Chronic kidney disease in disadvantaged populations.

G Garcia-Garcia,V Jha

doi:10.1590/1414-431x20144519

Abstract

The increased burden of chronic kidney disease (CKD) in disadvantaged populations is due to both global factors and population-specific issues. Low socioeconomic status and poor access to care contribute to health care disparities and exacerbate the negative effects of genetic or biological predisposition. Provision of appropriate renal care to these populations requires a two-pronged approach: expanding the reach of dialysis through development of low-cost alternatives that can be practiced in remote locations, and implementation and evaluation of cost-effective prevention strategies. Kidney transplantation should be promoted by expansion of deceased donor transplant programs and use of inexpensive, generic immunosuppressive drugs. The message of World Kidney Day 2015 is that a concerted attack against the diseases that lead to end-stage renal disease, by increasing community outreach, better education, improved economic opportunity, and access to preventive medicine for those at highest risk, could end the unacceptable relationship between CKD and disadvantage in these communities.

Highlights

‘‘Of all of the forms of inequality, injustice in health is the most shocking and inhumane.’’
The focus of World Kidney Day (WKD) 2015 is on chronic kidney disease (CKD) in disadvantaged populations
The fact that, even in developed countries, racial and ethnic minorities bear a disproportionate burden of CKD and have worse outcomes suggests that there is much to learn beyond the traditional risk factors contributing to CKD-associated complications [1]

Summary

Introduction

‘‘Of all of the forms of inequality, injustice in health is the most shocking and inhumane.’’. The focus of WKD 2015 is on chronic kidney disease (CKD) in disadvantaged populations. This article reviews the key links between poverty and CKD and the consequent implications for the prevention of kidney disease and the care of kidney patients in these populations. CKD is increasingly recognized as a global public health problem and a key determinant of the poor health outcomes. There is compelling evidence that disadvantaged communities, i.e., those from low-resource racial and minority ethnic communities and/or indigenous and socially disadvantaged backgrounds, suffer from marked increases in the burden of unrecognized and untreated CKD. The poor are more susceptible to disease because of lack of access to goods and services, in particular clean water and sanitation, information about preventive behaviors, adequate nutrition, and reduced access to health care [3].

CKD in developed countries

CKD in developing countries

Low birth weight and risk of CKD in disadvantaged populations

Disparities in access to RRT

Findings

Bidirectional relationship between poverty and CKD