Global Burden Of Kidney Disease Research Articles

Disposable Carbon Electrochemical Sensor Modified with Gold Nanoparticles for Creatinine Detection

The social and economic impact of Chronic Kidney Disease on global health systems is devastating. It is estimated that annual spending on the treatment of Chronic Kidney Patients is in the order of 2 to 3% of annual health budgets. (1) In 2015, considering the United States, medical expenses for individuals with chronic kidney diseases were more than 64 billion dollars (1). Indeed, the early diagnosis of chronic kidney diseases is very important for the implementation of preventive measures that delay or even interrupt the progression to more advanced stages of the disease. In this context, this work aims to develop a disposable electrochemical sensor aimed at detecting creatinine for diagnosing kidney diseases. The flexible disposable lab made carbon sensor has been modified with gold nanoparticles. Morphological and electrochemical characterizations were carried out to better understand the proposed device. From cyclic voltammetry measurements, the proposed sensor showed reduction and oxidation peaks related to gold oxides formed on its surface. When adding creatinine there is a decrease in the electrochemical signal due to the adsorption of the target analyte. Therefore, it was inferred that it was possible to detect creatinine present in the solution from the reduction in the analytical response of the gold-modified electrode. Using the square wave voltammetry technique, in accordance with what was previously presented, when CNN was added to the solution, the Au-CNN interaction caused a reduction in the analytical response, therefore, with the increase in CNN concentration, this reduction increased linearly in the range of 0.5 to 10 µmol L-1 with a limit of detection and quantification, 0.15 and 0.45 µmol L-1, respectively, were calculated. Furthermore, it presented a sensitivity of 0.97 µA mol-1 L with a linear equation of Ipeak (µA) = 0.97 x C(CNN) + 0.23. Furthermore, the proposed sensor was successfully applied to determine creatinine in human serum samples and the recovery results were close to 100%. Therefore, the device modified with gold nanoparticles is an interesting alternative for creatinine detection.References(1) Luyckx V. A. et al. The global burden of kidney disease and the sustainable development goals, Bulletin of the World Health Organization Published online: 20 April 2018.

Air pollution and acute kidney injury with comorbid disease: A nationwide case-crossover study in South Korea

Emerging evidence suggests that air pollution is a significant contributor to the global burden of kidney disease. Although acute kidney injury (AKI) is a common secondary event in ill patients, evidence regarding the association between air pollution and AKI accompanied by specific comorbidities is limited. This study aimed to estimate the association between short-term exposure to air pollution (fine particulate matter ≤2.5 μm [PM2.5] and ozone [O3]) and incident AKI by comorbid diseases using the Korea National Health Information Database (NHID). Total of 160,390 incident AKI cases, defined as an emergency department (ED) visit due to AKI, were observed within the period 2015–2021 in inland South Korea. A time-stratified case-crossover design was applied for PM2.5 and O3 individually, using a conditional logistic regression model within each case and its own control (three or four days of the same day of the week in the same month) to estimate the association between short-term air pollution exposure and ED visits due to AKI. Short-term exposure to PM2.5 and O3 was associated with ED visits due to AKI with ORs of 1.008 (95% confidence interval [CI]: 0.999, 1.017) and 1.019 (95% CI: 1.005, 1.033) for an interquartile range (IQR) increase in lag 0–1 day PM2.5 and O3 respectively, although OR for PM2.5 was marginally significant. The odds of incident AKI associated with PM2.5 was evident in conjunction with ischemic heart disease, cerebrovascular disease, gastrointestinal bleeding, and pneumonia. For O3, the estimated odds was prominent for AKI with ischemic heart disease. In addition, the comorbid disease-specific odds of AKI attributed to air pollution varied by sex and age. Our findings provide epidemiological evidence of a plausible mechanism between air pollution and incident AKI and suggest the need for personalized AKI prevention strategies attributed to air pollution.

Global kidney health priorities-perspectives from the ISN-GKHA.

