Volume 17, Issue 3, Pages 213-214 (May 2010)
FULL TEXT
CKD: A Pandemic Calling for Concerted Public Health ActionRajiv Saran, MBBS, MD, MRCP, MS, Vahakn Shahinian, MD, MS
Article Outline
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Chronic Kidney Disease aptly be termed the Cinderella of Chronic Diseases. It is increasingly becoming apparent that CKD typically develops stealthily among those with known risk factors, but can evolve rather acutely in others. In many parts of the world including the developed nations, large numbers progress without any awareness of the disease until it is very late; many succumb much earlier to complications or comorbidity. Thankfully, more attention is now being paid to this occult disease that has devastating consequences, and in recent years, albeit belatedly, it is getting the recognition it deserves, by the world community at large and is increasingly appreciated as a pandemic of unknown proportions.
Estimating the burden of disease globally should obviously be a top priority, as countries plan to allocate resources in preparation for the long battle envisaged in tackling this disease. In this issue of ACKD, Drs Olutayo and Ayodele kick off by providing a broad overview of the worldwide burden of CKD, setting the stage for the subsequent articles. Their article suggests that based on a review of available studies, the incidence and prevalence of CKD and ESRD are on the increase. Their overview also points to the relative paucity of data on burden of CKD around the globe. The article by Saran and colleagues provides a comprehensive overview of CKD screening and surveillance efforts in different areas of the world. They formally define the principles of disease surveillance as it pertains to CKD and highlight the importance of the health care system–based surveillance approach wherever possible. Organizations such as the WHO, ISN and KDIGO are key to bringing together public health efforts around the world to center stage and provide a common voice to the issues facing different regions. The celebration of World Kidney Day is testimony to such efforts and brings greater awareness about CKD worldwide.
The asymptomatic nature of chronic kidney disease (CKD) makes explicit screening strategies for individuals at risk the only means of early detection to avoid later consequences of disease progression or acute discovery of ESRD without prior preparation. Screening for CKD remains a contentious issue, however, with some countries such as Japan adopting a universal screening policy and others such as the United States, promoting screening in those at high risk only through efforts such as KEEP and the CDC CKD Screening Project termed CHERISH. Vassalotti and colleagues address the important topic of risk factors for CKD and issues germane to screening for CKD in the general population.
Although awareness of disease may be high among public health officials and specialists dealing with CKD, general population awareness and awareness among the large body of primary care physicians throughout the world is likely very low indeed. This is a huge impediment to progress and is an important topic that is admirably dealt with by Plantinga and colleagues in this issue of ACKD. Raising awareness would indeed be key to encouraging greater degree of testing for CKD among those at risk, earlier discover of disease and its optimum management and upstream arrest.
Furthermore, it is clear that nephrologists cannot face the challenge of providing care to the CKD population alone. The tremendous size of the population with early stage CKD, along with the even larger population at risk for CKD, requires the involvement of primary care physicians (PCPs). Shahinian and Saran review important aspects of CKD care for which PCPs are best positioned to address, enumerate potential barriers to increasing PCP involvement in CKD care, and discuss models of care for the CKD population that leverage the unique strengths of PCPs. This topic is particularly timely given the current interest in health care reform in the United States that in large part centers on increasing the role of primary care.
With the recognition that CKD represents a public health problem, it follows that a public health solution is needed. Narva and colleagues discuss important government sponsored efforts to improve the quality of care delivered to the CKD population in the United States. They review current initiatives being undertaken by various federal agencies, such as the Centers for Disease Control and Prevention, the Center for Medicare and Medicaid Services, and the National Institute of Diabetes and Digestive and Kidney Diseases. In addition, they draw attention to existing barriers to optimizing the federal response to CKD, such as a need to improve communication and coordination between agencies, and propose possible solutions.
Environmental toxins are an often under-recognized contributor to kidney disease, both in the United States and internationally. Kaufman and colleagues review common exposures such as lead to lesser known agents such as uranium, which can contribute to the development of CKD. More recently discovered “outbreaks” of CKD in various parts of the world, where the causative agent(s) are yet to be definitively identified, are also highlighted. They make the case that attention to environmental health should be an important part of efforts to reduce the incidence of kidney disease, particularly in developing nations.
In addition to the substantial human cost in the form of cardiovascular death, morbidity, and end-stage renal disease, CKD is also associated with a tremendous financial burden. Trivedi reviews the current state of knowledge of the financial impact of CKD, as well as the potential for cost-effectiveness of interventions directed at preventing or slowing the progression of CKD. In particular, he highlights important gaps in available data that pose a challenge to adequate assessment of cost-effectiveness.
We hope that this compilation of articles will further raise awareness about CKD as a public health priority among the readership, as well as serve to enhance the momentum that this field is currently witnessing.
Guest Editors
PII: S1548-5595(10)00052-2
doi:10.1053/j.ackd.2010.03.009
© 2010 National Kidney Foundation, Inc. Published by Elsevier Inc All rights reserved.
http://www.ackdjournal.org/article/PIIS1548559510000522/fulltext
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