Burden, Access, and Disparities in Kidney Disease

Kidney disease is a global public health problem that affects more than 750 million persons worldwide.1GBD 2015 DALYs and HALE CollaboratorsGlobal, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1603-1658Abstract Full Text Full Text PDF PubMed Scopus (1424) Google Scholar The burden of kidney disease varies substantially across the world, as does its detection and treatment. Although the magnitude and impact of kidney disease is better defined in developed countries, emerging evidence suggests that developing countries have a similar or even greater kidney disease burden.2Hill N.R. Fatoba S.T. Oke J.L. et al.Global prevalence of chronic kidney disease–a systematic review and meta-analysis.PLoS One. 2016; 11: e0158765Crossref PubMed Scopus (1775) Google Scholar In many settings, rates of kidney disease and the provision of its care are defined by socioeconomic, cultural, and political factors, leading to significant disparities in disease burden, even in developed countries.3Crews D.C. Liu Y. Boulware L.E. Disparities in the burden, outcomes, and care of chronic kidney disease.Curr Opin Nephrol Hypertens. 2014; 23: 298-305Crossref PubMed Scopus (75) Google Scholar These disparities exist across the spectrum of kidney disease—from preventive efforts to curb development of acute kidney injury (AKI) or chronic kidney disease (CKD), to screening for kidney disease among persons at high risk, to access to subspecialty care and treatment of kidney failure with renal replacement therapy (RRT). World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. In this editorial, we highlight these disparities and emphasize the role of public policies and organizational structures in addressing them. We outline opportunities to improve our understanding of disparities in kidney disease, the best ways for them to be addressed, and how to streamline efforts toward achieving kidney health equity across the globe. Availability of data reflecting the full burden of kidney disease varies substantially because of limited or inconsistent data collection and surveillance practices worldwide (Table 1).4Bello A.K. Levin A. Tonelli M. et al.Global Kidney Health Atlas: a report by the International Society of Nephrology on the current state of organization and structures for kidney care across the globe.https://www.theisn.org/images/ISN_advocacy/GKHAtlas_Linked_Compressed1.pdfGoogle Scholar Whereas several countries have national data collection systems, particularly for end-stage renal disease (ESRD) (eg, United States Renal Data System, Latin American Dialysis and Renal Transplant Registry, and Australia and New Zealand Dialysis and Transplant Registry), high-quality data regarding nondialysis CKD is limited, and often the quality of ESRD data is quite variable across settings. This situation is of particular concern in low-income countries. For example, a meta-analysis of 90 studies on CKD burden conducted across Africa showed very few studies (only 3%) with robust data.5Stanifer J.W. Jing B. Tolan S. et al.The epidemiology of chronic kidney disease in sub-Saharan Africa: a systematic review and meta-analysis.Lancet Glob Health. 2014; 2: e174-e181Abstract Full Text Full Text PDF PubMed Scopus (287) Google Scholar The provision of adequate resources and a workforce to establish and maintain surveillance systems (eg, screening programs and registries) is essential and requires substantial investment.6Davids M.R. Eastwood J.B. Selwood N.H. et al.A renal registry for Africa: first steps.Clin Kidney J. 2016; 9: 162-167Crossref PubMed Scopus (67) Google Scholar Incorporating kidney disease surveillance parameters in existing chronic disease prevention programs might enhance global efforts toward obtaining high-quality information on kidney disease burden and attendant consequences.Table 1World Bank Country Group Chronic Kidney Disease GapsCKD CareLow-income Countries (%)Lower-middle-income Countries (%)Upper middle-income Countries (%)High-income Countries (%)Governmental recognition of CKD as a health priority59501729Government funds all aspects of CKD care13214053Availability of CKD management and referral guidelines (international, national, or regional)46738397Existence of current CKD detection programs6242432Availability of dialysis registries24487289Availability of academic centers for renal clinical trial management12346263Abbreviation: CKD, chronic kidney disease.Data from Bello et al.4Bello A.K. Levin A. Tonelli M. et al.Global Kidney Health Atlas: a report by the International