Abstract
March 10, 2011 will mark the celebration of the 6th World Kidney Day (WKD), an annual event jointly sponsored by the International Society of Nephrology and the International Federation of Kidney Foundations. Since its inception in 2006, WKD has grown dramatically to become the most widely celebrated event associated with kidney disease in the world and the most successful effort to raise awareness among both the general public and government health officials about the dangers of kidney disease, especially chronic kidney disease (CKD). In 2011, WKD will call attention to the large, and often unappreciated, role played by kidney dysfunction in increasing premature cardiovascular disease, the most common cause of morbidity and mortality worldwide (1). Can a focus on early detection and prevention of kidney disease really improve long term cardiovascular health? In this editorial, we hope to convey the message that increased attention to the kidneys can indeed improve long-term health outcomes by reducing both kidney and cardiovascular disease and should therefore be a central component of any global health strategy intended to reduce the enormous and growing burden of chronic NCDs.
Highlights
There has been concern that chronic kidney disease (CKD) diagnosed by reduced GFR alone identifies predominately older adults at increased risk because of age alone [24], the connection between proteinuria as an independent risk factor for CV mortality has been confirmed by meta-analysis of 22 separate, general population, cohort studies and in both older (>65) and younger people of several nationalities and racial groups [23]
As celebrations of the sixth World Kidney Day approach on March 10, 2011, it is worth noting that prior to the past decade, kidney disease was seen by most government and public health authorities as largely confined to patients with ESRD, thankfully a rare condition because the enormous cost of renal replacement therapy disproportionately consumes scarce health care resources and is well beyond the means of countries inhabited by over 80% of the worlds population [37,38]
We appreciate that kidney disease is not rare– some 10% of the population has evidence of renal dysfunction
Summary
CVD is the most common of the chronic NCDs that impact global mortality. About 30% of all deaths worldwide and 10% of all healthy life lost to disease are accounted for by CVD alone [1]. Go et al reported an independent and graded association between GFR and risk of death, CV events and hospitalizations was reported in a community-based study of over 1000 individuals [6] Is this dramatic increase in CVD risk associated with CKD really due to CKD or does it just reflect the coexistent diabetes or hypertension that are present in a majority of these patients? The increased risk for CV events and mortality in people over 55 with CKD alone is equivalent, or even higher, to that seen in patients with diabetes or previous myocardial infarcts [11] Both general [6, 12] and high-risk populations [13,14] exhibit an increased risk of CVD with CKD. This increased risk for CVD is not confined to the elderly – in volunteers with an average age of 45, the risk for myocardial infarct, stroke and all cause mortality was doubled in those with CKD [14]
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