Chronic Kidney Disease and the Fight for a Longer, Healthier Life

 The information in this article is entirely based on the most up-to-date international consensus, published in July 2024 in the prestigious journal Nature Reviews Nephrology – “Chronic kidney disease and the global public health agenda: an international consensus” (Francis, A., Harhay, M. N., Ong, A. C. M., Tummalapalli, S. L., Ortiz, A., Fogo, A. B., Fliser, D., Roy-Chaudhury, P., Fontana, M., Nangaku, M., Wanner, C., Malik, C., Hradsky, A., Adu, D., Bavanandan, S., Cusumano, A., Sola, L., Ulasi, I., Jha, V., and representatives from the American Society of Nephrology, European Renal Association, and International Society of Nephrology).

This team of authors brings together leading nephrologists, medical experts, and researchers from around the globe – from Europe, Asia, Africa, North and South America – presenting a unified position and set of recommendations from the world’s most prominent kidney disease organizations.

The goal of this article is to provide, based on the best available scientific evidence, the most important, reliable, and practical information about chronic kidney disease (CKD) – not only for medical professionals but also for patients and their families. Below are five key questions and answers every patient should know about their condition, drawn directly from the content of the consensus article.

“Kidney diseases are now the third fastest-growing cause of death in the world – early detection and affordable treatment can save millions of lives.”

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Expert Insights on CKD

Chronic kidney disease (CKD) is one of the most critical challenges facing modern medicine and public health. It affects hundreds of millions of people worldwide, and its prevalence and mortality rates are rising at an alarming pace, especially among vulnerable and socially marginalized populations.

Despite the scale of the problem, public awareness – and even awareness among some medical professionals – remains insufficient. This leads to delayed diagnoses, inadequate treatment, and serious social and economic consequences.

The following expert opinions offer scientifically grounded recommendations and warnings that can help patients, their families, and stakeholders better understand, detect early, and properly manage CKD.

1. Early Detection of Kidney Disease Saves Lives: Why It's a Public Health Priority

"Early detection is a key strategy to prevent kidney disease, its progression and related complications, but numerous studies show that awareness of kidney disease at the population level is low. Therefore, increasing knowledge and implementing sustainable solutions for early detection of kidney disease are public health priorities."

Explanation: Early detection of kidney disease can delay or even prevent the progression to more severe stages such as kidney failure. It’s vital for patients to be informed about the risk factors and early symptoms because many people are unaware they have the disease until serious complications occur.

2. CKD Is the Third Fastest-Growing Cause of Death in the World

"Currently, kidney disease is the third fastest-growing cause of death globally and the only NCD to exhibit a continued rise in age-adjusted mortality. By 2040, CKD is projected to be the 5th highest cause of years of life lost (YLL) globally."

Explanation: This highlights that CKD is not just a medical issue but also a major societal concern with widespread consequences, particularly in developing countries. Projections suggest it will soon rank among the leading causes of years of life lost – surpassing other chronic illnesses such as diabetes.

3. Kidney Disease Has Many Causes – It’s Not Just About Diabetes and High Blood Pressure

"CKD and AKI have diverse causes, mediators and risk factors beyond diabetes and cardiovascular disease, especially in low- and middle-income countries, which account for two-thirds of the global burden of kidney disease. For example, dehydration and infections are leading causes of AKI in LICs and LMICs."

Explanation: Many patients assume that only diabetes and high blood pressure lead to kidney damage. However, infections, dehydration, poisoning, and even environmental factors are also leading causes, especially in lower-income regions. This calls for broader screening and monitoring, even in individuals without the traditional risk factors.

4. The Impact of Social and Environmental Factors: Why the Poor and Vulnerable Suffer the Most

"The burden of CKD risk factors that traditionally drive disease in high-income countries, such as diabetes, hypertension and obesity, is growing most rapidly in LICs and LMICs. Moreover, LICs and LMICs face a constellation of additional risks... Superimposed onto this background, limited public health architecture and high poverty levels create life-course threats to kidney health, with a particular impact on pregnancy and childhood."

Explanation: Poor social conditions, poverty, limited access to healthcare, lack of clean water, and malnutrition during pregnancy and early childhood expose people to a higher risk of developing kidney diseases. This makes the problem particularly acute in low-income countries and regions.

