Perspective:

The following are 10 points about the global public health burden of chronic kidney disease:

1. From 1990 to 2010, chronic kidney disease rose from a ranking of 27th to 18th on the list of causes of total number of global deaths (a magnitude of movement second only to HIV and AIDS).

2. Chronic kidney disease is defined as a reduced glomerular filtration rate (<60 ml/min/1.73 m³ for 3 months or longer), albuminuria, or both.

3. The demographics of chronic kidney disease vary globally, but >80% of all patients receiving treatment for end-stage kidney disease are estimated to be in affluent countries with large elderly populations and universal access to health care.

4. Diabetes and hypertension are the leading causes of chronic kidney disease in all developed and many developing countries. Other causes of chronic kidney disease in developing countries include environmental pollution, pesticides, analgesic abuse, herbal medications (through directly toxic effects, incorrect substitution of harmless herbs with toxic herbs, or contamination with toxic compounds), and use of unregulated food additives.

5. Awareness of chronic kidney disease remains low among many communities. In a nationwide health screening program for high-risk adults in the United States, the prevalence and awareness rates were, respectively, 29.7% and 8.6% for Caucasian respondents, and 22.8% and 6.3% for African-American respondents. Select studies may suggest that awareness is low among health care providers.

6. Chronic kidney disease is associated with a range of complications and increased all-cause mortality. In particular, cardiovascular mortality is 10-30 times higher in individuals with end-stage kidney disease than in the general population.

7. Effective prevention strategies for slowing the prevention of chronic kidney disease will involve control of blood pressure, lipid-lowering therapy, and glycemic control.

8. Screening for chronic kidney disease is cost-effective in diabetics.

9. National programs for noncommunicable diseases—diabetes, hypertension, and obesity—may naturally be a platform for screening and early management of chronic kidney disease to avert the potentially overwhelming health expenditures associated with advanced chronic kidney disease, especially in resource-limited settings.

10. Trained nephrologists are often in short supply. General practitioners and other specialists should be involved in caring for patients with chronic kidney disease.