Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney

Abstract

A brief comprehensive overview is provided of the elements constituting the burden of kidney disease [chronic kidney disease (CKD) and acute kidney injury]. This publication can be used for advocacy, emphasizing the importance and urgency of reducing this heavy and rapidly growing burden. Kidney diseases contribute to significant physical limitations, loss of quality of life, emotional and cognitive disorders, social isolation and premature death. CKD affects close to 100 million Europeans, with 300 million being at risk, and is projected to become the fifth cause of worldwide death by 2040. Kidney disease also imposes financial burdens, given the costs of accessing healthcare and inability to work. The extrapolated annual cost of all CKD is at least as high as that for cancer or diabetes. In addition, dialysis treatment of kidney diseases imposes environmental burdens by necessitating high energy and water consumption and producing plastic waste. Acute kidney injury is associated with further increases in global morbidity, mortality and economic burden. Yet investment in research for treatment of kidney disease lags behind that of other diseases. This publication is a call for European investment in research for kidney health. The innovations generated should mirror the successful European Union actions against cancer over the last 30 years. It is also a plea to nephrology professionals, patients and their families, caregivers and kidney health advocacy organizations to draw, during the Decade of the Kidney (2020-30), the attention of authorities to realize changes in understanding, research and treatment of kidney disease.

Keywords: acute kidney injury; chronic kidney disease; dialysis; environment; epidemiology; health economy; kidney transplantation; mortality; non-communicable diseases; peritoneal dialysis.

FIGURE 1:

Relationship between other diseases and CKD. The arrows indicate the direction of the interaction. With some diseases, the link is bidirectional. Several of these conditions also have mutual links on their own (e.g. diabetes mellitus and cardiovascular disease), but this is not represented.

FIGURE 2:

Percent 5-year survival of kidney replacement treatment modalities (red bars) (HD, PD, transplantation after deceased donation and transplantation after living donation) or 5 years after the diagnosis of cancer (blue bars). Only malignancies with an incidence >3% of all cancers are illustrated. Orange bar: all cancers aggregated. Based on 2016 data [40, 41].

FIGURE 3:

Comparative burden of selected diseases in the EU. (A) Prevalence numbers 2019. Bars reflect prevalence in million persons. (B) Changes in age-standardized mortality rates. Bars and numeric labels at the bars reflect percentage changes in age-standardized mortality rates between 1990 and 2019. CKD in orange. Source: Global Burden of Disease Study. Data available at https://vizhub.healthdata.org/gbd-compare/.

FIGURE 4:

Comparison of aggregated annual healthcare costs for Europe of cancer (yellow), diabetes mellitus (pink) and CKD. Costs of CKD (increasingly dark blue for each of the successive stages) are a composite of early CKD (Stages 1–2 not on dialysis or living with a functioning transplant), more advanced stages of CKD (Stages 3–5 not on dialysis or living with a functioning transplant), transplantation and dialysis. Sources and approaches for calculation: see Supplementary data.

FIGURE 5:

Country-level score card on availability of kidney care services across Europe comparing data from the ISN-GKHA for the year 2019. Central and Eastern Europe (above) and Western Europe (below). Available services: green; unavailable services: red; N/A: not available. Funding for medications: public funding that is free at the point of delivery exclusive of private medical insurance or other sources. Advocacy group: organizations or foundations advocating the case of kidney disease at national or regional level. Nephrology workforce: total number of nephrologists and trainees in nephrology in a country per million population. Source: GKHA (https://www.theisn.org/initiatives/global-kidney-health-atlas/).