A new study published in February 2020 in the journal The Lancet shows that over the last 20 years, there has been an increase in the number of people who have severe chronic kidney disease (CKD) requiring dialysis by over 40%. However, in many places around the world, the accessibility of dialysis is minimal, say the researchers.
Calling the disease "a global killer hidden in plain sight," researcher Theo Vos says the consequences of failing to keep up with the demand for dialysis the world around is deadly.
Hand swelling of kidney patient. Image Credit: MheePanda / Shutterstock
Chronic kidney disease
CKD is a condition in which the kidneys suffer damage and cannot carry out their function of filtering out wastes from the bloodstream as they should. It occurs over a long period of time and results in the accumulation of salts, waste chemicals, and water in the body. It is estimated that about 30 million adults in America have CKD.
CKD is the 12th leading cause of death in the world today, as per 2017 statistics. In 1990, it was at Number 17. The causes of death due to CKD include the build-up of toxins in the bloodstream, which impairs the normal functioning of multiple organs. Also, the risk of cardiovascular disease (CVD) is even higher in these patients.
CKD is caused most often by high blood pressure and diabetes. There are also many other important causes. Most of these are non-infectious. Thus, public health interventions to prevent and manage such non-communicable diseases as obesity, hypertension, and diabetes are essential in bringing down the burden of CKD. In some developing countries, in addition to these causes, HIV and heavy metal poisoning also act as an important contributor to CKD in certain parts of the world. In yet other areas, nobody quite knows what the cause is.
Death and disability due to CKD
The current study is part of the Global Burden of Disease study, an annual publication that is the most extensive global effort to measure the loss of health in the most comprehensive manner.
Altogether, estimates put the global death toll due to CKD at 1.23 million, and 1.36 million more deaths as a result of CVD secondary to reduced kidney function.
Global burden of CKD
The prevalence of CKD worldwide varies from country to country but is typically between 10 percent and 14 percent.
The number of people living with this condition was almost 700 million, but China and India contributed about a third of them, at approximately 130 million and 115 million cases, respectively.
In 2017, the number of countries with 10 million or more cases is 10, including the US, Russia, Japan, Indonesia, Pakistan, Bangladesh, and Vietnam, besides Brazil, Mexico, and Nigeria. There were another 79 countries with 1 million or more cases each.
The impact on productivity and life is immense, says the study. About 7 million years of life were lived with disability, and over 28 million years of life were cut short. The measure of years of life lost to ill-health is disability-adjusted life years, DALYs). In some countries like Samoa and Micronesia, the DALYs were above 1,500 per 100,000 population, whereas in others like Finland, Iceland, and Andorra, there were less than 120 DALYs per 100,000 population.
Even though one in every three patients with CKD is in the developing world, most studies come from high-income countries, and the data from these studies measure the prevalence, quality of life, mortality, and complications in these regions.
In Central America, Latin America, and Oceania, the data on CKD is very limited, and the estimates provided in the study are only computational-modeling based derivations. In places with programs for the screening of kidney disease on a large scale, estimates are provided for only smaller groups based on their age group, location, occupation, and other similar classification features.
Yet the writing is on the wall. The study shows massive inequities in the healthcare response to this disease in different parts of the world. Vos sums up: "The evidence is clear: Many nations' health systems cannot keep pace with the dialysis demand. Cases far exceed and are well beyond the ability of those systems to handle. The consequences are deadly."
Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 Bikbov, Boris et al. The Lancet, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30045-3/fulltext