Burden Of Chronic Kidney Disease Research Articles

Prevalence of Kidney Dysfunction and Its Relationship with Components of Metabolic Syndrome in a Hospital Setting

Metabolic syndrome (MetS) is defined by a set of components including hyperglycemia, dyslipidemia, hypertension, and central obesity. Despite the well-established association between MetS and chronic kidney disease (CKD) whose prevalence is on the increase, significant gap remains in our understanding of the relationship between kidney dysfunction and individual components of MetS, particularly in Nigeria. The objectives were to determine the prevalence of kidney dysfunction among adults with MetS and to examine the relationship of key components of MetS with kidney dysfunction using a cross-sectional study of randomly selected hospital outpatients with MetS. Kidney function was assessed using estimated glomerular filtration rate (eGFR). Descriptive and inferential statistical analyses were performed and statistical significance was set at p < .05. The mean age of the 75 study participants with MetS was 53.33 ± 13.94 years. Females constituted 65.3% and males, 34.7%. The prevalence of kidney dysfunction (eGFR < 60 mL/min/1.73 m²) was 36.0%, with no significant difference between genders. The key components of MetS that significantly correlated with kidney function were blood pressure, serum high density lipoprotein-cholesterol, and triglyceride. The same components independently predicted kidney function. To conclude, the study highlights the considerable burden of kidney dysfunction among adults with metabolic syndrome in Nigeria. Hypertension and dyslipidemia were the components of metabolic syndrome significantly associated with kidney dysfunction. Screening, early detection and targeted interventions including lifestyle modification and appropriate drug management are crucial to mitigate the impact of metabolic syndrome on kidney health, to improve health outcomes and to reduce CKD burden.

Inside CKD: a microsimulation modelling study projects the clinical and economic burden of chronic kidney disease in Hungary

ObjectivesThe Inside CKD programme implemented a microsimulation modelling approach to project the clinical and economic burden of chronic kidney disease (CKD) between 2024 and 2027 in Hungary.MethodsUsing the peer-reviewed Inside CKD microsimulation, a virtual Hungarian population was generated that was derived from national records, local demographic data and published epidemiological data. These inputs defined the likelihood of a change in health state for each individual as they progressed through the model in annual increments. Individual CKD status, including disease progression, cardiorenal complications and associated costs, was tracked annually to generate the population-level projections of the clinical and economic burden of CKD.ResultsBy 2027, people with CKD were projected to constitute 13.3% of the Hungarian national population. The prevalence of heart failure, myocardial infarction and stroke in people with CKD were projected to remain consistently high, reaching 323 447, 69 188 and 120 118 by 2027, respectively. Kidney replacement therapy cases were predicted to remain high at 20 515 in 2024 and 22 325 in 2027, with associated costs increasing from 71.4 billion HUF in 2024 to 79.6 billion HUF in 2027. Total annual healthcare costs associated with treating CKD were projected to constitute 5.4% of the overall national healthcare budget in 2027.ConclusionsInside CKD demonstrates that the future burden of CKD in Hungary will be substantial unless current management strategies change. The high prevalence of undiagnosed CKD and associated cardiorenal complications highlight the urgent need for policy interventions focused on early diagnosis and timely intervention to mitigate the future burden of CKD.

