By Bethany Baumann, PhD Student
Cover Photo by Hey Paul Studios
An estimated 8-16% of the world population suffers from chronic kidney disease, a progressive failing of the kidneys1. Does this statistic surprise you? Many people are unaware of the prevalence and toll of this disease, and likewise, many people are unaware that they have it. The goal of World Kidney Day this March 13th is to raise awareness of chronic kidney disease (CKD). Events in over 150 countries are planned to encourage screenings and preventative behaviors in high-risk populations and emphasize the role of medical professionals and local and national health authorities in controlling the CKD epidemic.
What is CKD?
Kidneys filter blood plasma to form urine, removing waste products and toxins, while retaining proteins and healthy metabolites. A glomerulus is a part of the kidney where the first steps of filtration occur. In an average-sized healthy adult the glomerular filtration rate (GFR) is >90ml/min. CKD is defined as a GFR of <60. Depending on cause and severity of disease, progression may occur over years or decades, until kidney failure occurs when GFR approaches 15. When CKD is detected early, interventions such as blood pressure control and dietary changes can slow or stabilize disease progression2. However, CKD is often not diagnosed until the emergence of serious symptoms, or never diagnosed at all. Awareness and proactivity can decrease many of the patient health and financial tolls associated with this disease.
What are the risk factors for CKD?
People with diabetes, hypertension, and cardiovascular disease are at risk for CKD. One in three people with diabetes, and one in five with hypertension have CKD. Aging is also a risk factor, with those over 50 at increased risk3. These groups represent a large – and growing – proportion of the population in many countries. HIV infection predisposes patients to CKD (6-fold increased risk), which may be due to the virus itself or nephrotoxic effects of long-term antiretroviral drug regimens4. Certain bacterial infections, consumption of polluted or unclean water, and some herbs used in traditional medicine (particularly those containing aristolochic acid) are also risk factors for CKD. Family history should be considered, as there are genetic causes of CKD1,2.
What are the complications of CKD?
Beyond providing filtration, kidneys are dynamic organs with roles in metabolism and endocrine signaling that function to maintain a healthy blood composition and volume. It is not surprising that decreased kidney function has severe health consequences throughout the body. A primary concern is increased risk for cardiovascular disease. CKD doubles the risk of dying from a cardiovascular event2,5. CKD patients are also at increased risk for malnutrition, infection, cognitive impairments, anemia (low red-blood cell count), blood acidosis, edema (swelling), and mineral disorders affecting bone2,3. Because the kidneys excrete drugs, errors in drug dosing are common in patients with undiagnosed CKD, and can result in toxicity3. When GFR reaches 15, patients require life-long dialysis treatments or kidney transplantation.
What are barriers to care of CKD?
To start, awareness of CKD is surprisingly low. In the United States a health screening program (Kidney Early Evaluation Program) of ~90,000 adults from populations at high-risk for CKD found a CKD awareness rate of only 8.1%, despite a CKD prevalence rate of 26.3%6. Of patients with stage 4-5 CKD (stage 5 is end-stage), only 30% had ever seen a nephrologist. Awareness rates in other countries also remain low1. It is imperative to raise motivation for a healthy lifestyle, and access to treatment for contributing conditions like high blood pressure and diabetes. These interventions are much more cost-effective and non-invasive than treatments for later-stage CKD.
Complications due to advanced CKD and renal failure are very expensive to patients and health-care systems. Treatment of chronic and end-stage renal disease patients totaled 24% of the 2013 Medicare Budget. A Medicare CKD patient’s cost is over twice that of a non-CKD patient5. Dialysis, where an artificial filter is used to clean the blood, is an expensive and time-consuming procedure. The 3-per-week sessions can last 4 hours, which limits ability to work. Approximately 80% of the world’s dialysis patients live in the US, Europe or Japan7. In other regions where dialysis is available, the cost may be prohibitive for many. Estimated annual cost of dialysis per patient is US$7500 in China and US$5000 in India7. Kidney transplantation is even more expensive and limited in access than dialysis. Many organizations such as ISN and IFKF (both founders of World Kidney day), KDIGO, and The Transplantation Society are working on initiatives toward bringing global equality to the prevention and care of CKD.
World Kidney Day events in Chicago
Visit the World Kidney Day site to find events in your area!
National Kidney Foundation of Illinois and John H. Stroger, Jr. Hospital of Cook County
John H. Stroger, Jr. Hospital of Cook County (Cafeteria, 1969 W. Ogden Ave) 10am – 3:30pm
- FREE health screenings for diabetes, high blood pressure and kidney disease
- Talk about your results with a doctor or nurse
- Healthy lifestyle and kidney disease prevention resources
Fresenius Medical Care and Chef Aaron McCargo, Jr.
Fresenius Medical Care South Chicago (9200 S. Chicago Ave.) 1pm – 3pm
Chef Aaron McCargo, Jr., sponsored by Fresenius Medical Care North America (FMCNA), is embarking on a tour of four U.S. cities during March in recognition of National Kidney Month. McCargo will share kidney-friendly cooking tips, food samples and recipes with dialysis patients and their families at two Chicago FMCNA dialysis clinics. He also will unveil a recipe he created for Chicago food enthusiasts, influenced by the region’s own cuisine.
1) Jha V. et. al. (2013). Chronic kidney disease: global dimension and perspectives. Lancet, 342, 260-72.
2) KDIGO (2012). CKD evaluation and management guidelines. Retrieved from: http://kdigo.org/home/guidelines/ckd-evaluation-management/
3) CDC (2014). National Chronic Kidney Disease Fact Sheet. Retrieved from: http://www.cdc.gov/diabetes/pubs/factsheets/kidney.htm
4) Remuzzi G. et. al. (2013). Kidney failure: aims for the next 10 years and barriers to success. Lancet, 382, 353-62.
5) USRS (2013). Atlas of CKD. Retrieved from: http://www.usrds.org/2013/view/Default.aspx
6) Vassaloti J. et. al. (2010). Kidney early evaluation program: a community based screening approach to address disparities in chronic kidney disease. Seminars in Nephrology, 30(1), 66-73.
7) White S. et. al. (2008). How can we achieve global equity in provision of renal replacement therapy? Bulletin of the World Health Organization, 86(3), 161-240.