Public health consequences of chronic kidney disease

Abstract

With its rising incidence and prevalence, chronic kidney disease (CKD) is a major public health concern, both in the United States and worldwide. Recent worldwide initiatives have attempted to garner attention for CKD by emphasizing that the condition is "common, harmful, and treatable." In the United States, as many as 26 million adults may have CKD, an increase from approximately 10% of the US adult population between 1988 and 1994 to >13% just one decade later. Similar rates have been seen worldwide, with a CKD prevalence of 13% in Beijing, China and 16% in Australia. In the United States, the dramatic rise in the prevalence of CKD likely reflects similar increases in obesity and its sequelae-namely, diabetes, hypertension, and cardiovascular disease. The prevalence of CKD, as well as its associated costs, is expected to continue to increase.

Figure 1

Concept diagram illustrating the effect of altering the rate of kidney disease progression in individuals with CKD. The base cases are patients with diabetic nephropathy, where the rate of GFR decline may be 10 mL/min per 1.73m² annually in the absence of treatment but can be slowed to 5 mL/min per 1.73m² annually with treatment. Two hypothetical patients are presented – one whose diabetic kidney disease was detected at a GFR of 90 and the other whose diabetic kidney disease was detected at a GFR of 60 mL/min per 1.73m². The light blue line illustrates expected age related decline in older individuals with normal kidney function.