Chronic Kidney Disease

Abstract

Thursday, March 8, 2007, is World Kidney Day! World Kidney Day was proposed by the International Society of Nephrology and International Federation of Kidney Foundations in 2006 to broadcast a message about kidney diseases to the public, government health officials, general physicians, allied health professionals, individuals, and families. It was launched on March 9, 2006, and will be fully inaugurated this year (http://www.worldkidneyday.org/). The message is that kidney disease is common, harmful, and treatable. In this article, we focus on chronic kidney disease (CKD) as a global public health problem and the urgent need for all countries to have a public health policy for CKD. 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 care of patients with CKD had been marginalized, relegated to the subspecialty of nephrology, with payment primarily directed at dialysis and transplantation, which are too costly for the vast majority of people who live outside the developed world. At the same time, costs for other chronic diseases have been mounting. In developed countries, hypertension, diabetes, and cardiovascular disease (CVD) consume a large fraction of resources for health care. The epidemic of obesity will magnify these costs, in the young as well as in the elderly. In developing countries, the burden of these noncommunicable diseases is rising even though communicable diseases are not yet under control. We now recognize that CKD is especially common in people with other chronic diseases and multiplies the risk for adverse outcomes and costs. The public health mandate now is clear. No country can afford to overlook the burden of CKD; prevention, early detection, and intervention are the only cost-effective strategies. In the following paragraphs, we outline the rationale for key elements of a …