CKD Management

Chronic Kidney Disease, the silent epidemic – a social challenge

Chronic kidney disease (CKD) is the general name for persistent irreversible damage to the kidney.¹ It is defined as either structured kidney damage or decreased kidney function (decreased glomerular filtration rate (GFR)) observed for 3 or more months.²

CKD is a serious condition associated with premature mortality, decreased quality of life, and increased healthcare expenditure.³ It presents a serious challenge for those affected, their families and healthcare providers ¹, yet it is often not recognised as a serious health problem.⁴ Early forms are asymptomatic and in its earliest stages, the kidneys may only have minor structural damage. But if undetected and untreated, such damage often tends to progress ¹ and can result in end-stage renal disease and necessitate dialysis or kidney transplantation.³ One in 10 adults has some degree of kidney disease, mostly with no awareness of it.¹

The significant threat to health posed by milder forms of kidney damage is now recognised to be particularly harmful as such damage, although common and frequently symptomless, has severe adverse consequences on the long term health of individuals.¹

A public issue and global burden

At present, there are almost 700,000 ESRD patients in Europe. And the burden of CKD is growing. During the past three decades, the incidence and prevalence of ESRD have risen progressively.⁴

At least 8% of the population of Europe currently has some degree of CKD and so it is estimated that at least 40 million people in the EU are affected. Furthermore, this figure is increasing each year and if the present trend is to continue, the number of people with CKD will double over the next decade.¹ In America, one in nine people are estimated to have CKD and another 20 million are at risk of developing CKD which has resulted in fear that the disease is out of control. In fact, CKD is the 9th leading cause of death in the United States⁴ and on a European scale, the annual risk of death in CKD 5 patients is 10-100 times higher than the risk of death in the general population.¹

The silent epidemic of CKD is a huge burden on national healthcare systems, with dialysis treatments alone accounting for 2% of national healthcare budgets.¹ This figure is set to double in the next 5 years, without taking into account the wider costs in terms of additional medical expenses, decreased quality of life and life expectancy, increased morbidity and reduced capacity to work.¹ Moreover, the costs involved with kidney disease are over four times what could be expected from the number of patients affected. Treating ESRD imposes a large economic burden on patients, healthcare systems and society.⁴ The cost of implementing CKD prevention strategies can be modest. 97% of health expenses are spent on treatment, only 3% on prevention. However, the cost of non-detection is enormous: for every person with kidney failure there are at least 30 people with lesser degrees of kidney damage who need treatment to minimise the risk of developing kidney failure.¹

There is therefore an urgent need for improved public awareness, prevention strategies, early detection, education and subsequent management of CKD in clinical practice to deal with this growing and costly problem.¹

Moreover, patients on renal replacement therapy currently face enormous problems: the access to, extent and quality of services for RRT varies greatly throughout the EU and most importantly opportunities for the best and most cost-effective treatment - renal transplantation - are severely restricted because of the significant shortage of donor kidneys.¹

Early identification and prevention is crucial

Despite the overwhelming burden of CKD, awareness and prevention of the disease remains relatively low. Early forms of CKD are often asymptomatic, making this ‘silent epidemic’ all the more critical to bring to light. However, there is evidence that earlier stages of CKD can be detected and treated, early and effective interventions can diminish the risk of complications and adverse outcomes of CKD can be prevented or delayed. With optimal medical care, progression of CKD and its attendant comorbidities can be slowed or potentially even halted; patient lifespan and quality of life can be increased.¹

A key is to identify those at risk or in the early stages of the disease, with the intent of effective implementation of proven preventive and therapeutic strategies.³ Effective strategies to prevent chronic kidney disease with its associated cardiovascular risks and the likelihood of its progression to kidney failure is crucial and is the only way to prevent the rapidly increasing personal, societal and financial costs of kidney disease. Also the improvement of existing technologies to detect CKD is needed.¹

Nearly 70% of diabetes patients have not discussed how to minimise the risk of kidney damage with their doctor and 73% of cardiovascular disease (CVD)/hypertension patients lack information about the related risk of kidney damage. There is a need for a fundamental shift in policy and for much greater attention to primary and secondary prevention for CKD.¹

References

¹ EKHA European Kidney Health Alliance; www.ekha.eu.

² Levey A.S. et al., National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification, Ann Intern Med (2003); 139: 137-147.

³ Kidney Disease: Improving Global Outcomes (KDIGO), KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease, Kidney Int Suppl (2013); 3: 1-150.

⁴Schoolwerth A.C. et al., Chronic Kidney Disease: A Public Health Problem That Needs a Public Health Action Plan, Preventing Chronic Disease -Public Health Research, Practice, and Policy (2006); 3(2): 1-6.