritoneal Dialysis (Home Dialysis) and Haemodialysis or Blood Dialysis. Deciding which modality is appropriate for each person living with kidney disease is a complex process. Often times, available resources, expertise, and the condition of the person living with kidney disease, guide the modality choice. The decision may also depend on other factors such as the education level or desire for independence of people living with kidney disease, wait time for transplantation, and distance to a dialysis centre, among others. The age of the person living with kidney disease at the time of treatment initiation may also be an important consideration.

We call on all health care professionals to check the kidney health of their patients at risk of kidney disease. Societies of nephrology must work with health care systems, governments and the WHO to prioritise kidney disease and create effective and efficient early detection programs for kidney disease. Only then will the paradigm-shifting benefits of lifestyle change and pharmacologic treatments translate into better kidney and overall health for people all around the world.