Kidney diseases have become a global epidemic with significant public health impact. Chronic kidney disease (CKD) is set to become the fifth largest cause of death by 2040, with major impacts on low-resource countries. This review is based on a recent report of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) which uncovered gaps in key vehicles of kidney care delivery assessed using World Health Organization building blocks for health systems (financing, services delivery, workforce, access to essential medicines, health information systems and leadership/governance). High-income countries had more centres for kidney replacement therapies (KRT), higher KRT access, higher allocation of public funds to KRT, larger workforces, more health information systems, and higher government recognition of CKD and KRT as health priorities than low-income nations. Evidence identified from the current ISN-GKHA initiative should serve as template for generating and advancing policies and partnerships to address the global burden of kidney disease. The results provide opportunities for kidney health policymakers, nephrology leaders and organizations to initiate consultations to identify strategies for improving care delivery and access in equitable, resource-sensitive manners. Policies to increase use of public funding for kidney care, lower the cost of KRT and increase workforces should be a high priority in low-resource nations, while strategies that expand access to kidney care and maintain current status of care should be prioritized in high-income countries. In all countries, the perspectives of people with CKD should be exhaustively explored to identify core kidney care priorities.

An update on the global disparities in kidney disease burden and care across world countries and regions

Since 2015, the International Society of Nephrology (ISN) Global Kidney Health Atlas (ISN-GKHA) has spearheaded multinational efforts to understand the status and capacity of countries to provide optimal kidney care, particularly in low-resource settings. In this iteration of the ISN-GKHA, we sought to extend previous findings by assessing availability, accessibility, quality, and affordability of medicines, kidney replacement therapy (KRT), and conservative kidney management (CKM). A consistent approach was used to obtain country-level data on kidney care capacity during three phases of data collection in 2016, 2018, and 2022. The current report includes a detailed literature review of published reports, databases, and registries to obtain information on the burden of chronic kidney disease and estimate the incidence and prevalence of treated kidney failure. Findings were triangulated with data from a multinational survey of opinion leaders based on the WHO's building blocks for health systems (ie, health financing, service delivery, access to essential medicines and health technology, health information systems, workforce, and governance). Country-level data were stratified by the ISN geographical regions and World Bank income groups and reported as counts and percentages, with global, regional, and income level estimates presented as medians with interquartile ranges. The literature review used information on prevalence of chronic kidney disease from 161 countries. The global median prevalence of chronic kidney disease was 9·5% (IQR 5·9-11·7) with the highest prevalence in Eastern and Central Europe (12·8%, 11·9-14·1). For the survey analysis, responses received covered 167 (87%) of 191 countries, representing 97·4% (7·700 billion of 7·903 billion) of the world population. Chronic haemodialysis was available in 162 (98%) of 165 countries, chronic peritoneal dialysis in 130 (79%), and kidney transplantation in 116 (70%). However, 121 (74%) of 164 countries were able to provide KRT to more than 50% of people with kidney failure. Children did not have access to haemodialysis in 12 (19%) of 62 countries, peritoneal dialysis in three (6%) countries, or kidney transplantation in three (6%) countries. CKM (non-dialysis management of people with kidney failure chosen through shared decision making) was available in 87 (53%) of 165 countries. The annual median costs of KRT were: US$19 380 per person for haemodialysis, $18 959 for peritoneal dialysis, and $26 903 for the first year of kidney transplantation. Overall, 74 (45%) of 166 countries allocated public funding to provide free haemodialysis at the point of delivery; use of this funding scheme increased with country income level. The median global prevalence of nephrologists was 11·8 per million population (IQR 1·8-24·8) with an 80-fold difference between low-income and high-income countries. Differing degrees of health workforce shortages were reported across regions and country income levels. A quarter of countries had a national chronic kidney disease-specific strategy (41 [25%] of 162) and chronic kidney disease was recognised as a health priority in 78 (48%) of 162 countries. This study provides new information about the global burden of kidney disease and its treatment. Countries in low-resource settings have substantially diminished capacity for kidney care delivery. These findings have major policy implications for achieving equitable access to kidney care. International Society of Nephrology.

Global perspective of kidney diseases: Challenges and changes.

Chronic kidney disease (CKD) is a major public health issue worldwide. Although strategies for prevention, early detection and treatment to reduce the progression of CKD should remain continuous endeavours, public funding for kidney replacement therapy is urgently needed in low-income countries (LICs) and lower-middle-income countries (LMICs). A multisectoral approach is needed to tackle the global burden of kidney disease. Getting a new drug, from first testing to final approval by a regulatory agency and ultimately to market, is a long, costly and risky process. While clinical trials and research have delivered new therapies and devices to patients with kidney disease during the last decade, there remains a significant residual risk for patients with CKD. Therefore, developing new drugs for better treatment and patient care is essential. For this purpose, the ISN held a consensus meeting entitled 'TRANSFORM; TRAnslational Nephrology Science FOR new Medications', which connected experts in the global kidney community and provided guidance on optimal management of translational animal studies for the development of new drugs to treat kidney diseases.

