Mind the gap in kidney care: translating what we know into what we do

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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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Sobre autores

Valerie Luyckx

University of Zurich; Brigham and Women’s Hospital, Harvard Medical School; University of Cape Town

Autor responsável pela correspondência
Email: valerie.luyckx@uzh.ch

Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute; Renal Division, Department of Medicine; Department of Paediatrics and Child Health

Suíça, Zurich; Boston, Massachusetts, USA; Cape Town, South Africa

Katherine Tuttle

Providence Medical Research Center, Providence Inland Northwest Health; University of Washington

Email: katherine.tuttle@providence.org

Nephrology Division, Department of Medicine

Estados Unidos da América, Spokane, Washington; Seattle, Washington

Dina Abdellatif

Cairo University Hospital

Email: st_roomliotis@hotmail.com

Department of Nephrology

Egito, Cairo

Ricardo Correa-Rotter

National Medical Science and Nutrition Institute Salvador Zubiran

Email: st_roomliotis@hotmail.com

Department of Nephrology and Mineral Metabolism

México, Mexico City

Winston Fung

Prince of Wales Hospital, The Chinese University of Hong Kong

Email: st_roomliotis@hotmail.com

Department of Medicine and Therapeutics

República Popular da China, Shatin, Hong Kong

Agnès Haris

Péterfy Hospital

Email: st_roomliotis@hotmail.com

Nephrology Department

Hungria, Budapest

Li-Li Hsiao

Brigham and Women’s Hospital, Harvard Medical School

Email: st_roomliotis@hotmail.com

Renal Division, Department of Medicine

Estados Unidos da América, Boston, Massachusetts

Makram Khalife

ISN Patient Liaison Advisory Group

Email: st_roomliotis@hotmail.com

Latha Kumaraswami

Tamilnad Kidney Research (TANKER) Foundation

Email: st_roomliotis@hotmail.com
Índia, Chennai

Fiona Loud

ISN Patient Liaison Advisory Group

Email: st_roomliotis@hotmail.com

Vasundhara Raghavan

ISN Patient Liaison Advisory Group

Email: st_roomliotis@hotmail.com

Stefanos Roumeliotis

AHEPA University Hospital Medical School, Aristotle University of Thessaloniki

Email: st_roomliotis@hotmail.com

2nd Department of Nephrology, MD, PhD, Nephrologist

Grécia, Thessaloniki

Marianella Sierra

ISN Patient Liaison Advisory Group

Email: st_roomliotis@hotmail.com

Ifeoma Ulasi

College of Medicine, University of Nigeria

Email: st_roomliotis@hotmail.com

Department of Medicine

Nígeria, Ituku-Ozalla, Enugu

Bill Wang

ISN Patient Liaison Advisory Group

Email: st_roomliotis@hotmail.com

Siu-Fai Lui

The Chinese University of Hong Kong

Email: st_roomliotis@hotmail.com

Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care

República Popular da China, Hong Kong

Vassilios Liakopoulos

AHEPA University Hospital Medical School, Aristotle University of Thessaloniki

Email: st_roomliotis@hotmail.com

2nd Department of Nephrology

Grécia, Thessaloniki

Alessandro Balducci

Italian Kidney Foundation

Email: st_roomliotis@hotmail.com
Itália, Rome

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2. Fig. 1. Top 10 global risk factors for death, regardless of age, 2019. Kidney dysfunction (estimated glomerular filtration rate <60 ml/min per 1.73 m2 or albumin-to-creatinine ratio >30 mg/g) was the seventh leading global level 3 risk factor for death in 2019. The three leading global risk factors for kidney disease, including hypertension, diabetes mellitus, and overweight/obesity, are also the leading global risk factors for death; therefore, holistic strategies to simultaneously address all risk factors are needed. Rankings are expressed in millions when mortality is attributable to risk factors. Error bars indicate confidence intervals. The global kidney dysfunction ranking, stratified by World Bank income category and sex, is shown in Supplementary Fig. S1. Data are from the Global Burden of Disease Study [2].

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3. Fig. 2. Proportion of people with chronic kidney disease (CKD) who are aware of their diagnosis and who receive appropriate standard-of-care treatment. The proportion of people with CKD who are aware of their diagnosis varies globally from 7% to 20%. Knowledge of CKD increases as CKD progresses. Among people diagnosed with CKD, the average proportion receiving appropriate medications to slow CKD progression (renin-angiotensin-aldosterone system [RAS] inhibitors and sodium-glucose cotransporter 2 [SGLT2] inhibitors) is suboptimal, as is the proportion achieving blood pressure targets, controlling diabetes, and following dietary advice. The treatment targets depicted in the figure are consistent with the 2012 Kidney Disease: Improving Global Outcomes (KDIG0) guidelines [15]. Most of the data reflect the situation in high-income countries; in resource-poor countries these figures are likely to be even lower. Data are presented for the proportion of patients achieving blood pressure <130/80 mmHg. Data reflect the results of previous studies [15–20].

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4. Fig. 3. Recommended optimal lifestyle and drug treatment for chronic kidney disease (CKD) in diabetes mellitus. Illustration of a comprehensive and holistic approach to optimizing kidney health in people with CKD. In addition to fundamental lifestyle interventions, kidney disease management should address diabetes mellitus, blood pressure (BP), and cardiovascular risk factors. “Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers should be first-line therapy for BP control in the presence of albuminuria; otherwise, a dihydropyridine calcium channel blocker (CCB) or a diuretic may also be considered.” Figure reproduced from the Kidney Disease Improving Global Outcomes (KDIGO) Working Group, KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney int. https://doi.org/10.1016/j.kint.2023.10.018 [22]. Copyright © 2023, Kidney Disease: Improving Global Outcomes (KDIGO) Published by Elsevier Inc. on behalf of the International Society of Nephrology under a CC BY-NC-ND license (htfp://creativecommons.orglicenses/by-nc-nd/4.0).

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5. Fig. 4. Illustration of the spectrum of factors influencing the provision of timely and high-quality care for kidney diseases.

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6. Supplementary Figure S1: Ranking of kidney dysfunction as a cause of death stratified by global income category and sex for level 2 mortality risk factors Data from the Global Burden of Diseases Study: https://vizhub.healthdata.org/gbd-results/

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7. Supplementary Figure S1:2

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8. Supplementary Figure S1: 3

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9. Supplementary Figure S1: 4

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10. Supplementary Figure S1: 5

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12. Supplementary Figure S1: 7

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13. Supplementary Figure S1: 8

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