1
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: translating what we know into what we do. Clin Exp Nephrol 2024; 28:835-846. [PMID: 38970648 PMCID: PMC11341759 DOI: 10.1007/s10157-024-02518-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 07/08/2024]
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, 105 W 8th Avenue, Suite 250 E, Spokane, WA, 99204, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Cranford, USA
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece.
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Cranford, USA
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Harbin, Hong Kong, China
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know Into What We Do. Am J Hypertens 2024; 37:640-649. [PMID: 39004933 PMCID: PMC11247168 DOI: 10.1093/ajh/hpae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 07/16/2024] Open
Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Brussels, Belgium
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Brussels, Belgium
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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3
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WW, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: translating what we know into what we do. J Bras Nefrol 2024; 46:e2024E007. [PMID: 38991207 PMCID: PMC11239182 DOI: 10.1590/2175-8239-jbn-2024-e007en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/01/2023] [Indexed: 07/13/2024] Open
Abstract
Historically, it takes an average of 17 years for new treatments to move from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. Now is the time to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions are diagnosed worldwide, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because it is often silent in the early stages. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from the patient to the clinician to the health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A. Luyckx
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Department of Public and Global Health, Zurich, Switzerland
- Harvard Medical School, Brigham and Women’s Hospital, Department of Medicine, Renal Division, Boston, Massachusetts, USA
- University of Cape Town, Department of Paediatrics and Child Health, Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Inland Northwest Health, Providence Medical Research Center, Spokane, Washington, USA
- University of Washington, Department of Medicine, Nephrology Division, Seattle, Washington, USA
| | - Dina Abdellatif
- Cairo University Hospital, Department of Nephrology, Cairo, Egypt
| | - Ricardo Correa-Rotter
- National Medical Science and Nutrition Institute Salvador Zubiran, Department of Nephrology and Mineral Metabolism, Mexico City, Mexico
| | - Winston W.S. Fung
- University of Hong Kong, Prince of Wales Hospital, Department of Medicine and Therapeutics, The Chinese Shatin, Hong Kong, China
| | - Agnès Haris
- Péterfy Hospital, Nephrology Department, Budapest, Hungary
| | - Li-Li Hsiao
- Harvard Medical School, Brigham and Women’s Hospital, Department of Medicine, Renal Division, Boston, Massachusetts, USA
| | | | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Brussel, Belgium
| | | | - Stefanos Roumeliotis
- Aristotle University of Thessaloniki, AHEPA University Hospital Medical School, 2nd Department of Nephrology, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- University of Nigeria, College of Medicine, Department of Medicine, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Brussel, Belgium
| | - Siu-Fai Lui
- The Chinese University of Hong Kong, Jockey Club School of Public Health and Primary Care, Division of Health System, Policy and Management, Hong Kong, China
| | - Vassilios Liakopoulos
- Aristotle University of Thessaloniki, AHEPA University Hospital Medical School, 2nd Department of Nephrology, Thessaloniki, Greece
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Singh A, Verma M, Das M, Parija PP, Nayak S, Jha V. Prevalence and associated factors of impaired kidney functions among children and adolescents in India: insights from the Comprehensive National Nutrition Survey (CNNS) 2016-18. BMC Pediatr 2024; 24:429. [PMID: 38965471 PMCID: PMC11223285 DOI: 10.1186/s12887-024-04903-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/21/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a significant public health problem. The burden of CKD in children and adolescents in India is not well described. We used data from the recent Comprehensive National Nutrition Survey (CNNS) to estimate the prevalence of impaired kidney function (IKF) and its determinants in children and adolescents between the ages of 5 and 19. METHODS CNNS 2016-18 adopted a multi-stage sampling design using probability proportional to size sampling procedure after geographical stratification of urban and rural areas. Serum creatinine was tested once in 24,690 children and adolescents aged 5-19 years. The estimated glomerular filtration rate (eGFR) was derived using the revised Schwartz equation. The eGFR value below 60 ml/min/1.73 m2 is defined as IKF. Bivariate analysis was done to depict the weighted prevalence, and multivariable logistic regression examined the predictors of IKF. RESULTS The mean eGFR in the study population was 113.3 + 41.4 mL/min/1.73 m2. The overall prevalence of IKF was 4.9%. The prevalence in the 5-9, 10-14, and 15-19 year age groups was 5.6%, 3.4% and 5.2%, respectively. Regression analysis showed age, rural residence, non-reserved social caste, less educated mothers, Islam religion, children with severe stunting or being overweight/obese, and residence in Southern India to be predictors of IKF. CONCLUSIONS The prevalence of IKF among children and adolescents in India is high compared to available global estimates. In the absence of repeated eGFR-based estimates, these nationally representative estimates are intriguing and call for further assessment of socio-demographic disparities, genetics, and risk behaviours to have better clinical insights and public health preparedness.