Sulfur-Containing Amino Acids, Hydrogen Sulfide, and Sulfur Compounds on Kidney Health and Disease

Hydrogen sulfide (H2S) plays a decisive role in kidney health and disease. H2S can ben synthesized via enzymatic and non-enzymatic pathways, as well as gut microbial origins. Kidney disease can originate in early life induced by various maternal insults throughout the process, namely renal programming. Sulfur-containing amino acids and sulfate are essential in normal pregnancy and fetal development. Dysregulated H2S signaling behind renal programming is linked to deficient nitric oxide, oxidative stress, the aberrant renin–angiotensin–aldosterone system, and gut microbiota dysbiosis. In animal models of renal programming, treatment with sulfur-containing amino acids, N-acetylcysteine, H2S donors, and organosulfur compounds during gestation and lactation could improve offspring’s renal outcomes. In this review, we summarize current knowledge regarding sulfide/sulfate implicated in pregnancy and kidney development, current evidence supporting the interactions between H2S signaling and underlying mechanisms of renal programming, and recent advances in the beneficial actions of sulfide-related interventions on the prevention of kidney disease. Modifying H2S signaling is the novel therapeutic and preventive approach to reduce the global burden of kidney disease; however, more work is required to translate this into clinical practice.

Impact of early life development on later onset chronic kidney disease and hypertension and the role of evolutionary trade-offs.

New Findings What is the topic of this review? In this report, we summarize the latest clinical evidence linking developmental programming in the kidney to later life blood pressure and kidney disease. What advances does it highlight? Population‐level studies now show convincingly that low birth weight, fetal growth restriction and preterm birth are associated with and have a synergistic impact on the risk of kidney disease in later life. A new approach also considers how evolutionary selection pressure might fail to select for long‐term robustness of kidney function. The global burden of kidney disease is high and rising. The risk of kidney disease among individuals is highly variable, in part related to genetic and environmental factors, but also likely to be modulated by developmental programming of the number of nephrons and kidney function in fetal life. The number of nephrons varies widely across the population and is lower among those who were born small or preterm. Population registry evidence clearly shows an association between these birth circumstances and later‐life risk of hypertension and kidney disease, not only for chronic kidney disease but also for acquired kidney disease, demonstrating an inherent susceptibility to kidney disease in these individuals. Gestational stressors impact kidney development, a process that is likely to be layered upon the evolutionary history of the kidney and how the organ has developed in response to selection pressure to support reproductive capacity in early adulthood, but not to withstand multiple stresses later in life. Reducing the global burden of kidney disease in future generations will require both individual‐ and population/environment‐level risks to be addressed.

Adverse Impact of Environmental Chemicals on Developmental Origins of Kidney Disease and Hypertension.

Chronic kidney disease (CKD) and hypertension are becoming a global health challenge, despite developments in pharmacotherapy. Both diseases can begin in early life by so-called “developmental origins of health and disease” (DOHaD). Environmental chemical exposure during pregnancy can affect kidney development, resulting in renal programming. Here, we focus on environmental chemicals that pregnant mothers are likely to be exposed, including dioxins, bisphenol A (BPA), phthalates, per- and polyfluoroalkyl substances (PFAS), polycyclic aromatic hydrocarbons (PAH), heavy metals, and air pollution. We summarize current human evidence and animal models that supports the link between prenatal exposure to environmental chemicals and developmental origins of kidney disease and hypertension, with an emphasis on common mechanisms. These include oxidative stress, renin-angiotensin system, reduced nephron numbers, and aryl hydrocarbon receptor signaling pathway. Urgent action is required to identify toxic chemicals in the environment, avoid harmful chemicals exposure during pregnancy and lactation, and continue to discover other potentially harmful chemicals. Innovation is also needed to identify kidney disease and hypertension in the earliest stage, as well as translating effective reprogramming interventions from animal studies into clinical practice. Toward DOHaD approach, prohibiting toxic chemical exposure and better understanding of underlying mechanisms, we have the potential to reduce global burden of kidney disease and hypertension.

