John Stanifer and colleagues at a World Kidney Day screening event in Moshi, Tanzania, in 2014.
Published March 8, 2016, last updated on April 20, 2016 under Research News
Commentary John W. Stanifer, MD, MSc-GH
On March 10, the International Society of Nephrology is celebrating the 11th annual World Kidney Day. This day of recognition was founded to raise awareness about kidney disease worldwide, and every year, individuals and organizations celebrate the day through screening campaigns, fundraising and educational events and many more activities.
This year’s World Kidney Day slogan is “Move Your Feet for World Kidney Day.” In addition to highlighting the risks and burden of kidney disease worldwide, this theme emphasizes the importance of the kidneys as vital organs that should be cared for through conscientious lifestyle choices.
The Growing Burden of Kidney Disease
Kidney disease contributes significantly to the global burden of disease; chronic kidney disease (CKD) now ranks 19th highest cause of death worldwide—an 82 percent increase since 1990. And in many low- and middle-income countries (LMICs), the annual death rate attributed to CKD is growing at more than five percent per year. Currently, 80 percent of people with CKD live in LMICs.
However, despite these striking statistics, kidney disease is given relatively low priority within the public health response to the growing non-communicable disease (NCD) burden in LMICs.
Annual percentage change per country in deaths attributed to chronic kidney disease from 1990 to 2013.
Source: Institute for Health Metrics and Evaluation, University of Washington.
Chronic Kidney Disease Is Unique among NCDs
The World Health Organization’s Global Action Plan for the Prevention and Control of NCDs stated that “conditions such as kidney disease result from lack of early detection and management of hypertension and diabetes … and kidney disease should be addressed through a common response to other major NCDs.”
However, CKD is unique and complex. Its mere status as an NCD does not fully capture its heterogeneous causes, which extend far beyond diabetes and hypertension to ailments such as HIV, tuberculosis, malaria, Hepatitis B and C and parasitic diseases. Use of traditional medicines and counterfeit drugs, as well as exposure to agricultural pesticides, industrial waste products and heavy metals also increase the risk of developing CKD.
Public health agendas geared toward addressing and preventing CKD in LMICs do not adequately account for this wide diversity of disease origin.
Public Health Efforts Must Reach beyond Hypertension and Diabetes
In many LMICs, rapid urbanization has led to densely crowded cities with unplanned infrastructure, heavy environmental pollution and poor sanitation and waste disposal. As a result, a growing number of people live in settings where numerous risk factors from environmental toxins, high infectious disease burdens, and increasing rates of NCDs—including hypertension and diabetes—are all juxtaposed, rendering these populations especially vulnerable to CKD.
In fact, hypertension and diabetes were actually responsible for fewer than half of the worldwide deaths attributed to CKD in 2010. Therefore, while addressing NCDs such as hypertension and diabetes will be a critical component of the public health response to CKD in LMICs, this effort alone is not sufficient. The prevention and treatment of CKD will require a broader and more nuanced approach than an NCD Action Plan targeting hypertension and diabetes.
Because of the range of causes associated with CKD, a better understanding of the epidemiology of kidney disease is urgently needed in order to raise awareness and global priority. Accordingly, the public health response needs to be multi-faceted and multi-disciplinary, addressing environmental, communicable, and non-communicable risk factors with a particular focus on the process of urbanization.
Much work is ahead of us, but on March 10, World Kidney Day, let’s get out and move our feet!
John Stanifer, a nephrology fellow at Duke, is a 2014 graduate of the Duke Master of Science in Global Health program. He recently co-authored an article, “Chronic Kidney Disease in Low- and Middle-Income Countries,” in Nephrology Dialysis Transplantation with Duke Global Health Institute colleagues Tazeen Jafar and Uptal Patel, along with Anthony Muiru from Massachusetts General Hospital in Boston, Massachusetts.
A better understanding of the epidemiology of kidney disease is urgently needed in order to raise awareness and global priority.