Society of Nephrology on the current state of organization and structures for kidney care across the globe.https://www.theisn.org/images/ISN_advocacy/GKHAtlas_Linked_Compressed1.pdfGoogle Scholar Open table in a new tab Abbreviation: CKD, chronic kidney disease. Data from Bello et al.4Bello A.K. Levin A. Tonelli M. et al.Global Kidney Health Atlas: a report by the International Society of Nephrology on the current state of organization and structures for kidney care across the globe.https://www.theisn.org/images/ISN_advocacy/GKHAtlas_Linked_Compressed1.pdfGoogle Scholar In addition to a need for functional surveillance systems, the global importance of kidney disease (including AKI and CKD) is yet to be widely acknowledged, making it a neglected disease on the global policy agenda. For instance, the World Health Organization (WHO) Global Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs) (2013) focuses on cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes but not kidney disease, despite advocacy efforts by relevant stakeholders such as the International Society of Nephrology and the International Federation of Kidney Foundations through activities such as World Kidney Day. This situation is quite concerning because estimates from the Global Burden of Disease study in 2015 showed that around 1.2 million people were known to have died of CKD,7GBD 2015 Mortality and Causes of Death CollaboratorsGlobal, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1459-1544Abstract Full Text Full Text PDF PubMed Scopus (4099) Google Scholar and more than 2 million people died in 2010 because they had no access to dialysis. It is estimated that another 1.7 million die from AKI on an annual basis.8Liyanage T. Ninomiya T. Jha V. et al.Worldwide access to treatment for end-stage kidney disease: a systematic review.Lancet. 2015; 385: 1975-1982Abstract Full Text Full Text PDF PubMed Scopus (1098) Google Scholar, 9Mehta R.L. Cerda J. Burdmann E.A. et al.International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology.Lancet. 2015; 385: 2616-2643Abstract Full Text Full Text PDF PubMed Scopus (604) Google Scholar It is possible, therefore, that kidney disease may contribute to more deaths than the 4 main NCDs targeted by the current NCD Action Plan. Data in recent decades have linked a host of genetic, environmental, sociodemographic, and clinical factors to risk of kidney disease. The population burden of kidney disease is known to correlate with socially defined factors in most societies across the world. This phenomenon is better documented in high-income countries, where racial/ethnic minority groups and people of low socioeconomic status carry a high burden of disease. Extensive data have demonstrated that racial and ethnic minorities (eg, African Americans in the United States, Aboriginal groups in Canada and Australia, Indo-Asians in the United Kingdom, and others) are affected disproportionately by advanced and progressive kidney disease.10Samuel S.M. Palacios-Derflingher L. Tonelli M. et al.Association between First Nations ethnicity and progression to kidney failure by presence and severity of albuminuria.CMAJ. 2014; 186: E86-E94Crossref PubMed Scopus (45) Google Scholar, 11Nicholas S.B. Kalantar-Zadeh K. Norris K.C. Racial disparities in kidney disease outcomes.Semin Nephrol. 2013; 33: 409-415Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar, 12Van den Beukel T.O. de Goeij M.C. Dekker F.W. et al.Differences in progression to ESRD between black and white patients receiving predialysis care in a universal health care system.Clin J Am Soc Nephrol. 2013; 8: 1540-1547Crossref PubMed Scopus (47) Google Scholar The associations of socioeconomic status and risk of progressive CKD and eventual kidney failure also have been well described, with persons of lower socioeconomic status bearing the greatest burden.13Crews D.C. Gutierrez O.M. Fedewa S.A. et al.Low income, community poverty and risk of end stage renal disease.BMC Nephrol. 2014; 15: 192Crossref PubMed Scopus (62) Google Scholar, 14Garrity B.H. Kramer H. Vellanki K. et al.Time trends in the association of ESRD incidence with area-level poverty in the US population.Hemodial Int. 2016; 20: 78-83Crossref PubMed Scopus (58) Google Scholar Recent works have associated apolipoprotein L1 risk variants15Parsa A. Kao W.H. Xie D. et al.APOL1 risk variants, race, and progression of chronic kidney disease.N Engl J Med. 2013; 369: 2183-2196Crossref PubMed Scopus (530) Google Scholar, 16Peralta C.A. Bibbins-Domingo K. Vittinghoff E. et al.APOL1 genotype and race differences in incident albuminuria and renal function decline.J Am Soc Nephrol. 