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Affiliation(s)
- Angad Singh
- International Institute for Population Sciences, Mumbai, India
| | - Madhur Verma
- Community and Family Medicine, All India Institute of Medical Sciences Bathinda, Punjab, India.
| | - Milan Das
- International Institute for Population Sciences, Mumbai, India
| | - Pragyan Paramita Parija
- Community and Family Medicine, All India Institute of Medical Sciences Vijaypur, Jammu, India
| | - Saurabh Nayak
- Nephrology, All India Institute of Medical Sciences Bathinda, Punjab, India
| | - Vivekanand Jha
- The George Institute for Global Health India, UNSW, New Delhi, India
- Manipal Academy of Higher Education, Manipal, India
- Faculty of Medicine, Imperial College London, London, UK
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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5
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris Á, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Fai Lui S, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know into What We Do. Indian J Nephrol 2024; 34:281-290. [PMID: 39156847 PMCID: PMC11328056 DOI: 10.25259/ijn_145_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 08/20/2024] Open
Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston WS Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Ágnes Haris
- Department of Nephrology, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Makram Khalife
- ISN Patient Liaison Advisory Group, Chennai, Tamil Nadu, India
| | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Chennai, Tamil Nadu, India
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Chennai, Tamil Nadu, India
| | - Siu Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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6
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Francis A, Harhay MN, Ong ACM, Tummalapalli SL, Ortiz A, Fogo AB, 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. Chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol 2024; 20:473-485. [PMID: 38570631 DOI: 10.1038/s41581-024-00820-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 04/05/2024]
Abstract
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. Economic and epidemiological data underscore why kidney disease should be placed on the global public health agenda - kidney disease prevalence is increasing globally and it is now the seventh leading risk factor for mortality worldwide. Moreover, demographic trends, the obesity epidemic and the sequelae of climate change are all likely to increase kidney disease prevalence further, with serious implications for survival, quality of life and health care spending worldwide. Importantly, the burden of kidney disease is highest among historically disadvantaged populations that often have limited access to optimal kidney disease therapies, which greatly contributes to current socioeconomic disparities in health outcomes. This joint statement from the International Society of Nephrology, European Renal Association and American Society of Nephrology, supported by three other regional nephrology societies, advocates for the inclusion of kidney disease in the current WHO statement on major non-communicable disease drivers of premature mortality.
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Affiliation(s)
- Anna Francis
- Department of Nephrology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Meera N Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Albert C M Ong
- Academic Nephrology Unit, Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Division of Nephrology & Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz UAM, RICORS2040, Madrid, Spain
| | - Agnes B Fogo
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Danilo Fliser
- Department of Internal Medicine IV, Renal and Hypertensive Disease & Transplant Centre, Saarland University Medical Centre, Homburg, Germany
| | - Prabir Roy-Chaudhury
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan
| | - Christoph Wanner
- Department of Clinical Research and Epidemiology, Renal Research Unit, University Hospital of Würzburg, Würzburg, Germany
| | - Charu Malik
- International Society of Nephrology, Brussels, Belgium
| | - Anne Hradsky
- International Society of Nephrology, Brussels, Belgium
| | - Dwomoa Adu
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Sunita Bavanandan
- Department of Nephrology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Ana Cusumano
- Instituto de Nefrologia Pergamino, Pergamino City, Argentina
| | - Laura Sola
- Centro de Hemodiálisis Crónica CASMU-IAMPP, Montevideo, Uruguay
| | - Ifeoma Ulasi
- Renal Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Enugu State, Nigeria
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India.
- School of Public Health, Imperial College, London, UK.
