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

Abstract

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.

Fig. 1. Multiple structural factors influence kidney health in children.

Conditions experienced during fetal life and early childhood affect the physical and psychosocial development of children. The effects of these conditions persist throughout the life course and influence an individual’s future health and that of their children. Achievement of the Sustainable Development Goals (SDGs) is urgent to enable each child to maximize their own capabilities and to improve the health of future generations. Poverty has an overarching impact on child health and well-being. Children require a safe home and school environment, access to healthy food, good education, freedom from forced labour and access to recreational time and space to thrive and grow up healthy. Moreover, healthy and educated mothers have healthier children.

Fig. 2. Availability of resources to detect kidney disease at primary, secondary or tertiary care levels across country income categories.

Spider diagrams illustrating the relative availability of services required to screen for and detect kidney disease at primary (a) and secondary or tertiary (b) care levels. Each concentric dodecagon reflects the proportion of countries within a specific income bracket (line colour) in which the given screening and/or diagnostic tool was available, beginning with 0% in the centre and 100% as the outermost line. Some important resources such as reporting of the estimated glomerular filtration rate (eGFR) and quantification of urinary protein were absent in low-income countries, which demonstrates marked global inequities in access to basic quality screening for kidney disease. UACR, urinary albumin-to-creatinine ratio; UPCR, urinary protein-to-creatinine ratio; HbA_1c, glycated haemoglobin. Adapted from ref., Elsevier.