Kidney disease should be a global priority for health policy worldwide. Is that worth even needing to persuade the NephJC readers? Duh! Just click on this link and sign the petition organized by the International Society of Nephrology (ISN). It takes less than a minute, we promise.
Is Kidney Disease so important to be a global health priority?
OK, for the skeptics out there, let’s discuss this a bit. The World Health Organization (WHO) is the body being petitioned to add kidney health to their priorities. Non-communicable diseases (NCDs, and not infections!) are now the leading cause of death worldwide. See this from Our World in Data for the breakdown of NCDs (green, 74%) and infections (red, 14%), pre-COVID.
Hence, in 2015, the United Nations (UN) set a target to reduce premature mortality from NCDs by a third by 2030. Yes, that’s a mere 6 years from now. Subsequent to this, the WHO assigned a few leading NCD causes of death as a global health priority. Which ones? Cancer, heart disease, stroke, chronic lung disease and diabetes make the cut. Notably absent are the beans.
Is Kidney Disease an important cause of morbidity and mortality?
Now you might argue that, hey, kidney diseases don’t even make the cut in one of the boxes in the image above! Are we lumped with ‘others’? What is going on here? It depends on how you slice and dice the numbers. See another graphic from the World in Data, where kidney disease ranks just under diabetes.
Now you can also argue, what do patients with diabetes die of? Often from heart disease and kidney disease! How do you classify these separately? Indeed, even the WHO website states
‘Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually, followed by cancers (9.3 million), chronic respiratory diseases (4.1 million), and diabetes (2.0 million including kidney disease deaths caused by diabetes).’
So is it the Heart or the Kidney or Diabetes? It’s the Cardio-Kidney-Metabolic (CKM) complex!
Indeed, it is really hard to tease out the differences and label one organ as a cause of death. Ths always going to be a bit simplistic. We know that CKD is a robust risk factor for developing and dying of cardiovascular causes. We know that more patients with CKD do die of cardiovascular causes than those who go on dialysis. We know that even on dialysis, cardiovascular causes (including sudden death) account for the commonest cause of death. Similarly with diabetes and diabetic nephropathy. Hence the American Heart Association has launched the Cardiovascular-Kidney-Metabolic health initiative (CKM) so that we can join together rather than play the ‘who is most important’ game (Ndumele et al, Circulation 2023).
Alright, you got me. But how will making it a priority help?
The WHO has a vast arsenal of tools and policy measures at its disposal (scroll thrpough all the links and tabs at this link). Making kidney health a priority will allow these tools also to be used for kidney disease. Many governmental and health jurisdictional bureaucracies do not take action unless WHO designs it as needing attention. We have had so many trials and new safe and effective options now to treat kidney disease. What is the use of talking flozination, glipination, and new advances in treating IgA nephropathy (the most common glomerular disease worldwide (™)) if we do not screen, we do not detect, and we do not get the opportunity to fix the problems early?
Sign the petition
So, in a nutshell, go to the ISN website, read the resources they have there if we have not convinced you, and sign the petition. It does not take more than a minute.
Swapnil Hiremath, on behalf of the NephJC Team