5. The Global Neglect of Kidney Disease Is a Moral Failing

"It is unacceptable that the only NCD consistently witnessing an increase in the number of deaths year-on-year is not identified as a priority for policy action. Kidney diseases disproportionately affect the poor and disadvantaged, globally and within each country. Moreover, kidney disease not only has a profound negative impact on patients owing to its debilitating symptom burden but it also increases their risk of developing other major NCDs, restricts their ability to work and care for family members, and is cripplingly expensive for individuals, families, health systems and governments."

Explanation: Chronic kidney disease has not received the attention it deserves from health institutions, even though it primarily affects the most vulnerable. Neglecting CKD contributes to deepening social inequalities, reduced quality of life, and severe economic losses for society.

Key Takeaways for Patients

• Don’t underestimate the risk of CKD, even if you don’t have classic causes like diabetes or high blood pressure.

• Seek early diagnosis, especially if you are part of a vulnerable group or have symptoms such as fatigue, swelling, or changes in urination.

• Be mindful of environmental and social factors – for example, outdoor labor in hot climates, poverty, or malnutrition.

• Demand proactive prevention and access to treatment from local health authorities.

• Understand that fighting kidney disease is part of a larger fight for social justice and accessible healthcare.

Frequently Asked Questions

1. How many people are affected by kidney disease, and how many receive treatment? 

Answer: According to the international consensus, approximately 850 million people worldwide are affected by kidney diseases, with the majority living in low- and middle-income countries. Unfortunately, less than half of those who need kidney replacement therapy (such as dialysis or a transplant) actually have access to it. In some low-income countries, up to 98% of people with kidney failure do not receive the necessary treatment, often resulting in premature death.

2. What are the main symptoms and complications of CKD? 

Answer: Symptoms of CKD often appear late and can include fatigue, itching, bone or muscle pain, swelling, insomnia, nausea, and difficulty breathing. Patients with advanced kidney failure often experience a symptom burden equal to or greater than those with terminal cancer. In addition to physical symptoms, depression and anxiety are common among patients and their families.

3. What are the financial consequences for patients and their families? 

Answer: Kidney disease treatment is extremely expensive – both for healthcare systems and for patients and their families. In poorer countries, only 13% of governments cover the costs of dialysis for adults, meaning most people pay out of pocket. This often leads to catastrophic healthcare costs and financial instability for entire households. Each year, over 188 million people globally face serious financial hardship due to kidney disease-related expenses.

4. What should I know about the link between kidney disease and other health conditions? 

Answer: CKD is not an isolated condition – it significantly increases the risk of other serious chronic diseases like cardiovascular disease, stroke, and infections (such as COVID-19 and tuberculosis). The relationship is two-way: people with CKD are more likely to experience complications from other diseases, and some diseases and their treatments can worsen kidney function. This complexity requires careful monitoring and a holistic approach to treatment.

5. Are there new treatment options, and is screening worthwhile? 

Answer: Yes, it is absolutely worthwhile. In recent years, new medications (such as SGLT2 inhibitors, mineralocorticoid receptor antagonists, and others) have been developed that significantly slow disease progression and improve outcomes. That’s why early detection through screening is so important. International expert recommendations advise people at increased risk – such as those with diabetes, high blood pressure, cardiovascular disease, or who belong to vulnerable groups – to be regularly tested for markers like protein in the urine and kidney function.

Conclusion

Chronic kidney disease affects millions of people worldwide and is becoming an increasingly serious challenge for society, healthcare systems, and individuals alike. The questions and answers outlined above, drawn directly from the international consensus of the world’s leading experts, emphasize the importance of understanding the risks, symptoms, treatment options, and economic impact of the disease.

The recognized need for earlier detection, better access to treatment, and comprehensive care for those living with kidney disease is not merely a medical issue – it is a matter of social justice and public solidarity.

Awareness and proactive engagement by patients and their loved ones are a crucial part of the fight against this disease – a fight that requires the commitment of the entire community.

Source: Francis, A. et al. (2024). Chronic kidney disease and the global public health agenda: an international consensus. Nature Reviews Nephrology, 20, 473–485. https://doi.org/10.1038/s41581-024-00820-6