Beyond Dialysis: Reshaping CKD Paradigms in Developing Nations

Dear Sir / Madam, Respected Editor, I am writing to bring attention to the critical need for increased research on conservative kidney management (CKM) in the context of patients with advanced chronic kidney disease (CKD). The recent advancements in developed nations have demonstrated that CKM is a novel and effective approach to caring for CKD patients, particularly those who choose not to pursue maintenance dialysis. Historically, medical care for individuals with CKD has adhered to a paternalistic model, where clinicians make treatment decisions independent of patient preferences. JS Scherer et al observed that a provider's assessment of a patient's frailty and response exerted a more substantial influence on the treatment provided than the patient’s comorbidities, functional status, and stated preferences. 2 Furthermore, another study showed that some individuals exhibited a preference for conservative care after shared-decision making, irrespective of the potential survival benefits offered by dialysis if it entailed frequent hospital visits or travel restrictions. 3 This underscores the significance of patient autonomy, where the pursuit of freedom can sometimes outweigh the emphasis on clinical outcomes. However, contemporary CKD management in the 21st century emphasizes shared decision-making and patient empowerment. While research suggests CKM can improve quality of life, reduce hospitalizations, and minimize invasive procedures, offering a valuable alternative to dialysis, its impact on survival becomes less clear for patients over 80 or those with multiple comorbidities.4 Additionally, the inclusion of patients and their families in collaborative decision-making processes has proven advantageous, supported by specialized decision aids that promote well-informed discussions regarding CKM with healthcare providers.5 Nephrologists face significant challenges in implementing effective conservative kidney management (CKM) due to a lack of clinical guidelines, training, evidence, and system-level infrastructure. This has resulted in limited awareness and discussion of CKM among patients and healthcare providers, hindering its adoption. With the global burden of chronic kidney disease (CKD) increasing significantly over the past three decades, particularly affecting low- and middle-income countries, there is a pressing need for innovative, cost-effective solutions. CKM emerges as a viable alternative where dialysis is often inaccessible or unaffordable, with the potential to significantly impact CKD management, especially in resource-limited settings such as Pakistan. I urge the scientific community and policymakers to recognize the importance of supporting and conducting research on conservative kidney management. ---Continue

Molecular Insight into Obesity-Associated Nephropathy: Clinical Implications and Possible Strategies for its Management.

Obesity is a significant health concern due to its rapid increase worldwide. It has been linked to the pathogenic factors of renal diseases, cancer, cardiovascular diseases, hypertension, dyslipidemia, and type 2 diabetes. Notably, obesity raises the likelihood of developing chronic kidney disease (CKD), leading to higher adult mortality and morbidity rates. This study explores the molecular mechanisms that underlie obesity-associated nephropathy and its clinical implications. Obesity-Associated Nephropathy (OAN) develops and worsens due to insulin resistance and hyperinsulinemia, which promote renal sodium reabsorption, glomerular hyperfiltration, and hypertension, leading to progressive kidney damage. Renal damage is further aggravated by persistent inflammation and redox damage, mediated by adipokines and proinflammatory cytokines, such as TNF-α and IL-6. Furthermore, stimulation of the sympathetic nervous system and the renin-angiotensin- aldosterone system (RAAS) intensifies glomerular hypertension and fibrosis. These elements cause glomerular hyperfiltration, renal hypertrophy, and progressive kidney damage. Clinical manifestations of obesity-associated nephropathy include proteinuria, reduced glomerular filtration rate (GFR), and ultimately, CKD. Management strategies currently focus on lifestyle modifications, such as weight loss through diet and exercise, which have been effective in reducing proteinuria and improving GFR. Pharmacological treatments targeting metabolic pathways, including GLP-1 receptor agonists and SGLT2 inhibitors, have shown renoprotective properties. Additionally, traditional RAAS inhibitors offer therapeutic benefits. Early detection and comprehensive management of OAN are essential to prevent its progression and lessen the burden of CKD.

