Chronic Kidney Disease and the Global Threat It Poses

 This article is based on the publication “The global burden of chronic kidney disease” in the prestigious medical journal The Lancet (2020), authored by Dr. Paul Cockwell and Dr. Lori-Ann Fisher. The authors are renowned nephrology specialists affiliated with Queen Elizabeth Hospital, the University Hospital of the West Indies, and the University of Birmingham. They bring extensive clinical and research experience in the treatment and study of chronic kidney disease (CKD). The article presents a comprehensive analysis of the global prevalence, societal burden, and key challenges in addressing this disease, relying on large-scale international research and the latest scientific data. The following content is entirely based on the findings and expert conclusions published by Cockwell and Fisher and is intended to help patients better understand their condition and its global context.

“Kidney disease is a silent epidemic — millions of lives are at risk, and early detection can change everything.”

Expert Insights

CKD is becoming one of the most serious global health challenges of our time. It is most often caused by other chronic diseases such as diabetes and hypertension, and its complications significantly increase the risk of cardiovascular events and premature death. The latest summary from the Global Burden of Disease (GBD) study highlights a dramatic rise in CKD cases, related mortality, and social inequalities in access to treatment. Below are key expert insights and quotes from leading researchers that will help you understand the nature and scale of this issue, as well as guide patients toward the most current strategies for prevention and treatment.

1. What is Chronic Kidney Disease and Why Is It So Dangerous?

“Chronic kidney disease (CKD) is a non-communicable disease usually caused by diabetes and hypertension. Cardiovascular disease is the major cause of the early morbidity and mortality sustained by patients with CKD. The severity of CKD can be quantified by a low serum creatinine-based estimated glomerular filtration rate (eGFR), which indicates excretory kidney function, and raised urinary albumin measured by the urinary albumin-to-creatinine ratio (ACR), which is a marker of kidney damage.”

Explanation: CKD often goes unnoticed until it reaches an advanced stage, while its main causes — diabetes and hypertension — are extremely common. A particularly alarming fact is that its complications most often involve cardiovascular events that lead to premature death.

2. What Is the Global Prevalence and Trend of the Disease?

“In 2017, the global prevalence of CKD was 9.1% (95% uncertainty interval [UI] 8.5 to 9.8), which is roughly 700 million cases. Since 1990, the prevalence of CKD has increased by 29.3% ... The global increase in mortality from CKD since 1990 was 41.5% ... such that mortality from CKD, and cardiovascular disease deaths attributable to impaired kidney function ... caused 4.6% of global deaths in 2017, making CKD the 12th leading cause of death globally in 2017, an increase from 17th in 1990.”

Explanation: The prevalence of CKD is growing rapidly, and it is climbing the ranks of the leading causes of death globally. This is a disturbing trend, especially considering the limited treatment resources available in many countries.

3. Why Is Access to Diagnosis and Treatment So Critical?

“CKD-attributable morbidity and mortality follow the paradigm for chronic disease, whereby access to identification and management is dependent on income and geography. Patients living in countries in low and middle SDI quintiles who do not die during progression of CKD will typically die within months when they reach ESKD, because renal replacement therapy is not available or dialysis is inadequate. Kidney transplantation, the best health-preserving and economic treatment for ESKD, only accounts for a fifth of renal replacement therapy, and programmes are underdeveloped in most countries.”

Explanation: Access to screening, timely diagnosis, and proper treatment is highly uneven across the globe. In many regions, the lack of dialysis or transplantation options is effectively a death sentence for patients who reach end-stage kidney disease (ESKD).

4. What Are the Most Important Steps for Prevention and Early Detection?

“Interventions to slow kidney disease progression require early testing of people at risk by measurement of eGFR and ACR. Even in high-income countries, ACR testing is generally not done, despite being a major independent risk factor for CKD progression and cardiovascular disease events. Inexpensive interventions for diabetes, hypertension, and CKD can have a substantial effect on clinical and societal outcomes.”

Explanation: Early diagnosis — by measuring eGFR and ACR — can significantly slow disease progression. However, in many countries, this routine testing is not performed even for high-risk patients, which represents a missed opportunity with serious consequences.

5. What Do Leading Experts Recommend to Combat the CKD Epidemic?

“Supporting countries to develop sustainable and affordable health-care infrastructure for CKD and other non-communicable diseases, from public health legislation to population-based identification and management programmes, is a global priority.”

Explanation: A long-term solution requires national and international programs for prevention, public education, and development of healthcare infrastructure. Effectively addressing CKD demands coordinated efforts at every level — from individual prevention to healthcare policy.

Questions and Answers

1. How Common Is the Disease Globally and How Has Its Frequency Changed Over Time? Answer: In 2017, the global prevalence of chronic kidney disease (CKD) was 9.1%, which corresponds to approximately 700 million people. From 1990 to 2017, CKD cases increased by 29.3%. This highlights a troubling trend of growing global incidence.

2. Why Is It Such a Serious Problem If the Disease Progresses to End-Stage? Answer: When CKD progresses to end-stage kidney disease (ESKD), patients require kidney replacement therapy such as dialysis or a transplant. In low- and middle-income countries, patients who don’t receive the necessary therapy typically die within a few months after reaching this stage due to lack of access to treatment.

3. What Are the Biggest Differences in CKD Morbidity and Mortality Between Regions? Answer: There are major disparities between countries and regions — for example, in Central Latin America, Central Asia, and North America, CKD mortality has risen by around 60% during the study period. In some countries, CKD has become the second or fifth leading cause of death. The most affected are countries with lower sociodemographic indexes.

4. Are There Different Forms or Causes of CKD in Different Regions? Answer: Yes. In certain areas, such as parts of Latin America, there is a high incidence of what is called “chronic kidney disease of unknown origin” (for example, Mesoamerican nephropathy). This suggests that diabetes and hypertension aren’t always the leading causes — in some cases, the contributing factors remain unknown and are still being investigated.

5. How Important Is Early Detection, and What Are the Challenges? Answer: Early detection through testing eGFR and ACR (markers of kidney function and damage) is crucial for slowing disease progression. Unfortunately, even in high-income countries, these tests are often not performed routinely on at-risk individuals, leading to missed opportunities for prevention and timely treatment.

Conclusion 

Chronic kidney disease is not only a medical issue, but also a global social and economic challenge affecting millions of people, regardless of their background or income. The data and analysis presented by Dr. Paul Cockwell and Dr. Lori-Ann Fisher in The Lancet emphasize the critical importance of early detection, preventive care, and equal access to treatment for all patients. Awareness of the nature, spread, and risks of CKD is the first step toward more effective management and a better quality of life for those affected. We hope the information provided here will help you make more informed decisions about your health and care.

Source Paul Cockwell and Lori-Ann Fisher, “The global burden of chronic kidney disease,” The Lancet, February 29, 2020. DOI: 10.1016/S0140‑6736(19)32977‑0.