The Contribution of Chronic Kidney Disease to the Global Burden of Major Noncommunicable Diseases

William G Couser; Giuseppe Remuzzi; Shanthi Mendis; Marcello Tonelli

Disclosures

Kidney Int. 2011;80(12):1258-1270. 

In This Article

Abstract and Introduction

Abstract

Noncommunicable diseases (NCDs) are the most common causes of premature death and morbidity and have a major impact on health-care costs, productivity, and growth. Cardiovascular disease, cancer, diabetes, and chronic respiratory disease have been prioritized in the Global NCD Action Plan endorsed by the World Health Assembly, because they share behavioral risk factors amenable to public-health action and represent a major portion of the global NCD burden. Chronic kidney disease (CKD) is a key determinant of the poor health outcomes of major NCDs. CKD is associated with an eight- to tenfold increase in cardiovascular mortality and is a risk multiplier in patients with diabetes and hypertension. Milder CKD (often due to diabetes and hypertension) affects 5–7% of the world population and is more common in developing countries and disadvantaged and minority populations. Early detection and treatment of CKD using readily available, inexpensive therapies can slow or prevent progression to end-stage renal disease (ESRD). Interventions targeting CKD, particularly to reduce urine protein excretion, are efficacious, cost-effective methods of improving cardiovascular and renal outcomes, especially when applied to high-risk groups. Integration of these approaches within NCD programs could minimize the need for renal replacement therapy. Early detection and treatment of CKD can be implemented at minimal cost and will reduce the burden of ESRD, improve outcomes of diabetes and cardiovascular disease (including hypertension), and substantially reduce morbidity and mortality from NCDs. Prevention of CKD should be considered in planning and implementation of national NCD policy in the developed and developing world.

Introduction

Noncommunicable diseases (NCDs) have replaced communicable diseases as the most common causes of morbidity and premature mortality worldwide.[1–3] An estimated 80% of the burden occurs in low- or middle-income countries, and 25% is in people younger than 60 years.[1] Moreover, the global economic impact of NCDs is enormous: by 2015, just two diseases (cardiovascular disease and diabetes) are expected to reduce global gross domestic product by 5%.[1] Approximately half of the total economic burden is accounted for by cardiovascular disease including stroke, ischemic heart disease, and peripheral vascular disease, which together cause more deaths than HIV/AIDS, malaria, and tuberculosis combined.[1,4] In recognition of the increasing burden and importance of chronic diseases, in 2008 the World Health Assembly endorsed a Global NCD Action Plan for NCD prevention and control.[5]

Four NCDs (cardiovascular disease, cancer, diabetes, and chronic respiratory disease) have been prioritized in the Global NCD Action Plan endorsed by the World Health Assembly in 2008 because they share major behavioral risk factors amenable to public-health action and together contribute to a major portion of the global NCD burden. Although not currently identified as a separate target, there is compelling evidence that kidney disease is a key determinant of the poor health outcomes of diabetes and cardiovascular disease (including hypertension), and prevention of kidney disease requires attention within national NCD programs particularly at the primary-care level as recommended by the WHO.[2,6]

processing....