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
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7
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Khan A, Cheema MF, Fatima R, Cheema SS, Butt Z, Gillani S, Ahmad A, Subhan Ullah M, Jalal U, Cheema S. Prevalence of Chronic Kidney Disease in a High-Risk Population in Urban Lahore, Pakistan: A Cross-sectional Study. Cureus 2024; 16:e63296. [PMID: 39077231 PMCID: PMC11284504 DOI: 10.7759/cureus.63296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/31/2024] Open
Abstract
Background Chronic kidney disease (CKD) is a globally increasing health concern, and there is a growing focus on early screening and prevention efforts. However, the availability of data on CKD prevalence in Pakistan, particularly in the urban area of Lahore district, is limited. The objective of the Kidney Early Evaluation Program (KEEP) Lahore was to assess the prevalence of CKD in a high-risk population residing in the urban area of Lahore, Pakistan. Methods A cross-sectional study was conducted involving 254 participants, who were over 18 years old and belonged to a high-risk population according to the pre-defined operational definitions. The participants were randomly selected from various towns in Lahore. Screening camps were set up to measure serum creatinine levels and urinary albumin to creatinine ratio (UACR), and then the estimated glomerular filtration rate (eGFR) was calculated using the CKD Epidemiology Collaboration 2021 (CKD EPI) equation. Results Out of the total 254 participants, a diagnosis of CKD was made in 62 (24.2%) individuals. Significant associations were found between CKD and risk factors including hypertension, diabetes, family history of CKD, ischemic heart disease (IHD) or congestive heart failure (CHF), intake of painkillers, and herbal medicines. However, no association was found between obesity (BMI ≥ 30) and CKD. Participants diagnosed with CKD had a mean age of 49.9 years and a mean serum creatinine level of 1.2 mg/dL, while non-CKD participants had a mean age of 43.7 years and a mean serum creatinine level of 0.7 mg/dL. Conclusion Our study revealed that CKD was prevalent in about one-fourth of the participants from the high-risk population of Lahore, indicating a high prevalence of the disease within society. Moreover, hypertension, diabetes, family history of CKD, heart disease, painkillers, and the use of herbal medicines were all significantly linked to CKD in the surveyed sample population.
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Affiliation(s)
- Afifa Khan
- Department of Nephrology, Jinnah Hospital, Lahore, PAK
| | - Manal F Cheema
- College of Medicine, CMH (Combined Military Hospital) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Rida Fatima
- Department of Internal Medicine, Jinnah Hospital, Lahore, PAK
| | - Sidra S Cheema
- Department of Pathology, CMH (Combined Military Hospital) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Zeeshan Butt
- Department of Internal Medicine, Baystate Medical Center, Springfield, USA
| | - Samreen Gillani
- Department of Internal Medicine, Fatima Memorial Hospital, Lahore, PAK
| | - Ayesha Ahmad
- Department of Internal Medicine, Jinnah Hospital, Lahore, PAK
| | | | - Urba Jalal
- Department of Internal Medicine, Jinnah Hospital, Lahore, PAK
| | - Shafiq Cheema
- Department of Nephrology, Jinnah Hospital, Lahore, PAK
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8
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WW, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know into What We Do. Kidney Int Rep 2024; 9:1541-1552. [PMID: 38899169 PMCID: PMC11184315 DOI: 10.1016/j.ekir.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/18/2023] [Accepted: 12/01/2023] [Indexed: 06/21/2024] Open
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A. Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W.S. Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | | | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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9
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: Translating what we know into what we do. J Ren Care 2024; 50:79-91. [PMID: 38770802 DOI: 10.1111/jorc.12495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 05/22/2024]
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Medicine, Brigham and Women's Hospital, Renal Division, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Department of Medicine, Nephrology Division, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Department of Medicine, Brigham and Women's Hospital, Renal Division, Harvard Medical School, Boston, Massachusetts, USA
| | - Makram Khalife
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marianella Sierra
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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10
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know Into What We do. Can J Kidney Health Dis 2024; 11:20543581241252506. [PMID: 38764602 PMCID: PMC11102772 DOI: 10.1177/20543581241252506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/12/2024] [Indexed: 05/21/2024] Open
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary-care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A. Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, USA
| | | | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Winston W. S. Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Makram Khalife
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | | | - Fiona Loud
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Vasundhara Raghavan
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Stefanos Roumeliotis
- 2nd Department of Nephrology, American Hellenic Educational Progressive Association University Hospital Medical School, Aristotle University of Thessaloniki, Greece
| | - Marianella Sierra
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Nigeria
| | - Bill Wang
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, American Hellenic Educational Progressive Association University Hospital Medical School, Aristotle University of Thessaloniki, Greece
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11
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know into What We Do. Blood Purif 2024; 53:691-703. [PMID: 38754386 PMCID: PMC11397411 DOI: 10.1159/000539071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Brussels, Belgium
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Brussels, Belgium
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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12
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: Translating what we know into what we do. J Family Med Prim Care 2024; 13:1594-1611. [PMID: 38948565 PMCID: PMC11213387 DOI: 10.4103/jfmpc.jfmpc_518_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 07/02/2024] Open
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A. Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W. S. Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Makram Khalife
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Vasundhara Raghavan
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Stefanos Roumeliotis
- 2 Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marianella Sierra
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2 Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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13
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: translating what we know into what we do. Kidney Int 2024; 105:406-417. [PMID: 38375622 DOI: 10.1016/j.kint.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/18/2023] [Accepted: 12/01/2023] [Indexed: 02/21/2024]
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA; Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA.