POS-819 BARRIERS AND FACILITATORS TO NEPHROLOGIST PARTICIPATION IN CLINICAL TRIALS RESEARCH: AN ISN-ACT SURVEY

Despite the high global burden of kidney disease, nephrology lags behind other medical disciplines in the availability of high-quality randomised controlled trials. In 2018, the International Society of Nephrology (ISN) surveyed nephrologists to better understand barriers to trial participation and identify potential areas for support. An online survey was developed by the ISN Advancing Clinical Trials (ISN-ACT) Group and emailed to 549 members across the 10 ISN regions between September and December 2018. Respondents were asked to indicate the extent to which different aspects of trial development and conduct were a barrier to their participation. Twenty-seven Likert items were grouped into five broad areas where barriers might arise: knowledge, time, research infrastructure, financial costs and patient factors. For the three most commonly reported barriers, associations between respondent characteristics and the perceived importance of the barrier were assessed using a Mann-Whitney test. Respondents were also asked to rate how valuable different activities would be in increasing their ability to participate in trials. The survey response rate was 32% (n = 177 respondents), of whom 137 responded to questions related to barriers to trial participation and were included in the analysis. There was at least one respondent from each of the 10 ISN regions, with 53 countries represented. One-fifth of respondents came from India. While 97% of respondents indicated an interest in RCTs, only 57% had dedicated time for research and 74% had previous trial experience. The most common barriers to participation was lack of funding opportunities (74% of respondents), financial compensation of research staff (55%) and time needed to manage research finances (45%). Individuals with no prior trial experience were more likely to report a lack of funding and staff remuneration as barriers to their participation (p-value < 0.0001 for both). Though knowledge was rarely reported a barrier to trial participation, 81-87% of respondents indicated that training in the design or conduct of clinicals trials would be highly or moderately valuable. Eighty percent of respondents deemed mentoring by a senior investigator to be valuable, while 85% reported that assistance with ethical and regulatory approval would be of use. Our survey findings suggest that funding is a major barrier to trial participation. Further work is necessary to understand the best ways to support individuals in engaging in trials research.

Prevalence of abnormal kidney function in a rural population of Benin and associated risk factors

BackgroundThe global burden of kidney disease has increased in recent years worldwide. Risk factors for kidney disease are common in Africa, but data on their prevalence are lacking. This study aims to determine the prevalence of abnormal kidney function and associated factors among participants included in the TAnve HEalth Study (TAHES) cohort in Benin.MethodsThis was a cross-sectional study nested within the TAHES cohort. It was carried out in 2019, among TAHES participants aged 25 years and above, living in Tanvè and Dékanmè, two villages located in southwestern Benin. Data on risk factors were collected using the World Health Organization’s STEPS questionnaire. Anthropometric measurements and capillary creatinine measurements were performed. Abnormal kidney function was defined as a low glomerular filtration rate (< 60 mL/min/1.73 m2).ResultsCreatinine was measured among 1360 out of the 1583 participants in the cohort in 2019. The median age was 39 [32–53]. The prevalence of abnormal kidney function was 16.10%; 95%CI = [14.15–18.05]. The results of the multivariate logistic regression showed that the probability of abnormal kidney function increased significantly with age (adjusted OR (aOR) = 2.75; 95%CI = [1.83–4.14]), female gender (aOR = 2; 95%CI = [1.37–2.91]), hypertension (aOR = 1.54; 95%CI = [1.12–2.13]), high body mass index (aOR = 1, 56; 95%CI = [1.12–2.17]) and hyperglycemia (aOR = 2.86; 95%CI = [1.68–4.88]).ConclusionThe prevalence of abnormal kidney function was high. These data should guide national authorities and help to raise community awareness of the benefits of early detection of this condition.

Sustainable Development Goals relevant to kidney health: an update on progress.

Globally, more than 5 million people die annually from lack of access to critical treatments for kidney disease — by 2040, chronic kidney disease is projected to be the fifth leading cause of death worldwide. Kidney diseases are particularly challenging to tackle because they are pathologically diverse and are often asymptomatic. As such, kidney disease is often diagnosed late, and the global burden of kidney disease continues to be underappreciated. When kidney disease is not detected and treated early, patient care requires specialized resources that drive up cost, place many people at risk of catastrophic health expenditure and pose high opportunity costs for health systems. Prevention of kidney disease is highly cost-effective but requires a multisectoral holistic approach. Each Sustainable Development Goal (SDG) has the potential to impact kidney disease risk or improve early diagnosis and treatment, and thus reduce the need for high-cost care. All countries have agreed to strive to achieve the SDGs, but progress is disjointed and uneven among and within countries. The six SDG Transformations framework can be used to examine SDGs with relevance to kidney health that require attention and reveal inter-linkages among the SDGs that should accelerate progress.