Revealing the burden of chronic kidney disease in Mexican women, 1990–2021

BackgroundChronic kidney disease (CKD) has become a concerning public health issue, affecting people regardless of their sex, age, or socioeconomic status. We aimed to analyze the burden of female CKD in Mexico between 1990 and 2021, expressed in terms of years lived with disability (YLDs), mortality, years of life lost (YLLs), and disability-adjusted life-years (DALYs). Additionally, we evaluated the relationship between DALYs and the Socio-Demographic Index (SDI) and the Healthcare Access and Quality Index (HAQI).MethodsSecondary data analysis from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021. We used mortality, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs to analyze CKD in women between 1990 and 2021. We used a log-linear segmented regression model to analyze trends in female CKD DALY rates over time. The information was disaggregated by age groups and sub-causes nationally and across the 32 states. Age-standardized rates (ASR) were used.ResultsBetween 1990 and 2021, the ASR mortality and ASR-DALYs due to CKD increased significantly at the national level. The DALYs are almost entirely explained by YLLs, indicating that a large proportion of women with CKD in Mexico die prematurely. Disparities in the burden of this disease were observed across different states and age groups within the country. In 2021, the highest ASR-DALY rate was recorded in Tabasco (1,972.0), while the lowest was in Sinaloa (865.1). The SDI and HAQI were associated with the CKD DALYs in most states.ConclusionsMexican women experience a significant burden due to CKD, reflected in premature deaths and years lived with disability, while disparities between states need to be addressed to reduce inequities. Over the past 32 years, improvements in socioeconomic indicators and the quality and access to healthcare have not contributed to reducing the DALYs rate due to CKD, indicating a need to redirect policies to impact women’s well-being and health positively.

"I won't ever feel normal": experience reported through photovoice by children with chronic kidney disease.

Much of the global chronic kidney disease burden is experienced in low- and middle-income countries. Children living with chronic kidney disease (CKD) face medical and social challenges, and they need support at the individual and family levels. This study aimed to explore children's experiences living with kidney replacement therapy (KRT) who attend the largest pediatric nephrology department in Guatemala. This qualitative study used photovoice and asked children to take pictures that represented what is like to live with CKD. Each child and their caregiver underwent an interview where the photos were used to elicit and facilitate discussion. The interviews were recorded, transcribed, and then analyzed using thematic analysis. Eight children and their mothers participated in the study. Three themes were identified: interactions with the health system, changing and difficult family dynamics, and strains on social interactions. Children face social challenges including self-isolation and alienation. The family dynamics and familial structures often are forced to change, inducing stress. This is all exacerbated by the difficulties that arise in navigating the Guatemalan health system. Photovoice techniques are a feasible way to understand the experiences of children and their families who face CKD. The disease affects all aspects of life and recognizing this while advising and administering care can help provide a comprehensive level of care. Health systems need to make efforts aimed at improving the quality of care as well as the multidisciplinary support available to children and their families.

Burden of Chronic Kidney Disease for Adults 70 Years and Older in Iran During 1990-2021

Objectives: To report the burden of chronic kidney disease (CKD) among those aged 70 and above in Iran by age, sex, and province from 1990 to 2021. Design: Systematic analysis. Outcome measures: Data were obtained from the Global Burden of Disease study 2021. All estimates were reported as counts and age-standardized rates per 100000 individuals, with their corresponding 95% uncertainty intervals (UIs). Results: In 2021, CKD recorded an age-standardized prevalence of approximately 44 thousand per 100000 population among adults 70 years and older in Iran (95% UI: 39807–47784.5 per 100000). This rate meant a 5% increase compared to 1990, which was statistically significant. CKD also accounted for 8,725 deaths in the elderly population of Iran in 2021. Furthermore, disability-adjusted life years (DALY) rates were 3697.7 per 100000 population and had a 28.2% increase in the span of 1990–2021. Fars and Chahar Mahaal and Bakhtiari had the highest and lowest point prevalence per 100000 at 50357.2 and 40453.9, respectively, in the elderly population. In 2021, the prevalence, deaths, and DALYs due to CKD did not differ significantly between the two sexes, although the numbers were slightly higher in the female population. Moreover, the age-standardized prevalence, deaths, and DALYs of CKD in the elderly of Iran in 2021 started to rise in the 70–74 and increased with aging. Conclusions: The burden of CKD in the elderly of Iran has increased over the past 30 years. This is in line with the increase in the elderly population and the rising of its related risk factors. Preemptive measures, public knowledge raising, and the implementation of risk management policies can brighten the future of Iran’s elderly population in terms of non-communicable diseases, especially CKD.

