Chronic kidney disease (CKD) is a major risk factor for heart disease, cardiac death, hepatitis, and a host of other preventable and treatable conditions. CKD currently affects approximately 850 million people worldwide—as much as 10% of adults—and that number is steadily increasing.

The economic costs of the disease are rising, as well. Dialysis and transplantation alone command two to three percent of yearly healthcare budgets in high-income countries. Meanwhile, most people with kidney failure in low- and middle-income countries lack access to not only those lifesaving interventions, but also basic screening and diagnostic tools.

This lack of adequate widespread care, resulting in astronomical human and economic costs, was the impetus behind this year’s World Kidney Day campaign.* Entitled “Kidney Health for Everyone Everywhere – From Prevention to Detection and Equitable Access to Care,” its focus was encouraging all countries to implement three main levels of CKD prevention.

Three Tiers of Prevention

Primary Prevention

Prevention begins with early detection, particularly for people at higher risk, such as:

• those with diabetes and high blood pressure (hypertension);
• those aged 65 or older;
• those with a family history of CKD; and
• those with a personal history of acute kidney injury (AKI).

Primary prevention aims to intervene before adverse health effects occur in order to prevent CKD altogether.

It focuses on:

• reducing CKD risk factors, such as diabetes and high blood pressure;
• addressing structural abnormalities of the kidney and urinary tract; and
• reducing exposure to environmental risk factors, including nephrotoxins.

Secondary Prevention

The goal of secondary prevention is to respond to early diagnosis and prevent the disease from progressing to later stages.

Secondary prevention may involve:

• blood pressure optimization;
• blood sugar (glycemic) control; and
• adoption of a low-sodium, low-protein diet.

Tertiary Prevention

The goal of tertiary prevention is to avoid further complications and delay the need for dialysis in patients with advanced CKD. This is done by managing uremia (excessive urea/waste in the blood) and concurrent conditions, such as anemia, cardiovascular disease, diabetes, hypertension, and mineral and bone disorders.

Tertiary prevention may include:

• medications;
• rehabilitative therapies; and
• further adjustments to diet and other lifestyle factors.

Experimental therapies, such as cell replacement therapy (regenerative medicine), are also being explored.

Call-to-Action

The intricate links between CKD and other non-communicable diseases (NCDs) create an urgency for CKD efforts to be aligned with existing programs that combat diabetes, hypertension, and cardiovascular disease. Only a few countries so far, including Cuba, Taiwan, and the U.S., have successfully introduced CKD prevention strategies as part of their national NCD management programs. More countries need to do so, especially in low- and middle-income regions.

To achieve this goal, the 2020 World Kidney Day steering committee has called on all nations to:

• provide fellowship programs and non-specialist training for healthcare professionals;
• improve health literacy among policy makers, health care providers, and the general public;
• develop and support national campaigns to raise awareness of CKD prevention strategies; and
• implement population-based initiatives to manage key risks for kidney disease.

*Li, K.T.; Garcia-Garcia, G.; Lui, S.F.; et al. (2020, Mar. 2). “World Kidney Day 2020: Kidney Health for Everyone Everywhere.” Renal & Urology News.