World Kidney Day is celebrated every year on the 2nd Thursday of March by convention. It is a joint initiative of the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF) including the Indian Society of Nephrology. All across the world several events take place every year. The aim is to create awareness: awareness, about risk factors for kidney disease, about preventive behaviors and increasing knowledge about how to live with a kidney disease.
The theme for 2023 is “Preparing for the unexpected, supporting the vulnerable!” The focus on raising awareness about disastrous events, natural or man-made, international or local, and their impact on people living with kidney disease whose access to appropriate diagnostic services, treatment, and care is hindered.
Chronic kidney disease (CKD) has become a common but underdiagnosed problem. Initial studies have shown that 1 out of 10 adult people worldwide having it. In the early stages, it is a silent disease and hence diagnosis is often delayed. If left untreated it can be deadly not only rapidly progressing to end stage renal disease but also causing damage to other organs notably the heart. Early detection allows for better disease care and management to helps prevent morbidity and mortality, and also improves cost effectiveness and sustainability. Inspite of recent advances in diagnosis and management, kidney disease related mortality continues to increase yearly and is projected to be the 5th leading cause of death by 2040.
Recent studies have shown that the prevalence of CKD is increasing. CKD is an independent predictor of hospitalization, reduced quality of life and increased economic burden on patients, payers and healthcare infrastructure. As per the Global Burden of Disease (GBD) study of 2017, approximately 843.6 million individuals worldwide were reported to have CKD. In 2016, an estimated 1.2 million persons died due to CKD, and it is forecasted that approximately 2.2–4.0 million lives will be lost to CKD by 2040.
The change in burden of CKD from 1990 to 2016 in terms of incidence, prevalence, death, and disability adjusted life years (DALYs) showed an alarming rising trend with CKD incidence increasing by 89%, prevalence by 87%, death due to CKD by 98%, and DALYs by 62%. This trend is driven partly by population growth, increased life expectancy and an aging population. The risk factors of CKD, particularly diabetes mellitus, 7846 hypertension and obesity are also contributing significantly to this upsurge. CKD presents an elevated risk of developing cardiovascular disease (CVD) and is also an independent risk factor for cardiovascular events.
A screening study was conducted in 165000 people all over the country by Indian Society of nephrology along with Astra ZenecaIn Tier 1 and Tier 2 cities. In the first phase of the study we trained 1100 general physicians about various aspects of CKD througha training module. In the next phase people were screed for CKD using the standard approved and validated test like microalbuminuria and estimated GFR. This shows that currently 20-30 out of 100 people are having CKD and most of it is undiagnosed. This shows prevalence has nearly doublednow. The reasons for these are multifold.
Although new therapies have become available in last few years their penetration and acceptance amongst the needy remains low. This has been compounded by the unbridled proliferation of social media platforms like Facebook, YouTube, Instagram and Twitter. The COVID pandemic resulting in lockdowns has further accelerated the growth of the social media .The commercial nature of these platforms often results in widespread proliferation of content that is not proven to be true by scientific methodology. The only measure of success in social media is the popularity of the post and the number of followers both of which can be manipulated by commercial tools like boosting. A lot of this information would not hold water if tested by standard scientific methodology.
The poorly informed public and patients find it challenging to access scientifically authentic and validated information. This is especially true for developing countries like India where there is a proliferation of quacks and untested therapies and regulatory mechanism are lax. A significant number of them often land up in the hands of these quacks loosing precious time as well as money. The widening knowledge gap is stifling the fight against kidney disease, and increasing the inherent associated mortality.
There are several simple measures that can be implemented:
- Encourage general public to adopt healthy diet and lifestyles (access to clean water, regular exercise, healthy diet, avoid smoking) to maintain good kidney health, preserve kidney function longer in those with CKD, and increase overall general awareness of the importance of kidneys.
- Extend kidney patient education (including accurate and practical advice on diet and lifestyle) to empower patients, their care-partners, and their support systems to achieve the health outcomes and life goals that are meaningful and important to those with CKD including kidney failure.
- Recognise patients’ and caregivers’ right to be able to assess, understand and use health information related to CKD.
- Require kidney healthcare providers and patient organisations to offer information related to CKD according to varying levels of health literacy.
- Educate and encourage primary care physicians to improve their recognition and management of patients with CKD across its entire spectrum from prevention and early detection of CKD to its secondary and tertiary prevention and kidney failure care
- Integrate CKD and kidney failure prevention into national non-communicable disease programs for comprehensive and integrated services, which are essential in improving the early detection and tracking of kidney care at country level.
- Inform politicians about the impact of kidney disease and kidney failure on their constituents’ health and its associated burden on healthcare budgets/systems to encourage the adoption of policies and allocation of resources which tackle the global burden of kidney disease and ensure living well with kidney disease
World Kidney Day is a global campaign aimed at increasing awareness amongst the general public of the role of kidneys in maintaining optimal health and also about various aspects of kidney diseases. Thus a coordinated effort is needed at all levels of society to address the growing epidemic of Kidney disease.
(The Author is Principal Director Nephrology and Kidney Transplant Fortis Gp of Hospitals and President Indian Society of Nephrology)