The global burden of kidney disease and the sustainable development goals

Abstract

Although often considered a comorbidity of diabetes or hypertension, kidney disease has numerous complex causes. mportantly, such disease has an indirect impact on global morbidity and mortality by increasing the risks associated with at least five other major killers: cardiovascular diseases, diabetes, hypertension, infection with human immunodeficiency virus (HIV) and malaria. For example, the Global Burden of Disease (GBD) 2015 study estimated that 1.2 million deaths, 19 million disability-adjusted life-years (DALYs) and 18 million years of life lost from cardiovascular diseases were directly attributable to reduced glomerular filtration rates. he GBD 2015 study also estimated that, in 2015, 1.2 million people died from kidney failure, an increase of 32% since 2005. In 2010, an estimated 2.3-7.1 million people with end-stage kidney disease died without access to chronic dialysis. 8 Additionally, each year, around 1.7 million people are thought to die from acute kidney injury. 9 Overall, therefore, an estimated 5-10 million people die annually from kidney disease. Given the limited epidemiological data, the common lack of awareness and the frequently poor access to laboratory services, such numbers probably underestimate the true burden posed by kidney disease. It is therefore possible that, each year, at least as many deaths are attributable to kidney disease as to cancer, diabetes or respiratory diseases, three of the four main categories targeted by the 2013 action plan. n addition, the estimated number of DALYS attributable to kidney disease globally increased from 19 million in 1990 to 33 million in 2013. In 2016, the DALYs associated with chronic kidney disease, along with those associated with cardiovascular disease, cancers, diabetes and neurological disorders, were found to have increased significantly between 1990 and 2015. A report from the GBD 2016 study highlighted the Abstract Kidney disease has been described as the most neglected chronic disease. Reliable estimates of the global burden of kidney disease require more population-based studies, but specific risks occur across the socioeconomic spectrum from poverty to affluence, from malnutrition to obesity, in agrarian to post-industrial settings, and along the life course from newborns to older people. A range of communicable and noncommunicable diseases result in renal complications and many people who have kidney disease lack access to care. The causes, consequences and costs of kidney diseases have implications for public health policy in all countries. The risks of kidney disease are also influenced by ethnicity, gender, location and lifestyle. Increasing economic and health disparities, migration, demographic transition, unsafe working conditions and environmental threats, natural disasters and pollution may thwart attempts to reduce the morbidity and mortality from kidney disease. A multisectoral approach is needed to tackle the global burden of kidney disease. The sustainable development goals (SDGs) emphasize the importance of a multisectoral approach to health. We map the actions towards achieving all of the SDGs that have the potential to improve understanding, measurement, prevention and treatment of kidney disease in all age groups. These actions can also foster treatment innovations and reduce the burden of such disease in future generations.