Preventing CKD in Developed Countries

Abstract

Chronic kidney disease (CKD) is an important public health concern in developed countries because of both the number of people affected and the high cost of care when prevention strategies are not effectively implemented. Prevention should start at the governance level with the institution of multisectoral polices supporting sustainable development goals and ensuring safe and healthy environments. Primordial prevention of CKD can be achieved through implementation of measures to ensure healthy fetal (kidney) development. Public health strategies to prevent diabetes, hypertension, and obesity as risk factors for CKD are important. These approaches are cost-effective and reduce the overall noncommunicable disease burden. Strategies to prevent nontraditional CKD risk factors, including nephrotoxin exposure, kidney stones, infections, environmental exposures, and acute kidney injury (AKI), need to be tailored to local needs and epidemiology. Early diagnosis and treatment of CKD risk factors such as diabetes, obesity, and hypertension are key for primary prevention of CKD. CKD tends to occur more frequently and to progress more rapidly among indigenous, minority, and socioeconomically disadvantaged populations. Special attention is required to meet the CKD prevention needs of these populations. Effective secondary prevention of CKD relies on screening of individuals at risk to detect and treat CKD early, using established and emerging strategies. Within high-income countries, barriers to accessing effective CKD therapies must be recognized, and public health strategies must be developed to overcome these obstacles, including training and support at the primary care level to identify individuals at risk of CKD, and appropriately implement clinical practice guidelines.

Keywords: chronic kidney disease; multisectoral approach; prevention; public health; risk factors.

Figure 1

Illustration of the spectrum of strategies for chronic kidney disease (CKD) prevention across the life course. *Primordial prevention refers to strategies to optimize upstream factors which may lead to increased risk of CKD at an individual or population level. AKI, acute kidney injury; ANC, ante-natal care; BMI, body mass index; BP, blood pressure;CVD, cardiovascular disease; DM, diabetes mellitus; GFR, glomerular filtration rate; HT, hypertension; ICU, intensive care unit; LBW, low birth weight; SDGs, Sustainable Development Goals; SGA, small for gestational age at birth; UHC, Universal Health Coverage.

Figure 2

Highlighting the importance of public health strategies and advocacy for the prevention of chronic kidney disease. AKI, acute kidney injury. Images reproduced with permission from World Kidney Day. Copyright ©World Kidney Day 2006–2020.