Summary and Action Plan for the Future
Top priority for prevention of all NCDs (including CKD) must focus on effective and cost-effective methods to control tobacco use, reduce harmful use of alcohol, facilitate physical activity, and promote a healthy diet (including salt reduction in processed food). In addition, individual disease-specific health-care interventions are also required to address those with disease or at high risk of developing disease. Ironically, some government programs that reimburse the enormous cost of renal replacement therapy often provide little or no incentive to conduct inexpensive early detection and prevention programs that have the potential to reduce those costs in the future. There is strong evidence supporting the detection and treatment of CKD as a key component of integrated national NCD strategies.[39] The major benefits will occur in people at high risk and in developing countries. Simple and inexpensive measurements of proteinuria (and, if affordable, GFR) can be used for case finding, especially in high-risk populations, including people over 55 and those with diabetes, hypertension, cardiovascular disease, and a family history of kidney disease. These recommendations are already incorporated in the WHO package of essential NCD interventions for primary care and have been incorporated into government policies in several developed countries, including the United States, the United Kingdom, Japan, Australia, and Canada. Further efforts to implement the inexpensive, cost-effective interventions now available to treat people found to have CKD (including reduction in proteinuria, and control of traditional cardiovascular risk factors) must be extended to other countries—especially in the developing world, where the burden of NCDs is especially high. Such interventions will reduce the risk of both ESRD and cardiovascular disease—and thereby improve health outcomes to the maximum extent possible.
Acknowledgments
The authors gratefully acknowledge the detailed review and helpful comments provided by Rashad Barsoum, Dick de Zeeuw, Kai-Uwe Eckhardt, Abdel Meguid El-Nahas, Guillermo García García, Richard Glassock, Kunitoshi Iseki, and Vivek Jha.
Kidney Int. 2011;80(12):1258-1270. © 2011 Nature Publishing Group