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | | | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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14
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Gummidi B, Gautam V, John R, Joshi R, John O, Jha V. CKD is the Major Cause of Death in Uddanam: A Population-Representative Study Using Smart Verbal Autopsy. Kidney Int Rep 2024; 9:108-113. [PMID: 38312788 PMCID: PMC10831392 DOI: 10.1016/j.ekir.2023.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/03/2023] [Accepted: 10/23/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Uddanam is an agricultural area with a high burden of chronic kidney disease of unknown etiology (CKDu). Despite reports of many deaths due to CKD in the lay press, the exact contribution of CKD to deaths remains uncertain because most deaths occur outside medical care. Methods We used SmartVA automated verbal autopsy tool to ascertain the cause-specific mortality fractions among a 2419 subject-strong general population cohort of adult subjects in Uddanam between 2018 and 2022. Verbal autopsy interviews were conducted twice with the family members of the deceased. Results A total of 133 deaths were recorded, giving a crude death rate of 5.5%, 10 times higher than that recorded in national surveys. CKD was responsible for 45% of all deaths, followed by ischemic heart disease (15%) and respiratory disease (6%). Conclusion This study confirms CKD as the leading cause of mortality in this high CKD burden area and provides crucial data for public health decision-making and resource allocation.
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Affiliation(s)
- Balaji Gummidi
- The George Institute for Global Health India, UNSW, New Delhi, India
| | - Vaishali Gautam
- The George Institute for Global Health India, UNSW, New Delhi, India
| | - Renu John
- The George Institute for Global Health India, UNSW, New Delhi, India
| | - Rohina Joshi
- The George Institute for Global Health India, UNSW, New Delhi, India
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Oommen John
- The George Institute for Global Health India, UNSW, New Delhi, India
- Manipal Academy of Higher Education, Manipal, India
| | - Vivekanand Jha
- The George Institute for Global Health India, UNSW, New Delhi, India
- Manipal Academy of Higher Education, Manipal, India
- Faculty of Medicine, Imperial College London, London, UK
- Faculty of Medicine, University of New South Wales, Sydney
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15
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Meena P, Jha V. Environmental Change, Changing Biodiversity, and Infections-Lessons for Kidney Health Community. Kidney Int Rep 2023; 8:1714-1729. [PMID: 37705916 PMCID: PMC10496083 DOI: 10.1016/j.ekir.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 09/15/2023] Open
Abstract
There is a direct and accelerating connection between ongoing environmental change, the unprecedented decline in biodiversity, and the increase in infectious disease epidemiology worldwide. Rising global temperatures are threatening the biodiversity that underpins the richness and diversity of flora and fauna species in our ecosystem. Anthropogenic activities such as burning fossil fuels, deforestation, rapid urbanization, and expanding population are the primary drivers of environmental change resulting in biodiversity collapse. Climate change is influencing the emergence, prevalence, and transmission of infectious diseases both directly and through its impact on biodiversity. The environment is gradually becoming more suitable for infectious diseases by affecting a variety of pathogens, hosts, and vectors and by favoring transmission rates in many parts of the world that were until recently free of these infections. The acute effects of these zoonotic, vector and waterborne diseases are well known; however, evidence is emerging about their role in the development of chronic kidney disease. The pathways linking environmental change and biodiversity loss to infections impacting kidney health are diverse and complex. Climate change and biodiversity loss disproportionately affect the vulnerable and limit their ability to access healthcare. The kidney health community needs to contribute to the issue of environmental change and biodiversity loss through multisectoral action alongside government, policymakers, advocates, businesses, and the general population. We describe various aspects of the environmental change effects on the transmission and emergence of infectious diseases particularly focusing on its potential impact on kidney health. We also discuss the adaptive and mitigation measures and the gaps in research and policy action.