The global burden of kidney disease

The global burden of kidney disease

Estimates of the 2016 global burden of kidney disease attributable to ambient fine particulate matter air pollution

ObjectiveTo quantitate the 2016 global and national burden of chronic kidney disease (CKD) attributable to ambient fine particulate matter air pollution ≤ 2.5 μm in aerodynamic diameter (PM2.5).DesignWe used the...

How can we make renal medicine careers more appealing to UK trainees?

BackgroundThere is a global decline in interest in careers in renal medicine. This is concerning given the increasing global burden of kidney disease. Previous studies in the USA and Australia have identified factors such as a poor work–life balance, lack of role models and the challenging nature of the speciality as possible reasons behind recruitment struggles. This study aimed to identify factors associated with declining interest among trainees in the UK.Methods We conducted a survey of 150 National Health Service Foundation trainees (interns) and Core Medical Trainees in Health Education West Midlands. Participants completed a 14-part paper-based questionnaire capturing data on trainee demographics, medical school and postgraduate exposure to renal medicine and perceptions of a career in renal medicine.Results There was limited early clinical exposure to renal medicine both in terms of time spent in the speciality and perceived exposure to the range of domains of the speciality. Trainees perceived the speciality as complex with a heavy workload. Very few trainees considered the speciality to be lifestyle oriented. There was also disinterest in taking on the associated general medicine commitments of the training programme. Job experience and identification of role models increased the likelihood of consideration of the speciality.Conclusion This survey has identified key areas to drive interest in the speciality, including early engagement, enthusiastic supervision and increased training flexibility. Urgent attention is required to address these areas and make renal medicine careers more appealing.

The global burden of kidney disease and the sustainable development goals

Kidney disease has been described as the most neglected chronic disease. Reliable estimates of the global burden of kidney disease require more population-based studies, but specific risks occur across the socioeconomic spectrum from poverty to affluence, from malnutrition to obesity, in agrarian to post-industrial settings, and along the life course from newborns to older people. A range of communicable and noncommunicable diseases result in renal complications and many people who have kidney disease lack access to care. The causes, consequences and costs of kidney diseases have implications for public health policy in all countries. The risks of kidney disease are also influenced by ethnicity, gender, location and lifestyle. Increasing economic and health disparities, migration, demographic transition, unsafe working conditions and environmental threats, natural disasters and pollution may thwart attempts to reduce the morbidity and mortality from kidney disease. A multisectoral approach is needed to tackle the global burden of kidney disease. The sustainable development goals (SDGs) emphasize the importance of a multisectoral approach to health. We map the actions towards achieving all of the SDGs that have the potential to improve understanding, measurement, prevention and treatment of kidney disease in all age groups. These actions can also foster treatment innovations and reduce the burden of such disease in future generations.

Chronic kidney disease: Low birth weight and the global burden of kidney disease.

Low birth weight (LBW) and intrauterine growth restriction are major contributors to the global burden of non-communicable diseases. A Norwegian registry study has confirmed that LBW is associated with an increased risk of developing end-stage renal disease by 40 years of age, which could not be explained by familial factors.

Kidney disease among children in sub-Saharan Africa: systematic review.

The global burden of kidney disease is increasing, and several etiologies first begin in childhood. Risk factors for pediatric kidney disease are common in Africa, but data regarding its prevalence are lacking. We completed a systematic review of community-based studies describing the prevalence of proteinuria, hematuria, abnormal imaging, or kidney dysfunction among children in sub-Saharan Africa (SSA). Medline and Embase were searched. Five hundred twenty-three references were reviewed. Thirty-two references from nine countries in SSA were included in the qualitative synthesis. The degree of kidney damage and abnormal imaging varied widely: proteinuria 32.5% (2.2-56.0%), hematuria 31.1% (0.6-67.0%), hydronephrosis 11.3% (0.0-38.0%), hydroureter 7.5% (0.0-26.4%), and major kidney abnormalities 0.1% (0.0-0.8%). Serum creatinine was reported in four studies with insufficient detail to identify the prevalence renal dysfunction. A majority of the studies were performed in Schistosoma haematobium endemic areas. A lower prevalence of kidney disease was observed in the few studies from nonendemic areas. Published data on pediatric kidney disease in SSA are highly variable and dependent on S. haematobium prevalence. More community-based studies are needed to describe the burden of pediatric kidney disease, particularly in regions where S. haematobium infection is nonendemic.