Initiative Aims to Reduce Kidney-Related Deaths Worldwide

Diedtra Henderson

March 13, 2015

Acute kidney injury (AKI), implicated in an estimated 1.7 million deaths across the globe annually, could be preventable and treatable with timely intervention, according to a human rights statement by a commission of the International Society of Nephrology. The commission has announced a new initiative, called 0by25, that aims to reduce preventable deaths caused by AKI to zero by 2025.

The vast majority of AKI — 85% — occurs in the developing world, according to the commission, jointly led by Ravindra L. Mehta, MD, from the University of California, San Diego; Jorge Cerdá, MD, from the Albany Medical College, New York; Emmanuel A. Burdmann, MD, PhD, from the University of Sao Paulo, Brazil; and Marcello Tonelli, MD, from the University of Calgary, Canada.

In the developing world, AKI occurs mostly in the community setting during acute illness, usually in connection with diarrhea and dehydration, infections such as malaria, and toxins such as venoms or poisons. In high-income countries, AKI affects hospitalized patients, especially patients treated in the intensive care unit and the elderly, and is associated with multiple-organ failure.

AKI is a risk factor for impaired kidney function, heightens the chance of developing chronic kidney disease, hastens progression to end-stage renal disease, and accounts for $286 million in lifetime healthcare costs after hospital discharge.

"The 0by25 project will be viewed by many with skepticism as to its feasibility and likelihood of success given the many complex problems in management of AKI," the authors acknowledge in an article published online March 13 in the Lancet. "However, the remarkable accomplishment of the AIDS 3by5 initiative (3 million people with HIV on anti-retroviral treatment by 2005) in low-resource countries provides evidence that concerted efforts can lead to success in reductions in the burden of devastating diseases."

During the next decade, the 0by25 initiative will rely on three strategies to permit timely diagnosis and treatment of reversible AKI: developing a stronger evidence base to establish the disease burden and the linkage between AKI and adverse health outcomes, standardizing disease management around the world, and erecting a sustainable educational, training, and care delivery infrastructure.

As a first step toward strengthening the evidence base, the authors searched for papers published from January 1, 2012, to August 31, 2014, and included 313 reports in their meta-analysis. The epidemiologic studies they uncovered indicated that AKI was seen in 21% of hospital admissions in the developed world; in the developing world, the true incidence rate remains unknown. Future activities will include amassing epidemiology data from around the world, which will shed light on the prevalence of renal disease and inform and catalyze action by global political leaders.

At the heart of the AKI awareness campaign are elements crucial to effective AKI management that the authors dub "the 5 Rs": risk assessment, recognition, response, renal support, and rehabilitation.

A second paper published online March 13 in the Lancet projects that the number of people needing renal replacement therapy is expected to double, going from 2.62 million in 2010 to 5.44 million in 2030, with spikes projected in Asia and Africa. Thaminda Liyanage, MBBS, from the George Institute for Global Health, University of Sydney, Australia, and coauthors write that the trend underscores the "pressing need" to level access to treatment and prevention, which have the potential to reduce the burden of illness and "lead to cost savings."

Bolstering infrastructure, the third element of the three-prong 0by25 strategy envisioned by the commission includes building "material and human capacity"; innovating new approaches to prevention, diagnosis, and treatment; and using a scorecard for accountability. In addition to a heightened emphasis on access to and adequate funding for primary care, the initiative strives to equalize access to lifesaving care without cannibalizing scarce healthcare resources.

In an accompanying commentary, Richard Horton, MB, and Philippa Berman, editor-in-chief and senior editor of the Lancet, respectively, call the strategy "achievable" and pledge the journal's support "to ensure accountability for the goals set out in this Commission — to monitor, review, and act to ensure progress towards 0by25."

Financial support for the 0by25 study was provided by the International Society of Nephrology, Astute Medical, Danone Nutricia Research, and Bellco. The authors have disclosed no relevant financial relationships.

Lancet. Published online March 13, 2015. Mehta abstract, Thaminda abstract, Commentary extract

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