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Affiliation(s)
- Priti Meena
- Department of Nephrology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- School of Public Health, Imperial College, London, UK
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16
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Pais P, Iyengar A. Kidney Care for All: Addressing the Gaps in an Imperfect World-A Global Perspective on Improving Access to Kidney Care in Low-Resource Settings. KIDNEY360 2023; 4:982-986. [PMID: 37068174 PMCID: PMC10371280 DOI: 10.34067/kid.0000000000000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/17/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Priya Pais
- Department of Pediatric Nephrology, St John's Medical College, St John's National Academy of Health Sciences, Bengaluru, India
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17
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H Hathaway M, L Patil C, Odhiambo A, Onyango D, Dorevitch S. Prevalence and predictors of chronic kidney disease of undetermined causes (CKDu) in Western Kenya's "sugar belt": a cross-sectional study. BMC Nephrol 2023; 24:157. [PMID: 37280533 DOI: 10.1186/s12882-023-03213-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Epidemics of chronic kidney disease of undetermined causes (CKDu) among young male agricultural workers have been observed in many tropical regions. Western Kenya has similar climatic and occupational characteristics as many of those areas. The study objectives were to characterize prevalence and predictors of CKDu, such as, HIV, a known cause of CKD, in a sugarcane growing region of Kenya; and to estimate prevalence of CKDu across occupational categories and evaluate if physically demanding work or sugarcane work are associated with reduced eGFR. METHODS The Disadvantaged Populations eGFR Epidemiology Study (DEGREE) protocol was followed in a cross-sectional study conducted in Kisumu County, Western Kenya. Multivariate logistic regression was performed to identify predictors of reduced eGFR. RESULTS Among 782 adults the prevalence of eGFR < 90 was 9.85%. Among the 612 participants without diabetes, hypertension, and heavy proteinuria the prevalence of eGFR < 90 was 8.99% (95%CI 6.8%, 11.5%) and 0.33% (95%CI 0.04%, 1.2%) had eGFR < 60. Among the 508 participants without known risk factors for reduced eGFR (including HIV), the prevalence of eGFR < 90 was 5.12% (95%CI 3.4%, 7.4%); none had eGFR < 60. Significant risk factors for reduced eGFR were sublocation, age, body mass index, and HIV. No association was found between reduced eGFR and work in the sugarcane industry, as a cane cutter, or in physically demanding occupations. CONCLUSION CKDu is not a common public health problem in this population, and possibly this region. We recommend that future studies should consider HIV to be a known cause of reduced eGFR. Factors other than equatorial climate and work in agriculture may be important determinants of CKDu epidemics.
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Affiliation(s)
- Michelle H Hathaway
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL, 60612, USA.
| | - Crystal L Patil
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, 845 S. Damen Ave., MC 802, Chicago, IL, 60612, USA
| | - Aloyce Odhiambo
- Safe Water and AIDS Project, Behind Royal City Garden Hotel, Milimani Estate, Off Aga Khan Road, P.O. Box, Kisumu, 3323-40100, Kenya
| | - Dickens Onyango
- County Department of Health, County Government of Kisumu, Kisumu, Kenya
| | - Samuel Dorevitch
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL, 60612, USA
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18
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Levin A, Okpechi IG, Caskey FJ, Yang CW, Tonelli M, Jha V. Perspectives on early detection of chronic kidney disease: the facts, the questions, and a proposed framework for 2023 and beyond. Kidney Int 2023; 103:1004-1008. [PMID: 37125982 DOI: 10.1016/j.kint.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa; Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chih-Wei Yang
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
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19
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Jha V. Renal Revolution: Anticipating the Next 25 Years of India's Kidney Care. Indian J Nephrol 2023; 33:79-82. [PMID: 37234432 PMCID: PMC10208534 DOI: 10.4103/ijn.ijn_125_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 05/28/2023] Open
Affiliation(s)
- Vivekanand Jha
- Executive Director, The George Institute for Global Health, New Delhi, India, School of Public Health, Imperial College, London, UK, Manipal Academy of Higher Education, Manipal, India
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20
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dos Santos DGM, Ferreira LGS, Pallone JM, Ottaviani AC, Santos-Orlandi AA, Pavarini SCI, Zazzetta MS, Orlandi FDS. Association between frailty and depression among hemodialysis patients: a cross-sectional study. SAO PAULO MED J 2022; 140:406-411. [PMID: 35507995 PMCID: PMC9671252 DOI: 10.1590/1516-3180.2021.0556.r1.14092021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/14/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Frailty is consensually understood to be a clinical syndrome in which minimal stressors can lead to negative outcomes such as hospitalization, early institutionalization, falls, functional loss and death. Frailty is more prevalent among patients with chronic kidney disease (CKD), and those on dialysis are the frailest. Depression contributes towards putting patients with CKD into the frailty cycle. OBJECTIVE To assess frailty and its relationship with depression among patients with CKD undergoing hemodialysis. DESIGN AND SETTING Observational and quantitative cross-sectional study conducted in a renal therapy unit, located in the interior of the state of São Paulo, Brazil. METHODS This investigation took place in 2019, among 80 patients. The following instruments were applied: a sociodemographic, economic and health condition characterization and the Subjective Frailty Assessment (SFA) and Patient Health Questionnaire-9 (PHQ-9). RESULTS Among the patients, there was higher prevalence of females, individuals with a steady partner and retirees, and their mean age was 59.63 (± 15.14) years. There was high prevalence of physical frailty (73.8%) and depression (93.7%). Depression was associated with frailty, such that patients with depression were 9.8 times more likely to be frail than were patients without depression (odds ratio, OR = 9.80; 95% confidence interval, CI, 1.93-49.79). CONCLUSION Based on the proposed objective and the results achieved, it can be concluded that depression was associated with the presence of frailty among patients with CKD on hemodialysis.
