A Call to Action on World Kidney Day, March 8, 2007

Abstract

World Kidney Day – a joint initiative of the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF) aims to spread the crucial message that “kidney disease is common, harmful, and treatable.” Kidney disease is common because chronic kidney disease (CKD), defined as a glomerular filtration rate of less than 60 ml/min and/or the presence of microalbuminuria or proteinuria, has now been consistently shown to affect about 10% of the adult population in studies of different races living on different continents world wide (1–5). It is harmful not just because some of these patients progress to end stage renal disease (ESRD), but more because these renal abnormalities are associated with a many-fold increase in risk of cardiovascular complications and premature cardiovascular death (6,7). Indeed, the risk of premature death, primarily from cardiovascular disease is, on average, 100 fold higher in patients with CKD than the risk of developing ESRD (8). It is treatable because there is now strong scientific evidence that early detection, altering lifestyle factors, and aggressively controlling blood pressure, can not only slow or halt the progression of patients with CKD to ESRD, but can also significantly reduce the incidence of cardiovascular disease that leads to premature death in the majority of these patients (9–13). Cardiovascular disease is today by far the most common cause of premature death worldwide (14). We do not yet know exactly how many people dying of premature cardiovascular disease have CKD and might have benefited from early detection and treatment aimed at the kidney, but the number is certainly very large. When we as a renal community become aware that early detection programs focused on the kidney can identify large numbers of patients who may be spared from other health complications or even premature death by simple interventions, we incur, in our view, a moral and ethical imperative to advocate for the implementation of such programs. That such programs can be successful and cost effective, has now been shown in several proof-of-concept prevention projects sponsored by the ISN and others (15–18). The four major United States renal societies, in celebration of World Kidney Day 2007, have jointly described and called for a comprehensive change in both funding and delivery of renal health care in the US to emphasize early detection and prevention (19). We strongly endorse their conclusions and recommendations and feel these could be adapted for cultural and economic realities in other developed and developing countries where there is also an urgent need for this message to be heard. How can we deliver our message of prevention worldwide? One of the greatest challenges we face is ignorance about the kidneys. Surveys, even in better educated and developed countries, have shown that less than 5% of the population can provide accurate answers to questions about where the kidneys are located and what they do. This is because kidney disease, when viewed solely in the context of ESRD, is essentially an orphan disease affecting less than 0.2% of the population. And by that definition it does not even exist in many parts of the world where no renal replacement therapy options are available and therefore no patients with ESRD survive. To overcome this ignorance about an “invisible” disease such as CKD, we will build on the remarkable success of the first World Kidney Day held on March 9, 2006 and celebrated in 45 countries around the world. The creativity shown by groups in all of these countries was extraordinary. Local events included walkathons, marathons, auctions, sales of T-shirts and other paraphernalia, screening programs, educational seminars, and media interviews. Meetings were arranged that led to proclamations and endorsement of World Kidney Day 2006 by a number of government officials in many cities, states, and countries. We want to capture and build on that remarkable local energy in 2007. “Tool kits” have been made available to all renal organizations and contain suggestions for events, posters, and a variety of media releases that can be used in any language. We are encouraging the use of a simple slogan – “Are your kidneys OK?” – to raise curiosity among the general public. Professional WKD staff in Brussels work with the WKD Steering Committee and Scientific Advisory Board to provide a coordinating center for all WKD activities and maintain a website (www.worldkidneyday.org) that makes all informational materials available to anyone, free of charge. But World Kidney Day 2007 is not only our cause at ISN or IFKF. It is a cause that involves all of us in the renal community worldwide – physicians, scientists, nurses, other health care providers, patients, administrators, health policy experts, government officials, nephrology organizations, and foundations. All need to be aware of the ways in which more attention to the kidney in setting government policies can lead to major benefits to both patients and to health care budgets. The readers of this editorial, mostly nephrologists, need to continue to be the outspoken advocates for our patients that we have always been. Especially now, when the discoveries we have made ourselves in the last decade put us in a much stronger position to demonstrate that increased awareness of the role of the kidney, particularly in the epidemic of diabetes and cardiovascular disease worldwide, can truly have a major impact on global public health. We urge you to become involved in World Kidney Day this year and thereafter. Participate in events organized by your local societies and foundations, organize events if none is planned in your area, involve your hospitals and institutions, meet with local government officials such as mayors and public health officers, contact your local media and make yourself available for interviews and comments. And equally important – share with us and others what you are doing through the World Kidney Day website! The message of World Kidney Day is that kidney disease is common harmful and treatable. On March 8, 2007, let's ensure that hundreds of thousands of people worldwide ask the question “Are your kidneys OK?” and try to find out the answer. William G. Couser President, International Society of Nephrology Sudhir Shah President, International Federation of Kidney Foundations