World Kidney Day 2023:

APPROXIMATELY 850 million people worldwide are living with chronic kidney disease (CKD) which represents more than 10% of the world’s population. Risk factors for CKD include diabetes, hypertension, older age and being female. CKD is a leading cause of death globally and the number of deaths associated with CKD continues to increase despite advances in treatment.

Developing countries have a higher burden of CKD and less resources to properly treat CKD making these countries vulnerable to disasters. The rise in risk factors such as obesity and diabetes have resulted in rising rates of kidney disease in low- and middle-income countries, especially in the Caribbean. With limited resources to deal with the rising demand for dialysis and kidney transplants, it is imperative that we prevent CKD by screening for risk factors and addressing these risk factors in primary care settings. Active screening for kidney disease can identify early stages of chronic kidney disease and given the right interventions, kidney failure can be prevented, or it can be significantly delayed.

Globally, health care systems have faced several disastrous events, these include natural disasters such as the COVID-19 pandemic, earthquakes, floods, and extreme weather, and man-made disasters such as wars, crimes and political unrest. These disasters lead to disruption of access to services such as proper food, medications, laboratory testing, dialysis, kidney transplants and follow-up care.

The World Kidney Day Steering Committee dedicated 2023 to preparing for disasters since the COVID-19 pandemic was a clear example of the challenges faced by health care systems in providing essential health services to patients with chronic diseases. Planning, anticipation, and preparation for disasters with a forward-thinking approach and being proactive will help to mitigate some challenges when the next disaster arrives.

As the kidney community was launching the theme ‘supporting the vulnerable and preparing for the unexpected’, Turkey and Syria experienced a massive earthquake which killed more than 40,000 persons including health care providers and front-line workers, flattened hospitals, destroyed airports and access roads, limiting delivery of supplies and human resources, and resulted in significant damage.

Persons trapped under rubbles and buildings are at high risk of kidney failure due to dehydration, and crushed muscles which releases a product of muscle breakdown called myoglobin that is toxic to the kidney. Emergency dialysis is often required for persons with crush injuries. Anticipating crush injuries and early intervention are crucial for survival in disasters such as earthquakes and wars.

The most famous disaster that affected heath care in our time is COVID-19 pandemic which placed an added strain on persons with kidney disease who have had to deal with the risk of becoming infected while visiting health facilities, or indeed the suspension or cancellation of non-COVID-19 care due to health service capacity limits and lockdown policies. Health services have struggled to provide access to the ongoing incidence of new chronic disease cases needing diagnoses, management, and care. With no actual cure or treatment to prevent progression of CKD, the under-detected and unhindered progression of CKD to kidney failure will most certainly increase the global need for life-saving costly treatments of dialysis and transplantation.

The COVID-19 pandemic has aggravated an already insufficient global political health commitment on chronic diseases. During this pandemic, it was clear that those with noncommunicable diseases were more likely to develop serious illness and die, as the needs of providing and prioritizing ongoing complex care for these patients were deprioritized in favor of acute health responses.

Data from the United States and England showed that deaths for those with kidney failure and persons who received a kidney transplant were higher than anticipated during the pandemic which may have been a reflection that chronic diseases were not prioritized during the pandemic. The global health community has recognized that there is a real need for health care systems and jurisdictions to develop more resilient systems.

Chronic diseases are too often incorrectly perceived as due to poor lifestyle choices, with policy deficits compounded by allocation of insufficient public health funds that focus on management rather than prevention, and of only a few of the recognised non-communicable chronic diseases – cardiovascular disease, cancer, diabetes, and chronic respiratory disease. Yet, it is estimated that 55% of the global non-communicable chronic diseases burden is attributed to diseases outside of this group, such as kidney disease.

Furthermore, the burden of cardiovascular disease, cancer, diabetes, and chronic respiratory disease is amplified in the presence of kidney disease, frequently co-existing. The World Kidney Day Steering Committee calls for public health policies that reflect preventative strategies and the importance of both the magnitude and synergistic aspects of kidney disease as part of the non-communicable chronic diseases burden.

Preparation for unexpected events is incredibly important for kidney patients. Prioritizing prevention, early detection, and management of non-communicable chronic diseases, including kidney disease can improve health outcomes. Health equity and proper access to care for chronic patients in times of emergency along with emergency preparedness plans are recommended by the World Kidney Day Steering Committee. In addition, persons with chronic diseases, including kidney disease should plan for emergencies by preparing an emergency kit that includes food, water, medical supplies, and medical records.

In conclusion, as the burden of chronic kidney disease continue to rise globally, we are encouraged to implement effective primary preventative measures and treatments to prevent and slow the progression of kidney disease. Chronic kidney failure is devastating, and irreversible, active prevention is the best option. Anticipating and planning for disasters as a global health community, being cognisant of the lessons learned from the COVID-19 pandemic, can improve health outcomes.

(Adapted from the World Kidney Day Steering Committee 2023 editorial)