Projecting the Population Level Burden of CKD Progression According to Urine Albumin-to-Creatinine Ratio Categories

IntroductionUrinary albumin-creatinine ratio (uACR) is an independent predictor of chronic kidney disease (CKD) progression, however there is limited evidence on the burden of CKD according to uACR categories at a population level. This study estimates future clinical and financial burden of CKD according to uACR categories using the Inside CKD microsimulation. MethodsThe Inside CKD model is an individual patient level microsimulation that emulates national populations based on demographic, epidemiological and economic data. The analysis estimates clinical and economic outcomes over time according to KDIGO uACR categories (A1–A3) at a population level for 31 countries and regions. ResultsCKD populations (diagnosed and undiagnosed individuals, stages G3-5) were projected to be predominantly within uACR categories A1 and A2 in 2022. Projected cumulative incidence of CKD stage transitions (disease progression) and cardio-renal complications (heart failure, myocardial infarction, stroke, and all-cause mortality) occurred mostly in uACR categories A1 and A2 between 2022–2027. Patients in uACR categories A1 and A2, who represent the largest proportion of patients with CKD, were projected to incur most of the healthcare costs associated with CKD management and cardio-renal complications for the diagnosed population (prevalence 2027). ConclusionThis study highlights the disproportionate population-level clinical and economic burden associated with individuals within KDIGO uACR categories A1 and A2, who represent most of the CKD population. This awareness will help healthcare decision makers to appropriately allocate resource and interventions to the CKD population, including those with mildly to moderately increased albuminuria, to reduce clinical and economic burden associated with CKD.

Glucose-Lowering Drugs and Primary Prevention of Chronic Kidney Disease in Type 2 Diabetes Patients: A Real-World Primary Care Study

Background/Objectives: The burden of chronic kidney disease (CKD) is increasing, as is the prevalence of type 2 diabetes mellitus (T2DM). Post-hoc analyses of clinical trials support that sodium–glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptors agonists (GLP-1RAs) prevent CKD in T2DM patients. Methods: We used the Spanish primary care database BIFAP to perform a retrospective cohort study with a nested case-control analysis to assess the incidence, risk factors, and the effect of glucose-lowering drugs (GLDs) on the primary prevention of CKD. Results: From a cohort of 515,701 T2DM subjects (2.75 million person-years), we found 89,075 incident CKD cases, yielding an overall incidence rate (95%CI) of 324.3 (322.1–326.5) per 10,000 person-years. In the nested case–control analysis, gout, hyperuricemia, and hyperkalemia were the factors showing the highest AORs. Long-term users (≥3 years) of GLP1-RAs and SGLT-2i, compared to other GLDs, showed a decreased risk for CKD (AOR = 0.85; 95%CI: 0.73–0.99 and AOR = 0.89; 95%CI: 0.74–1.08, respectively), and for incident CKD at KDIGO stages G3-G5 (AOR = 0.72; 95%CI: 0.56–0.94 and AOR = 0.64; 95%CI: 0.46–0.91, respectively). Conclusions: In a real-world primary care setting, the long-term use of GLP-1RAs and SGLT-2i, but not other GLDs, appeared to decrease the risk of incident CKD in T2DM, supporting a role in primary prevention of CKD.

Higher prevalence of kidney function impairment among older people living with HIV in Uganda

