The Global Burden of Chronic Kidney Disease and the Way Forward

Chronic kidney disease (CKD) is increasing worldwide at an annual growth rate of 8%. Regional differences exist in the epidemiology of the condition, and non-Whites are more affected. An English-language literature search using Medline (January 1984-October 2003) was done to assess research/review articles on burden and prevention of CKD. Particular attention was paid to epidemiology and prevention of chronic kidney diseases. The prevalence of CKD is higher in developing countries than in the developed world. The most common causes of CKD in the developing countries are chronic glomerulonephritis and systemic hypertension, diabetic nephropathy being the most common cause in Europe, the United States, and Japan. Factors contributing to the regional differences in the etiology and prevalence of CKD are race and ethnicity, genetic predisposition, increasing prevalence of type 2 diabetes, mortality caused by other disease, obesity, and possibly cigarette smoking. The control of hypertension, dyslipidemia, proteinuria, obesity, avoidance of low birth weight, smoking, and preventing ingesting of heavy metals such as lead are intervention strategies that retard or prevent progression of renal diseases. The magnitude of the existing burden of illness caused by renal failure, the projections for increasing incidence of CKD, and the limitations of our existing treatments for renal insufficiency all point to the need for clinical and population-based interventions aimed at prevention of CKD. A comprehensive health education campaign and screening of the general populace are needed in order to detect chronic kidney disease early. These measures will ensure appropriate and timely institution of proven measures to halt or reduce progression of CKD.