2016; 27: 887-893Crossref PubMed Scopus (96) Google Scholar with increased kidney disease burden among persons with African ancestry. In Central America and Southeastern Mexico, Mesoamerican nephropathy (also referred to as CKD of unknown causes) has emerged as an important cause of kidney disease. While multiple exposures have been studied for their potential role in CKD of unknown causes, recurrent dehydration and heat stress are common denominators in most cases.17Correa-Rotter R. Mesoamerican nephropathy or chronic kidney disease of unknown origin.in: García-García G. Agodoa L.Y. Norris K.C. Chronic Kidney Disease in Disadvantaged Populations. Academic Press, Cambridge, MA2017: 221-228Crossref Scopus (28) Google Scholar Other perhaps more readily modifiable risk factors for kidney disease and CKD progression that disproportionately affect socially disadvantaged groups also have been identified, including disparate rates and poor control of clinical risk factors such as diabetes and hypertension, as well as lifestyle behaviors. Diabetes is the leading cause of advanced kidney disease worldwide.18Levin A. Stevens P.E. Bilous R.W. et al.Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.Kidney Int Suppl. 2013; 3: 1-150Abstract Full Text Full Text PDF Scopus (1578) Google Scholar In 2016, 1 in 11 adults worldwide had diabetes and more than 80% were living in low- and middle-income countries19Chan J.C. Gregg E.W. Sargent J. Horton R. Reducing global diabetes burden by implementing solutions and identifying gaps: a Lancet Commission.Lancet. 2016; 387: 1494-1495Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar where resources for optimal care are limited. Hypertension is also estimated to affect 1 billion persons worldwide20Kearney P.M. Whelton M. Reynolds K. et al.Global burden of hypertension: analysis of worldwide data.Lancet. 2005; 365: 217-223Abstract Full Text Full Text PDF PubMed Scopus (3983) Google Scholar and is the second leading attributed cause of CKD.18Levin A. Stevens P.E. Bilous R.W. et al.Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.Kidney Int Suppl. 2013; 3: 1-150Abstract Full Text Full Text PDF Scopus (1578) Google Scholar Hypertension control is important for slowing CKD progression and decreasing mortality risk among persons with or without CKD. Hypertension is present in more than 90% of persons with advanced kidney disease,18Levin A. Stevens P.E. Bilous R.W. et al.Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.Kidney Int Suppl. 2013; 3: 1-150Abstract Full Text Full Text PDF Scopus (1578) Google Scholar yet racial/ethnic minorities and low-income persons with CKD who live in high-income countries have poorer blood pressure control than their more socially advantaged counterparts.21Plantinga L.C. Miller 3rd, E.R. Stevens L.A. et al.Blood pressure control among persons without and with chronic kidney disease: US trends and risk factors 1999-2006.Hypertension. 2009; 54: 47-56Crossref PubMed Scopus (113) Google Scholar Lifestyle behaviors, including dietary patterns, are strongly influenced by socioeconomic status. In recent years, several healthful dietary patterns have been associated with favorable CKD outcomes.22Banerjee T. Liu Y. Crews D.C. Dietary patterns and CKD progression.Blood Purif. 2016; 41: 117-122Crossref PubMed Scopus (63) Google Scholar Low-income persons often face barriers to healthful eating that may increase their risk of kidney disease.23Johnson A.E. Boulware L.E. Anderson C.A. et al.Perceived barriers and facilitators of using dietary modification for CKD prevention among African Americans of low socioeconomic status: a qualitative study.BMC Nephrol. 2014; 15: 194Crossref PubMed Scopus (43) Google Scholar, 24Crews D.C. Kuczmarski M.F. Miller 3rd, E.R. et al.Dietary habits, poverty, and chronic kidney disease in an urban population.J Ren Nutr. 2015; 25: 103-110Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar, 25Suarez J.J. Isakova T. Anderson C.A. et al.Food access, chronic kidney disease, and hypertension in the J Med. 2015; Full Text Full Text PDF PubMed Scopus Google Scholar of low socioeconomic status often limited access to is a risk for D.C. Kuczmarski M.F. V. et of on chronic kidney disease in J Nephrol. 