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Affiliation(s)
| | | | - Joice Marques Pallone
- Undergraduate Student, Department of Gerontology, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.
| | - Ana Carolina Ottaviani
- PhD. Postdoctoral Student, Department of Nursing, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.
| | | | - Sofia Cristina Iost Pavarini
- PhD. Senior Professor, Department of Gerontology, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.
| | - Marisa Silvana Zazzetta
- PhD. Associate Professor, Department of Gerontology, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.
| | - Fabiana de Souza Orlandi
- PhD. Associate Professor, Department of Gerontology, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.
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21
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Regensteiner JG, Reusch JEB. Sex Differences in Cardiovascular Consequences of Hypertension, Obesity, and Diabetes: JACC Focus Seminar 4/7. J Am Coll Cardiol 2022; 79:1492-1505. [PMID: 35422246 PMCID: PMC9503760 DOI: 10.1016/j.jacc.2022.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 12/14/2022]
Abstract
It has long been recognized that there are significant differences between the sexes affecting prevalence, incidence, and severity over a broad range of diseases. Until the early 1990s, the limited research conducted on women's health focused primarily on diseases affecting fertility and reproduction, and women were excluded from most clinical trials. For these reasons, the prevention, diagnosis, and treatment of serious chronic diseases such as cardiovascular disease in women continue to be based primarily on findings in men, and sex-specific clinical guidelines are mostly lacking. Hypertension, obesity, and diabetes, interrelated risk factors for cardiovascular disease, differ by sex in terms of prevalence and adverse effects as well as by genetics and biology. Research is needed to understand sex differences in hypertension, obesity, and diabetes to optimally inform sex-specific prevention, diagnosis, and treatment strategies for women and men. In this way, sex-specific clinical guidelines can be developed where warranted.
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Affiliation(s)
- Judith G Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Ludeman Family Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - Jane E B Reusch
- Ludeman Family Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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22
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Gummidi B, John O, John R, Chatterjee S, Jha A, Ghosh A, Jha V. Catastrophic Health Expenditure and Distress Financing Among Patients With Nondialysis Chronic Kidney Disease in Uddanam, India. Kidney Int Rep 2022; 7:319-321. [PMID: 35155870 PMCID: PMC8820977 DOI: 10.1016/j.ekir.2021.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Balaji Gummidi
- The George Institute for Global Health, University of New South Wales, New Delhi, India
| | - Oommen John
- The George Institute for Global Health, University of New South Wales, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Renu John
- The George Institute for Global Health, University of New South Wales, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Susmita Chatterjee
- The George Institute for Global Health, University of New South Wales, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Anubhuti Jha
- The George Institute for Global Health, University of New South Wales, New Delhi, India
| | - Arpita Ghosh
- The George Institute for Global Health, University of New South Wales, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Vivekanand Jha
- The George Institute for Global Health, University of New South Wales, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- School of Public Health, Imperial College, London, UK
- Correspondence: Vivekanand Jha, The George Institute for Global Health, University of New South Wales, 308-309, 3rd Floor, Elegance Tower, Plot Number 8, Jasola District Centre, New Delhi 110025, India.
