One in 10 people worldwide have chronic kidney disease, but there are huge knowledge gaps, a new report shows

Australia ranks 12th among high income countries, with around 13% of Australian adults having chronic kidney disease, although around 90% are thought to be unaware they have the condition.

A new global report, The Global Kidney Health Atlas, is being presented at this week’s World Congress of Nephrology in Mexico City. Compiled by the International Society of Nephrology and kidney health experts worldwide, it highlights “huge” gaps in kidney disease care and prevention in both developed and developing countries.

One in three people in the general population is at increased risk of CKD.

Among high-income countries, Saudi Arabia and Belgium have the highest estimated CKD prevalence (24%), followed by Poland (18%), Germany (17%) and the UK and Singapore (16%). Norway and the Netherlands have the lowest estimates at 5%.

The USA’s estimated prevalence is 14%, while Canada and Australia are on 13%. Globally, estimated CKD prevalence worldwide varies from 7% in South Asia and 8% in Africa to as high as 11% in North America and 12% in Europe, The Middle East, and East Asia, and Latin America.

IWorldwide, an estimated million people die each year from untreated kidney failure and those with the condition are up to 20 times more likely to die of other causes (largely cardiovascular diseases such as heart attack or stroke) before they reach the point of dialysis or transplant care.

Adeera Levin, President of the International Society of Nephrology which produced the Atlas, and a Professor of Medicine at the University of British Colombia, Vancouver, BC, Canada, says it is vital that all countries improve their rates of early diagnosis and treatment.

“However, our Atlas shows that, across countries of all incomes, many governments are not making kidney disease a priority. This makes no sense, as the costs for treating people with end stage kidney disease are enormous, along with the devastating effect it has on patients and their families.”

The Atlas highlights this low priority in many settings. For example, although only one to two in every 1000 people (0.1-0.2%) in high-income countries receives dialysis or transplantation, these services use up 2-3% of the total health budget in those countries.

For every one person living on dialysis or kidney transplant, there are as many as 100 people with an earlier stage of CKD that if appropriately identified and treated might have their risk of progressing to kidney failure and/or development of CVD mitigated.

Although high-income countries like Australia have the highest costs for dialysis and transplantation, only one in three (29%) considered CKD a priority, compared with almost two in three (59%) low income countries.

Experts in Australia, Canada, the USA, and New Zealand said their governments were not considering CKD a priority, yet low-income countries such as Burkina Faso, Ethiopia and Nepal were among those that despite poverty and poor healthcare systems, recognised CKD as a priority.

“A general lack of awareness of CKD, among patients and family doctors alike, and a lack of symptoms in the early stages, means that kidney function is usually hugely reduced by the time symptoms arise,” says Professor David Johnson, co-chair of the Global Kidney Health Atlas, and Professor of Medicine and Population Health at the University of Queensland, Brisbane, and Director of Queensland Renal Transplant Services, Australia.

Simple lifestyle advice including a healthy diet low in salt and high in fibre, more physical activity, stopping smoking, and good control of diabetes and high blood pressure if present can slow the rate of progression of CKD by up to 50% and in some cases reverse damage.

 

Some key findings from the Atlas include:

  • CKD prevalence worldwide varies from 7% in South Asia and 8% in Africa to as high as 11% in North America and 12% in Europe, The Middle East, and East Asia, and Latin America.
  • The global silent epidemic of CKD can only grow, since risk factors such as obesity, diabetes, smoking and high blood pressure continue to grow in many regions.
  • Availability of dialysis and transplantation therapy varied by almost 1000-fold worldwide, with treatment rates from 2.8 per million population in Rwanda to over 2000 per million in Japan,
  • High-risk ethnic groups had the lowest screening rates of any high-risk populations for CKD, even in high-income countries, where just one quarter are screened.
  • Just over one third (36%) of countries that provided information for the Atlas recognised CKD as a health priority. Unusually for a chronic disease, more low-income countries (59%) and lower-middle income countries (50%) recognised CKD as a health priority than HIC (29%) or upper-middle income countries (17%).
  • Less than a quarter (24%) of all countries reported an active CKD detection program. This means active screening of those at high risk through specific screening processes, and active screening of population at-risk through routine health encounters. For HIC, the figure was higher (32%) while only one LIC (6%)—Togo—had such a program.
  • Apart from Germany and the Netherlands, all countries included in the Atlas reported  nephrology workforce shortages, whether nephrologists, specialist nurses and health workers, or all of these. Unsurprisingly 9 of 10 countries with the lowest density of nephrologists were in Africa. Lithuania and Taiwan had the highest density of nephrologists worldwide; and Malawi and Mozambique the lowest. In Western Europe, Spain had the highest nephrologist density and the UK the lowest.
  • Lack of awareness of CKD among primary care physicians was highlighted as a major problem in the fight against CKD, even in HIC, where two thirds of primary care physicians were rated as having extremely low (8%) or low/below average (58%) awareness of the condition.
  • Data from the USA renal Data System shows spending on all CKD rose from $US 41.2 billion in 2010 to 50.4 billion in 2014, a 22% increase in cost. This amount exceeds the entire national budgets of many developing nations. 

A summary of the Atlas is being published in the Journal of the American Medical Association (JAMA); and a roadmap to improving kidney care will also be published in The Lancet.