Exploring the impact of chronic kidney disease

The message of World Kidney Day 2007 is that kidney disease is common, harmful and treatable. Until recently, decision makers in public health and biomedical science had viewed CKD as uncommon, without consequences and untreatable until the stage of kidney failure. The public health mandate is now clear: No country can afford to overlook the burden of CKD. The article outlines risk factors and strategies to come to grips with this problem.

In both developed and developing nations, a consistent picture is emerging of increased risk for CKD among people with cardiovascular disease (CVD) risk factors or established CVD. On the other hand, the most important adverse outcomes of CKD include not only complications of decreased glomerular filtration rate and progression to kidney failure, but also an increased risk of CVD. Most guidelines for CVD risk factor conditions and for CVD now recommend testing for CKD as well as different treatments for people found to have CKD compared to treatments for people without CKD.

In principle, a surveillance program for CKD stages 4-5 would enable all countries to monitor the magnitude and the care of this high-risk, high-cost population, and possibly to reduce the risk of progression to kidney failure, and reduce the cost of dialysis and transplantation. A surveillance program for patients with CKD stage 3 would reach many more people and might also be an effective way to lower rates of CVD and death, especially among the elderly with CVD risk factors or CVD.

Strong, effective public health care policies focusing on prevention, detection and treatment of these common chronic diseases – including investment in basic and clinical research – may also reduce the risk of developing CKD.