One in 10 People Worldwide Have Chronic Kidney Disease

Marcia Frellick

April 21, 2017

One in 10 people worldwide have kidney disease, according to the first detailed global report on care delivery for kidney disease. And although high-income countries have the highest costs for dialysis and kidney transplantation, fewer than one (29%) in three high-income countries consider chronic kidney disease a priority compared with almost two (59%) in three low-income countries.

That finding was one of the most striking in the report, said Aminu Bello, MD, PhD, co–lead author of the Global Kidney Health Atlas.

Publication of the atlas, which included survey results from 125 countries (representing 93% of the world's population), was timed to correspond with today's opening of the International Society of Nephrology's Global Kidney Policy Forum in Mexico City. The survey was conducted between May and September 2016.

A paper on the original investigation also appears today in JAMA, and a roadmap on how to close the gaps is being simultaneously published in the Lancet.

Overall, the report showed 10% of the world's adults had some form of kidney disease. "Many don't know they have it," Dr Bello told Medscape Medical News. Dr Bello is an assistant professor of medicine at the Division of Nephrology and Immunology, University of Alberta, Edmonton, Canada.

The report also found a wide range of prevalence globally. By region, the estimated prevalence ranges from 7% in South Asia and 8% in Africa to 11% in North America and 12% in Europe, the Middle East, East Asia, and Latin America.

Among high-income countries, Saudi Arabia and Belgium had the highest prevalence rates, at 24% each, followed by Poland (18%), Germany (17%), the United Kingdom (16%), and Singapore (16%). At the other end of the spectrum among high-income countries, Norway and the Netherlands had the lowest prevalence of CKD, at 5%.

The United States, where prevalence is 14%, is one of the countries from which respondents said kidney disease is not considered a priority by the government.

Yet, in high-income countries, the authors note, although only 0.1% to 0.2% of the population receive dialysis or transplantation, the services use up 2% to 3% of the countries' total health budget. For example, in the United States, in 2013, the cost of CKD care exceeded "the entire national budgets of many countries in sub-Saharan Africa, Latin America, and Central and East Asia," Dr Bello and colleagues write.

Dr Bello said part of the reason CKD is not considered a priority in some countries is that it is competing with diseases such as cancer and cardiovascular disease for funding.

"But key is lack of awareness among policymakers," he said.

Another surprise in the report, Dr Bello said, was that "facilities for testing and monitoring for CKD in primary care were limited across regions. For example, serum creatinine with estimated glomerular filtration rate was reported as always available in only 18% of countries, and proteinuria measurements in only 8% of countries. This is an important piece of information that should be used for advocacy to plug the gap."

In an accompanying editorial published in JAMA, Sreedhar Mandayam, MD, MPH, and Wolfgang C. Winkelmayer, MD, MPH, ScD, from Baylor College of Medicine in Houston, Texas, say the Atlas is "of enormous importance." Among important gaps it highlights, they say, are that the most cost-effective treatments for end-stage kidney disease, "such as peritoneal dialysis and kidney transplantation were available in 80% of all countries but showed significant regional differences, with only 40% of African countries able to provide either service."

"[T]his report mandates a resounding opportunity to join forces globally, regionally, and locally toward improving kidney health now rather than waiting until kidney diseases become one of the top 10 global causes of death, a potential development that is quite foreseeable," the editorialists write.

Among other findings in the Atlas:

  • Except for Germany and the Netherlands, all countries reported nephrology workforce shortages. Nine of 10 countries with the lowest density of nephrologists were in Africa.

  • Only 24% of all countries reported an active CKD detection program. High-income countries had a higher percentage (32%). Only one low-income country (Togo) had an active program.

  • Just 41% of countries could provide estimates of patients with acute kidney injury (AKI) who required dialysis.

  • Whereas 64% of countries had a registry for patients requiring dialysis, only 7% of countries had AKI registries, and only 8% had registries for patients with nondialysis CKD.

  • Slightly more than half (52%) of the countries had access to international CKD guidelines, and 27% had national guidelines.

The report represents a huge opportunity to change the current trajectory, Dr Bello said.

"This is the first attempt ever to show the capacity and readiness of nations across all parts of the world for kidney care delivery," he said.

Results will be used for advocacy to make political leaders, health organizations, and policymakers more aware, and also to hold countries accountable.

"This is baseline data," he noted. "In 2 years, 5 years, 10 years down the line, we'll check to see if they're making progress."

A copy of the full report is available on the International Society of Nephrology website.

Financial disclosures are available with the papers.

JAMA. Published online April 24, 2017. Article, Editorial

Lancet. Published online April 24, 2017. Article

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