Equity and Quality of Global Chronic Kidney Disease Care: What Are We Waiting for?

Abstract

Plain Language SummaryKidney disease is common and treatable. These two facts are often underappreciated world-wide. Only around 1 in 5 people with kidney disease are aware of their diagnosis. Kidney disease is silent until late; therefore, if opportunities for early diagnosis and treatment are to be maximized, people at risk should be screened early. With the addition of new medications to the established standard of care, unprecedented advances have been made in reducing kidney failure, heart failure, and death. Despite knowledge of these effective therapies, their prescription and use remain suboptimal globally. Many challenges contribute to this gap between what we know in terms of effective treatment and what we do in clinical care, where opportunities to diagnose and treat kidney disease early are often missed. Delivery of guideline-directed care is hampered by lack of awareness of the importance of kidney disease, late or missed diagnosis, clinician inertia, poor quality care, high cost of therapy, systemic biases, and lack of patient empowerment and education. Health systems must be strengthened to support delivery of quality care. Advocacy, implementation research, and action are required to improve equitable access to sustainable kidney care for everyone, everywhere, such that the people with kidney disease are diagnosed early, are well informed about their disease, and receive and continue to receive affordable quality care to live better, longer, and healthier.