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23
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Shi JC, Chen XH, Yang Q, Wang CM, Huang Q, Shen YM, Yu J. A simple prediction model of hyperuricemia for use in a rural setting. Sci Rep 2021; 11:23300. [PMID: 34857832 PMCID: PMC8639845 DOI: 10.1038/s41598-021-02716-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/18/2021] [Indexed: 01/20/2023] Open
Abstract
Currently, the most widely used screening methods for hyperuricemia (HUA) involves invasive laboratory tests, which are lacking in many rural hospitals in China. This study explored the use of non-invasive physical examinations to construct a simple prediction model for HUA, in order to reduce the economic burden and invasive operations such as blood sampling, and provide some help for the health management of people in poor areas with backward medical resources. Data of 9252 adults from April to June 2017 in the Affiliated Hospital of Guilin Medical College were collected and divided randomly into a training set (n = 6364) and a validation set (n = 2888) at a ratio of 7:3. In the training set, non-invasive physical examination indicators of age, gender, body mass index (BMI) and prevalence of hypertension were included for logistic regression analysis, and a nomogram model was established. The classification and regression tree (CART) algorithm of the decision tree model was used to build a classification tree model. Receiver operating characteristic (ROC) curve, calibration curve and decision curve analyses (DCA) were used to test the distinction, accuracy and clinical applicability of the two models. The results showed age, gender, BMI and prevalence of hypertension were all related to the occurrence of HUA. The area under the ROC curve (AUC) of the nomogram model was 0.806 and 0.791 in training set and validation set, respectively. The AUC of the classification tree model was 0.802 and 0.794 in the two sets, respectively, but were not statistically different. The calibration curves and DCAs of the two models performed well on accuracy and clinical practicality, which suggested these models may be suitable to predict HUA for rural setting.
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Affiliation(s)
- Jia-Cheng Shi
- Department of Nephrology, Haining People’s Hospital, No. 2 West Qianjiang Road, Jiaxing, 314400 Zhejiang China
| | - Xiao-Huan Chen
- Department of Endocrinology and Rheumatology, The First People’s Hospital of Linping District, No. 369 Yingbin Road, Hangzhou, 311100 Zhejiang China
| | - Qiong Yang
- grid.452806.d0000 0004 1758 1729Department of Endocrinology, The Affiliated Hospital of Guilin Medical University, No. 15 Lequn Road, Guilin, 541001 Guangxi China
| | - Cai-Mei Wang
- grid.452806.d0000 0004 1758 1729Department of Laboratory Medicine, The Affiliated Hospital of Guilin Medical University, No. 15 Lequn Road, Guilin, 541001 Guangxi China
| | - Qian Huang
- grid.452806.d0000 0004 1758 1729Department of Endocrinology, The Affiliated Hospital of Guilin Medical University, No. 15 Lequn Road, Guilin, 541001 Guangxi China
| | - Yan-Ming Shen
- grid.452806.d0000 0004 1758 1729Department of Endocrinology, The Affiliated Hospital of Guilin Medical University, No. 15 Lequn Road, Guilin, 541001 Guangxi China
| | - Jian Yu
- Department of Endocrinology, The Affiliated Hospital of Guilin Medical University, No. 15 Lequn Road, Guilin, 541001, Guangxi, China.
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24
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Seasonal Changes in Kidney Function in CKD of Uncertain Etiology. Kidney Int Rep 2021; 6:2918-2921. [PMID: 34805642 PMCID: PMC8589687 DOI: 10.1016/j.ekir.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
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25
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John O, Gummudi B, Jha A, Gopalakrishnan N, Kalra OP, Kaur P, Kher V, Kumar V, Machiraju RS, Osborne N, Palo SK, Parameswaran S, Pati S, Prasad N, Rathore V, Rajapurkar MM, Sahay M, Tatapudi RR, Thakur JS, Venugopal V, Jha V. Chronic Kidney Disease of Unknown Etiology in India: What Do We Know and Where We Need to Go. Kidney Int Rep 2021; 6:2743-2751. [PMID: 34805627 PMCID: PMC8589686 DOI: 10.1016/j.ekir.2021.07.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Chronic kidney disease (CKD) not associated with known risk factors has been reported from parts of India and is presumed to be similar to CKD of unknown etiology (CKDu) that has been described from Central America. The reports from India have been fragmented without clear description of the disease phenotype or its determinants. This paper summarizes the current state of knowledge around CKDu in India based on a review of literature, multi-stakeholder consultation, and a survey of Indian nephrologists. We also contacted individual research groups to solicit data. Our findings suggest that that CKDu is reported from most regions in India; however, it is interpreted differently from the phenotype described from Central America and Sri Lanka. The differences include lack of a clear demographic or occupation group, older age of affected participants, and presence of mild hypertension and low-grade proteinuria. Well-designed prospective field studies with appropriate diagnostic workup are needed to establish the disease burden and identify etiologies, along with socioeconomic and health consequences, the intersection with the environment, and the public health response. Community-based research should phenotype the entire CKD population rather than be restricted to cases with presumed CKDu based on predefined criteria. Guidelines are needed for clinical evaluation, referral, management, and harmonization of clinical documentation and health records. More data are needed to support the existence of a unique CKDu phenotype in India.