2014; PubMed Scopus (95) Google Scholar and progression to kidney T. Crews D.C. et al.Food CKD, and ESRD in US J Kidney Full Text Full Text PDF PubMed Scopus Google Scholar In low-income countries, may to and has for the in the case of of to their low and including M. Liu et and kidney disease: on World Kidney Day Int. Full Text Full Text PDF PubMed Scopus Google Scholar of are as high as or more in countries such as and and Organization of the United Scholar in high-income countries, is associated with and persons with have increased risk of and and evidence from a of in J Nutr. 2005; PubMed Scopus Google Scholar, of and its impact on PubMed Scopus Google Scholar has been associated with several including diabetes and AKI is an that is estimated to in to of S. A. et and of of acute kidney injury a J Kidney Full Text Full Text PDF PubMed Scopus Google Scholar and is well as a risk for M. K. et kidney injury and risk of an analysis of Health J Kidney 2016; Full Text Full Text PDF PubMed Scopus Google Scholar Disparities in AKI risk are also a similar to that in persons with K. Y. et the racial in AKI Am Soc Nephrol. 2014; 25: PubMed Scopus Google Scholar AKI to and and are more in low-income and countries and contribute to increased risk of mortality and CKD in G. et risk factors for chronic kidney disease.Kidney Int Suppl. Full Text Full Text PDF PubMed Scopus Google Scholar the of annual AKI worldwide of more than million are in low-income and countries, leading to million Cerda J. R.L. awareness of acute kidney a global of a Int. 2013; Full Text Full Text PDF PubMed Scopus Google Scholar of the and of kidney disease its provision is linked with the public policies and status of countries. For example, is with lower greater rates of kidney in more In several high-income countries, universal health care is by the and CKD and ESRD In countries, such as the United States, ESRD care is for optimal treatment of CKD and its risk factors may not be for persons health and care of with kidney disease is not L. D. R. et al.Association of with mortality and health care among with end-stage renal Med. PubMed Scopus (85) Google Scholar In low-income and countries, CKD ESRD care may be and CKD prevention efforts are often limited. In several such countries, between public and have emerged to for For example, in a of dialysis and kidney through community and has for more than S.A. S.A. kidney in a an from Int Suppl. 2013; 3: Full Text Full Text PDF Scopus (47) Google Scholar In many settings, persons with advanced CKD who have no or limited public or for care a substantial systematic review of studies including patients from countries significant including care of on and of life because of capacity to J. A. M. et of an with chronic kidney disease: a systematic review of qualitative 8: PubMed Scopus Google Scholar of another study conducted in that patients and were with to multiple health and care and their health and health G. et health systems are barriers to health by kidney One. 2013; 8: PubMed Scopus Google Scholar may be even greater for of with because many care The of recognition and the of a global for kidney disease the substantial in structures and capacity for kidney care around the globe. This situation has in in health care care and human J. for the of health World Health Google Scholar and advocacy efforts are at regional, and national to kidney disease and on the global policy agenda. In the International Society of Nephrology data on capacity for kidney care using a the Global Kidney Health A.K. Levin A. Tonelli M. et al.Global Kidney Health Atlas: a report by the International Society of Nephrology on the current state of organization and structures for kidney care across the globe.https://www.theisn.org/images/ISN_advocacy/GKHAtlas_Linked_Compressed1.pdfGoogle Scholar with the of a health The Global Kidney Health limited awareness of kidney disease and its and in resources to the burden of kidney disease across the globe. For example, CKD as a health care by in of countries that in this The to CKD a health care in more than of low-income and countries but in than of and high-income countries. capacity and resources for kidney many countries access to a universal access to health and Low-income and countries, in had limited for the and of CKD at the care with including estimated of low-income countries had access to qualitative using no low-income had access to or at the care all countries, of at the care than at the care and A.K. Levin A. Tonelli M. et al.Global Kidney Health Atlas: a report by the International Society of Nephrology on the current state of organization and structures for kidney care across the globe.https://www.theisn.org/images/ISN_advocacy/GKHAtlas_Linked_Compressed1.pdfGoogle Scholar, H. M. et al.Global access of patients with kidney disease to health and from the Global Kidney Health Int Suppl. 