BackgroundPeople living with HIV (PLWH) are at risk of kidney function impairment due to HIV-related inflammation, antiretroviral therapy (ART), diabetes mellitus, and hypertension. Older persons may experience a higher burden of chronic kidney disease (CKD) as kidney function declines with increasing age. There is a paucity of data comparing the prevalence of kidney function impairment in older PLWH to that in people without HIV in sub-Saharan Africa.MethodsWe conducted a cross-sectional study among people aged ≥ 60 years living with and without HIV in Kampala, Uganda who were matched 1:1 by community location. We collected data on sociodemographics, comorbidities, and HIV-related clinical characteristics. We defined kidney function impairment as an estimated glomerular filtration rate(eGFR) < 60mls/min/1.73m2 with or without proteinuria. We constructed multivariable logistic regression models to study associations between participant characteristics and kidney function impairment.ResultsWe enrolled 278 people (median age 66 years); 50% were PLWH, and 51.8% were female. Among PLWH, 33.1% (95% CI: 25.7-41.4%) had kidney function impairment versus 12.9% (95% CI: 8.3-19.7%) among people without HIV, (p-value < 0.01). The prevalence of proteinuria among PLWH versus people without HIV was 43.9% (95% CI:35.8-52.3%) versus 19.4% (95% CI:13.6-26.9%) p-value < 0.01. Living with HIV (OR = 3.89(95% CI: 2.04–7.41), p-value < 0.01), older age (OR = 1.13, (95% CI:1.07–1.20), p-value < 0.01), female sex (OR = 1.95, (95% CI:1.06–3.62), p-value = 0.03) and a prior diagnosis of hypertension (OR = 2.19(95% CI:1.02–4.67), p-value = 0.04) were significantly associated with kidney function impairment.ConclusionsHIV infection is strongly associated with kidney function impairment among older PLWH. Prioritizing routine measurements of kidney function and proteinuria in older PLWH will enable early detection and institution of measures to reduce the progression of kidney disease.

Prevalence and associated factors of chronic kidney disease among Truká Indigenous adults in Cabrobó, Brazil: a population-based study

The prevalence of chronic kidney disease (CKD) is increasing worldwide, especially in developing countries, due to factors such as lifestyle changes and the rise of non-communicable diseases. Populations living in socioeconomically disadvantaged areas are subject to a higher burden of CKD. However, the burden of CKD on Brazilian Indigenous people, especially those undergoing an advanced urbanisation process, has not yet been described. This cross-sectional study included 1715 Truká Indigenous adults from Cabrobó, Brazil. CKD was defined according to the Kidney Disease Improving Global Outcomes guidelines classification as a urinary albumin/creatinine ratio ≥30mg/g and/or an estimated glomerular filtration rate <60mL/min/1.73m2. Univariate and multiple logistic regression models were used to evaluate factors associated with CKD. Odds ratio (OR) with a 95% confidence interval (CI) was used to measure association. Out of the 1654 participants analysed (61 excluded due to missing data), the prevalence of CKD was 10% (95% CI, 8.6%-11.5%), with a higher prevalence in women compared to men (12.4% versus 6.9%, p<0.001). The mean age was 40.5 years, with 55.6% being women. In univariate analysis, female sex (OR, 1.9; 95% CI, 1.3-2.7), age ≥60 years (OR, 4.6; 95% CI, 3.2-6.6), cardiovascular disease (OR, 2.1; 95% CI, 1.1-4.1), and dyslipidemia (OR, 1.6; 95% CI, 1.1-2.4) were identified as associated factors with CKD. Multiple logistic regression analysis identified age ≥60 years, female sex, and dyslipidemia as independently associated factors with CKD. The prevalence of CKD among Truká Indigenous adults analysed is high and affects a higher proportion of women. Our study found no association between hypertension, diabetes, obesity, and CKD risk, despite their high prevalence. These findings assist in developing early CKD detection strategies in Brazilian Indigenous communities, supporting disease treatment and prevention. National Council for Scientific and Technological Development (CNPq)-Ministry of Science, Technology, and Innovation of Brazil, and the Maria Emília Foundation.

Challenges in predictive modelling of chronic kidney disease: A narrative review.

The exponential rise in the burden of chronic kidney disease (CKD) worldwide has put enormous pressure on the economy. Predictive modeling of CKD can ease this burden by predicting the future disease occurrence ahead of its onset. There are various regression methods for predictive modeling based on the distribution of the outcome variable. However, the accuracy of the predictive model depends on how well the model is developed by taking into account the goodness of fit, choice of covariates, handling of covariates measured on a continuous scale, handling of categorical covariates, and number of outcome events per predictor parameter or sample size. Optimal performance of a predictive model on an independent cohort is desired. However, there are several challenges in the predictive modeling of CKD. Disease-specific methodological challenges hinder the development of a predictive model that is cost-effective and universally applicable to predict CKD onset. In this review, we discuss the advantages and challenges of various regression models available for predictive modeling and highlight those best for future CKD prediction.