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Affiliation(s)
- Oommen John
- George Institute for Global Health India, UNSW, New Delhi, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Balaji Gummudi
- George Institute for Global Health India, UNSW, New Delhi, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Anubhuti Jha
- George Institute for Global Health India, UNSW, New Delhi, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | - Om P Kalra
- Pt BD Sharma University of Health Sciences, Rohtak, India
| | | | - Vijay Kher
- Medanta Kidney & Urology Institute, Medanta the Medicity, Gurugram, India
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Nicolas Osborne
- School of Public Health University of Queensland Herston Australia.,School of Population Health University of New South Wales Australia
| | | | - Sreejith Parameswaran
- Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | | | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vinay Rathore
- All India Institute of Medical Sciences, Raipur, India
| | | | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital, Hyderabad, India
| | | | - Jarnail S Thakur
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vidhya Venugopal
- Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Vivekanand Jha
- George Institute for Global Health India, UNSW, New Delhi, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.,School of Public Health, Imperial College, London, UK
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26
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Divyaveer SS, Ramachandran R, Sahay M, Singh Shah D, Akhtar F, Bello AK, Iyengar A, Johnson DW, Harris DC, Levin A, Lunney M, Rahman M, Rashid HU, Saad S, Zaidi D, Osman MA, Varughese S, Wijewickrama ES, Khan M, Ye F, Tonelli M, Okpechi IG, Jha V. International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in South Asia. Kidney Int Suppl (2011) 2021; 11:e97-e105. [PMID: 33981475 PMCID: PMC8084730 DOI: 10.1016/j.kisu.2021.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/11/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022] Open
Abstract
Information about disease burden and the available infrastructure and workforce to care for patients with kidney disease was collected for the second edition of the International Society of Nephrology Global Kidney Health Atlas. This paper presents findings for the 8 countries in the South Asia region. The World Bank categorizes Afghanistan and Nepal as low-income; Bangladesh, Bhutan, India, and Pakistan as lower-middle-income; and Sri Lanka and the Maldives as upper-middle-income countries. The prevalence of chronic kidney disease (CKD) in South Asia ranged from 5.01% to 13.24%. Long-term hemodialysis and long-term peritoneal dialysis are available in all countries, but Afghanistan lacks peritoneal dialysis services. Kidney transplantation was available in all countries except Bhutan and Maldives. Hemodialysis was the dominant modality of long-term dialysis, peritoneal dialysis was more expensive than hemodialysis, and kidney transplantation overwhelmingly depended on living donors. Bhutan provided public funding for kidney replacement therapy (dialysis and transplantation); Sri Lanka, India, Pakistan, and Bangladesh had variable funding mechanisms; and Afghanistan relied solely on out-of-pocket expenditure. There were shortages of health care personnel across the entire region. Reporting was variable: Afghanistan and Sri Lanka have dialysis registries but publish no reports, whereas Bangladesh has a transplant registry. South Asia has a large, but poorly documented burden of CKD. Diabetes and hypertension are the major causes of CKD throughout the region with a higher prevalence of infectious causes in Afghanistan and a high burden of CKD of an unknown cause in Sri Lanka and parts of India. The extent and quality of care delivery is suboptimal and variable. Sustainable strategies need to be developed to address the growing burden of CKD in the region.
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Affiliation(s)
- Smita S. Divyaveer
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College and General Hospital, Hyderabad, Telangana, India
| | - Dibya Singh Shah
- Department of Nephrology and Transplant Medicine, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Fazal Akhtar
- Sind Institute of Urology and Transplantation, Karachi, Pakistan
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Arpana Iyengar
- Department of Pediatric Nephrology, St. Johns Medical College Hospital, Bangalore, India
| | - David W. Johnson
- Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translation Research Institute, Brisbane, Queensland, Australia
| | - David C.H. Harris
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Muhibur Rahman
- Department of Nephrology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
| | - Harun-Ur Rashid
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Syed Saad
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed A. Osman
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Eranga S. Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Maryam Khan
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Ikechi G. Okpechi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - ISN South Asia Regional Board
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Nephrology, Osmania Medical College and General Hospital, Hyderabad, Telangana, India
- Department of Nephrology and Transplant Medicine, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
- Sind Institute of Urology and Transplantation, Karachi, Pakistan
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatric Nephrology, St. Johns Medical College Hospital, Bangalore, India
- Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translation Research Institute, Brisbane, Queensland, Australia
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Nephrology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Nephrology, Christian Medical College, Vellore, India
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
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