8: Full Text Full Text PDF Scopus Google Scholar The of the all countries and more than 90% of countries access to and of across countries and often particularly in low-income For instance, more than 90% of and high-income countries chronic dialysis these were in and of low-income and countries, In acute dialysis had the across all countries. than 90% of and high-income countries kidney with more than of these countries living and as the low-income countries had the of kidney with and live as the also in the of the kidney care particularly The million very common in low-income countries, the million in high-income countries A.K. Levin A. Tonelli M. et al.Global Kidney Health Atlas: a report by the International Society of Nephrology on the current state of organization and structures for kidney care across the globe.https://www.theisn.org/images/ISN_advocacy/GKHAtlas_Linked_Compressed1.pdfGoogle Scholar, M. et al.Global and opportunities toward a kidney care Int Suppl. 8: Full Text Full Text PDF PubMed Scopus Google Scholar, Health Organization Global Health Scholar countries as for CKD and AKI care had more for CKD care than for AKI as of countries that care are for CKD care and that they are for AKI care were for AKI in of countries, because AKI is in of low-income countries that care were for with 90% of high-income this may be to a of care in low-income countries. The of in a on many factors, including and and as such is no global with to the demonstrated low in low-income countries for concern as are essential to in kidney disease and a of may in for policy and it is quite that the of and is in low-income and countries, in to programs by D.C. S. J. from developing does it have a Int Suppl. 2: Full Text Full Text PDF PubMed Scopus (67) Google Scholar It is important to that the role of a may on how the health care is The the of million population and no of the to the of the population or quality of on of patients with kidney disease and workforce (eg, of For care essential for kidney exist in and were for renal access and and of countries a and the were more common in low-income countries. countries a in This information significant and in the current capacity for kidney care across the world. in and capacity for optimal care were in many countries and A.K. Levin A. Tonelli M. et al.Global Kidney Health Atlas: a report by the International Society of Nephrology on the current state of organization and structures for kidney care across the globe.https://www.theisn.org/images/ISN_advocacy/GKHAtlas_Linked_Compressed1.pdfGoogle Scholar The have for policy development with to of robust kidney care particularly for low-income and G. S. Tonelli M. The of chronic kidney disease to the global burden of Int. Full Text Full Text PDF PubMed Scopus Google Scholar The Global Kidney Health has a understanding of where countries and with to several of the health the of through the of at achieving and quality care for the many patients with kidney disease across the globe. this information be to existing barriers to kidney for be at the care for detection and management of AKI and CKD across all G. S. Tonelli M. The of chronic kidney disease to the global burden of Int. Full Text Full Text PDF PubMed Scopus Google Scholar optimal kidney care emphasize prevention to of kidney disease at the population countries low-income and be at the to more in For example, acute dialysis be an for because this of dialysis is as as requires and be with solutions and to et of dialysis in a systematic J Am Soc Nephrol. 2013; 8: PubMed Scopus Google Scholar kidney be through increased awareness among the public and political across countries, because this is the optimal of and it is also that of the and and are through public A. S. The need for kidney in low- and middle-income countries in an 2015; PubMed Scopus (45) Google Scholar most kidney are conducted in high-income countries in because of of resources and in low-income and countries, as well as practices and of A. S. The need for kidney in low- and middle-income countries in an 2015; PubMed Scopus (45) Google Scholar disadvantaged persons a burden of kidney disease The provision and of kidney care varies widely across the world. universal health worldwide by is of the Although universal health may not all of kidney care in all countries this is a function of and understanding is and important for a or with a on the burden and of kidney disease be an important toward achieving kidney health

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.