Risk Factors of Chronic Kidney Diseases: A Retrospective, Record based Study from a Tertiary Care Hospital in India

Abstract Background: There is a alarming rise of chronic kidney diseases (CKDs) prevalence globally, which is associated with significant morbidity and mortality. The burden of Chronic Kidney Diseases is rapidly rising in developing countries. The study aimed to assess the major risk factors of CKD in patients of a tertiary hospital. Materials and Methods: Hospital-based, retrospective study was conducted at a hospital, in Mumbai, among CKD patients. Medical records of 500 CKD patients were analysed. Results: The mean age of participants was 53.87 years. Majority of the patients had risk factors for CKD such as hypertension and diabetes. The mean serum creatinine was 4.04 mg/dL. Majority of the cases were in G4 and G5 stages of CKD and 201 patients had undergone kidney transplant. Association between age and transplant was significant. Furthermore, association between developing New Onset Diabetes Mellitus After Transplantation (NODAT) was statistically significant. Conclusion: Major risk factors for CKD were hypertension, diabetes and advancing age. Most of the cases of CKD were diagnosed late. There should be increased awareness about CKD among the population with special emphasis on cases of hypertension and diabetes.

Current Understanding of Cardiovascular Calcification in Patients with Chronic Kidney Disease.

The burden of chronic kidney disease (CKD) is increasing, posing a serious threat to human health. Cardiovascular calcification (CVC) is one of the most common manifestations of CKD, which significantly influences the morbidity and mortality of patients. The manifestation of CVC is an unusual accumulation of mineral substances containing calcium and phosphate. The main component is hydroxyapatite. Many cells are involved in this process, such as smooth muscle cells (SMCs) and endothelial cells. CVC is an osteogenic process initiated by complex mechanisms such as metabolic disorders of calcium and phosphorus minerals, inflammation, extracellular vesicles, autophagy, and micro-RNAs with a variety of signaling pathways like Notch, STAT, and JAK. Although drug therapy and dialysis technology continue to advance, the survival time and quality of life of CVC patients still face challenges. Therefore, early diagnosis and prevention of CKD-related CVC, reducing its mortality rate, and improving patients' quality of life have become urgent issues in the field of public health. In this review, we try to summarize the state-of-the-art understanding of the progression of CVC and hope that it will help in the prevention and treatment of CVC in CKD.

Epidemiological analysis of chronic kidney disease from 1990 to 2019 and predictions to 2030 by Bayesian age-period-cohort analysis

ABSTRCAT Background Chronic Kidney Disease (CKD) has emerged as a significant global health issue. This study aimed to reveal and predict the epidemiological characteristics of CKD. Methods Data from the Global Burden of Disease Study spanning the years 1990 to 2019 were employed to analyze the incidence, prevalence, death, and disability-adjusted life year (DALY) of CKD. Joinpoint analysis assessed epidemiological trends of CKD from 1990 to 2019. An age-period-cohort model evaluated risk variations. Risk factor analysis uncovered their influences on DALYs and deaths of CKD. Decomposition analysis explored the drivers to CKD. Frontier analysis evaluated the correlations between CKD burden and the sociodemographic index (SDI). A Bayesian Age-Period-Cohort model was employed to predict future incidence and death of CKD. Results In 2019, there were 18,986,903 incident cases, 697,294,307 prevalent cases, 1,427,232 deaths, and 41,538,592 DALYs of CKD globally. Joinpoint analysis showed increasing age-standardized rates of CKD incidence, prevalence, mortality, and DALY from 1990 to 2019. High systolic blood pressure significantly contributed to CKD-related deaths and DALYs, particularly in the high SDI region. Decomposition analysis identified population growth as the primary driver of CKD incident cases and DALYs globally. Countries like Nicaragua showed the highest effective differences, indicating room for improvement in CKD management. By 2030, while incident cases of CKD were predicted to rise, the global deaths might decrease. Conclusions The study revealed a concerning upward trend in the global burden of CKD, emphasizing the need for targeted management strategies across different causes, regions, age groups, and genders.

