CKD in disadvantaged populations.

Guillermo García-García,Vivekanand Jha

doi:10.4067/s0034-98872015000200018

Abstract

March 12, 2015 will mark the 10th anniversary of World Kidney Day (WKD), an initiative of the International Society of Nephrology and the International Federation of Kidney Foundations. Since its inception in 2006, WKD has become the most successful effort ever mounted to raise awareness among decison-makers and the general public about the importance of kidney disease. Each year WKD reminds us that kidney disease is common, harmful and treatable. The focus of WKD 2015 is on 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.

Highlights

CKD in developed countriesEthnic minorities (African American, Hispanic and Native Americans in the US; South Asians and Afro-caribbeans in the UK and Malays and Indians in Singapore) and indigenous populations (Canadian First Nations people, Australian Aborigines, New Zealand Maoris and Native Americans) experience end stage renal disease (ESRD) at rates 1.5-4 times higher than the general population[2]
Overall treatment outcomes are relatively poor among the indigenous, ethnic minorities, and uninsured populations who do receive RRT, even after adjustment for co-morbidities
The aforementioned places a special burden on the professional community and policymakers to ensure provision of appropriate renal care to the disadvantaged populations. This will require both supply and demand side actions: expanding the reach of dialysis through development of lowcost alternatives that can be practised in remote locations, and implementation and evaluation of cost-effective prevention strategies

Summary

CKD in developed countries

Ethnic minorities (African American, Hispanic and Native Americans in the US; South Asians and Afro-caribbeans in the UK and Malays and Indians in Singapore) and indigenous populations (Canadian First Nations people, Australian Aborigines, New Zealand Maoris and Native Americans) experience end stage renal disease (ESRD) at rates 1.5-4 times higher than the general population[2]. The etiology remains under investigation, but the implicated factors include exposure to agrochemicals, dehydration, and consumption of high-sucrose drinks or contaminated water Another distinguishing feature of the ESRD population in developing countries is the relative youth. A correlation between LBW and development of CKD later in life, perhaps linked to low nephron number, has been described in ethnic minorities, indigenous populations and the impoverished. Many of these manifestations, such as hypertension and proteinuria start in childhood and adolescence[4]. Morphometric studies of kidney biopsies in the Aboriginals show glomerulomegaly, perhaps secondary to nephron deficiency, which might predispose to glomerulosclerosis

Disparities in Access to Renal Replacement Therapy

Summary