Chronic kidney disease disproportionally affects younger people in low and middle-income countries. Image: REUTERS/Ueslei Marcelino.
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- Chronic kidney disease affects approximately 700 million people around the world.
- Without investment in early detection, the cost of kidney failure will continue to spiral.
- Here are four steps to alleviate the growing pressure on health systems.
Approximately 700 million people worldwide live with chronic kidney disease (CKD) – that’s equivalent to the population of Europe. It is a silent disease in its early stages, contributing to the unacceptably low diagnosis rates. CKD is a progressive disease and it’s divided into five stages based on the level of kidney function – stage 1 indicates normal kidney function to stage 5 kidney failure.
If left untreated, the majority of patients with CKD will die from cardiovascular disease before kidney failure which requires dialysis or transplant. When CKD progresses to kidney failure, it results in significant burden to healthcare expenditures. Many developed countries spend 2-3% of their annual healthcare budget on the treatment of kidney failure, even though those receiving such treatment represent less than 0.1% of the global population.
The impact of kidney failure on patients and their families is brutal. Patients undergoing dialysis will sit on a chair three times a week for sessions that last roughly four hours and many face temporary or permanent loss of earned income. In low and middle-income countries, CKD disproportionately affects younger people, meaning that premature mortality resulting from a lack of access to dialysis may also reduce the labour force and drive household poverty.
Yet, despite this, CKD is rarely prioritized by decision makers. The Global Kidney Health Atlas 2019 found that most countries did not have a national strategy for improving CKD care. We urgently need effective strategies for prevention, early identification and effective management which could slow progression of CKD in high-risk patients, reduce the risk of cardiovascular death and the financial burden incurred by health systems.
At AstraZeneca, we stand with the kidney community. Through our partnerships with the International Society of Nephrology (ISN), regional and local scientific associations, patient advocacy groups, and our efforts to support health care providers to more effectively diagnose and treat CKD, we are providing the necessary tools to reinforce earlier detection and intervention.
World Kidney Day: time to rethink our approach
This year’s World Kidney Day also marks exactly one year since the COVID-19 outbreak was declared a pandemic by the World Health Organisation – a timely moment to stop and reflect on how the virus has impacted those at risk and living with CKD and the sustainability and resilience of the health systems that support them.
CKD is the most prevalent risk factor for severe complications from the virus, and with approximately 20-30% of patients hospitalised with COVID-19 developing kidney failure, hospitals are struggling to meet the demand for dialysis.
Given the enormous costs of dialysis, there is a substantial economic rationale for early CKD detection. And there is no better time to take action than now amidst the pandemic.
What is the World Economic Forum doing about healthcare value and spending?
Where do we start?
1. Setting clear targets and measuring progress
Governments need to set up a clear goal to reduce the number of patients developing kidney failure and establish a national strategy for improving CKD care. To measure progress, patient registries and development of quality indicators across all stages of CKD are imperative to a successful outcome.
2. Investing in prevention and early detection
CKD can be detected using two simple and inexpensive tests (blood and urine) and patients at risk should be part of early detection programmes for CKD which have been found to be cost-effective. People with diabetes, hypertension, heart disease and family history are at increased risk for developing CKD and depending on the region, it may also be important to consider comorbidities, environmental exposures or genetic risk factors. Yet, currently, only 3% of healthcare expenditure goes to prevention – of which only 20% is spent on early diagnosis.
3. Empowering primary care physicians
With a global shortage of healthcare professionals specializing in CKD care, empowering primary care physicians and developing effective multidisciplinary teams to play a greater role in early detection and management can help reduce the burden on hospitals and health systems.
4. Harnessing the potential of digital health solutions
Technology is another way to ease the strain, while increasing access to care for patients – particularly those in remote areas. Underpinning all of this is a need for continued collaboration and innovation. For example, new diagnostic tests that allow people to measure kidney function from home could reduce the need for visits to the doctor’s office, while allowing patients to take a more active role in their health.
CKD is the perfect example of health systems’ failure to act early when the disease is treatable at much lower cost and with much better outcomes. Kidney failure challenges the sustainability of the health system and it leads to deteriorating health which exposes patients to other diseases such as COVID-19. The socio-economic implications of CKD have been underestimated and investment in prevention and early detection is paramount to tackle this growing burden.
Meaningful improvements require deeper collaboration with patient communities, clinicians, policymakers and industry to ensure we have the right policies and solutions in place. With public and private partnerships, we now have a real opportunity within CKD to shift our focus to build more sustainable and resilient health systems.
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The views expressed in this article are those of the author alone and not the World Economic Forum.
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