Global burden of chronic kidney disease in adolescents and young adults, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.

The global status of chronic kidney disease (CKD) is underestimated, particularly the burden on adolescents and young adults (early-onset, aged 15-39). We aim to investigate the pattern and trend of early-onset CKD from 1990 to 2019. We analyzed age-specific rates of early-onset CKD incidence, death, and disability-adjusted life years (DALY) using Global Burden of Disease Study 2019 data. We examined the global, regional, national, gender-based, age group-based, and temporal changes of early-onset CKD burden from 1990 to 2019, as well as proportional DALY attributions of various risk factors. From 1990 to 2019, the global age-specific incidence rate (per 100,000 population) significantly increased from 25.04 (95% confidence interval 18.51, 31.65) to 32.21 (23.73, 40.81) for early-onset CKD. However, the global age-specific death rate significantly decreased from 2.96 (2.76, 3.15) to 2.86 (2.61, 3.11), and the age-specific DALY rate remained stable. Regarding sociodemographic indexes (SDI), countries with middle SDI had the highest incidence rates and the fastest increasing trends, while those with low and low-middle SDI experienced the highest death and DALY rates. Women had a generally higher age-specific incidence rate than men, whereas men showed higher age-specific death and DALY rates. In addition, the burdens of CKD increased with age among adolescents and young adults. Moreover, the main attributable risk factors for DALY of early-onset CKD were high systolic blood pressure (SBP), fasting plasma glucose (FPG), and body mass index (BMI). The age-specific incidence rate of early-onset CKD increased significantly from 1990 to 2019, and the age-specific DALY rate remained stable. High SBP, high FPG, and high BMI were the primary risk factors. Targeted prevention and healthcare measures should be developed considering age, gender, and region.

The burden of chronic kidney disease in Asia region: a review of the evidence, current challenges, and future directions.

The disease burden of chronic kidney disease (CKD) and its impact on healthcare systems has been poorly studied in Asia, a socioeconomically diverse region with wide variations in availability, access, and quality of CKD care. The high CKD burden in this region is predominantly driven by an increased prevalence of risk factors including diabetes mellitus, hypertension, obesity, and use of traditional medicines and is further aggravated by challenges associated with effective implementation of population-based screening and surveillance systems in early detection and intervention of CKD. The Asian continent mostly comprised of low- and middle-income countries with resource restraints lacks robust population-based CKD registries resulting in a paucity of data on CKD incidence and prevalence, various treatment modalities, uptake of current guidelines, and the overall impact of implementation of developmental programs. There is an urgent need for a collaborative action plan between the healthcare community and governments in this region to detect CKD in its early stages and prevent its complications including kidney failure, cardiovascular disease, and death. Research-based evidence on the impact of early detection, sustainable treatment options, quality of life, delay or avoidance of dialysis, and related cost analysis is the need of the hour. We highlight successful implementation of strategic and policy-sharing programs adopted in a few countries; also, consolidate available region-specific data, quantify estimates of CKD burden and propose strategies with a multidisciplinary approach involving patients, the healthcare community and governmental bodies to combat CKD and its complications.

Experiences of social isolation and loneliness in chronic kidney disease: a secondary qualitative analysis.

Many patients with chronic kidney disease (CKD) experience loneliness and social isolation, which are associated with a higher risk of mortality, morbidity, and poor mental health. We aimed to describe the perspectives of patients with CKD and their caregivers on loneliness and social isolation, to inform strategies to increase social participation. A secondary analysis of qualitative data from the Standardized Outcomes in Nephrology (SONG) initiative dataset (36 focus groups, three Delphi surveys and seven consensus workshops) was conducted. We extracted and thematically analyzed data from patients with CKD, including those receiving hemodialysis or peritoneal dialysis and those with a kidney transplant, as well as their caregivers, on the perspectives and experiences of loneliness and social isolation. Collectively the studies included 1261 patients and caregivers from 25 countries. Six themes were identified: restricted by the burdens of disease and treatment (withdrawing from social activities due to fatigue, consumed by the dialysis regimen, tethered to treatment, travel restrictions); external vulnerability (infection risk, anxiety of dining out); diminishing societal role (grieving loss of opportunities, social consequences of inability to work); fending for oneself in healthcare (no one to relate to, lost in uncertainty, unmet psychosocial needs); undermining self-esteem (unable to engage in activities which previously defined self, shame and self-consciousness about appearance, hindering confidence for intimate relationships); and feeling ostracized (disconnected by family and friends, fear of stigma and being misunderstood, guilt of burdening others). For patients with CKD and their caregivers, social participation is substantially impaired by the burden of CKD and its treatment, and fear of risks to health such as infection. This undermines patient and caregiver mental health, particularly self-esteem and sense of belonging. Additional interventions are needed to improve social connections among people with CKD and their caregivers.

The direct cost of chronic kidney disease (CKD) reported in Asian countries; a systematic literature review

BackgroundThe direct and indirect costs of chronic kidney disease (CKD) are substantial and increase over time. Concerns regarding our capacity to manage the financial burden that CKD) places on patients, caregivers, and society are raised by its increasing prevalence and progression. Lack of awareness of CKD’s economic effects is a major reason that lawmakers and administrators pay little attention to this chronic illness.ObjectiveWe aimed to analyze the direct burden of CKD across Asian countries and evaluate the main cost drivers among all mentioned cost centers in previous studies.MethodologyRelated works evaluating the expenditures of CKD from the perspective of the patient were interpreted by a thorough search of PUBMED and GOOGLE SCHOLAR.ResultsCountry-wise, in Asia, the direct mean average medical costs in RRT patients were reported in 8 studies as $4574, $18668, $2901, $6848, $16669, $3489, $5945, and $6344 in Singapore, Korea, Taiwan, China, Jordan, Vietnam, Lebanon, and India respectively and the direct mean average medical costs in non-RRT patients were reported in six studies as $3412, $2241, $4534, $290 and $1500 in Singapore, Japan, China, Vietnam, and India respectively.ConclusionHemodialysis is the main cost driver having an average mean cost of $23,358 per patient per year while the average mean cost of disease management is $4977 per patient per year. More research is needed to understand the specific economic challenges disadvantaged populations face, including the impact of income, education, and access to healthcare resources on the financial burden of CKD.

Late diagnosis of CKD and associated survival after initiation of renal replacement therapy in Kazakhstan: analysis of nationwide electronic healthcare registry 2014–2019

Chronic kidney disease (CKD) presents a significant global health challenge, often progressing to end-stage renal disease (ESRD) necessitating renal replacement therapy (RRT). Late referral (LR) to nephrologists before RRT initiation is linked with adverse outcomes. However, data on CKD diagnosis and survival post-RRT initiation in Kazakhstan remain limited. This study aims to investigate the impact of late CKD diagnosis on survival prognosis after RRT initiation. Data were acquired from the Unified National Electronic Health System (UNEHS) for CKD patients initiating RRT between 2014 and 2019. Survival post-RRT initiation was assessed using the Cox Proportional Hazards Model. Totally, 211,655 CKD patients were registered in the UNEHS databases and 9,097 (4.3%) needed RRT. The most prevalent age group among RRT patients is 45–64 years, with a higher proportion of males (56%) and Kazakh ethnicity (64%). Seventy-four percent of patients were diagnosed late. The median follow-up time was 537 (IQR: 166–1101) days. Late diagnosis correlated with worse survival (HR = 1.18, p < 0.001). Common comorbidities among RRT patients include hypertension (47%), diabetes (21%), and cardiovascular diseases (26%). The history of transplantation significantly influenced survival. Regional disparities in survival probabilities were observed, highlighting the need for collaborative efforts in healthcare delivery. This study underscores the substantial burden of CKD in Kazakhstan, with a majority of patients diagnosed late. Early detection strategies and timely kidney transplantation emerge as crucial interventions to enhance survival outcomes.