A call to action on World Kidney Day, 8 March 2007.

W orld Kidney Day, a joint initiative of the International Society of Neph-rology (ISN) and the International Federation of Kidney Foundations (IFKF), aims to spread the crucial message that kidney disease is common, harmful, and treatable. Common because chronic kidney disease (CKD), defi ned as a glomerular fi ltration rate of less than 60 ml per minute and/or the presence of microalbuminuria or proteinuria, has now been consistently shown to aff ect about 10% of the adult population in studies of diff erent races living on diff erent continents worldwide. 1–5 Harmful not just because some of these patients progress to end-stage renal disease (ESRD), but more because these renal abnormalities are associated with a manyfold increase in risk of cardiovascular complications and premature car-diovascular death. 6,7 Indeed, the risk of premature death primarily from cardiovascular disease is, on average, 100-fold higher in patients with CKD than the risk of ESRD. 8 Treatable because there is now strong scientifi c evidence that early detection, altering lifestyle factors, and aggressive control of blood pressure , can not only slow or halt the progression of CKD to ESRD but can also signifi cantly reduce the incidence of cardiovascular disease that leads to premature death in the majority of these patients. 9–13 Cardiovascular disease is today by far the most common cause of premature death worldwide. 14 We do not yet know exactly how many people dying of premature cardiovascular disease have CKD and might have benefi ted from early detection and treatment aimed at the kidney, but the number is certainly very large. When we as a renal community become aware that early-detection programs focused on the kidney can identify large numbers of patients who may be spared from other health complications or even premature death by simple interventions, we incur, in our view, a moral and ethical imperative to advocate for the implementation of such programs. Th at such programs can be successful and cost eff ective has now been shown in several proof-of-concept prevention projects sponsored by the ISN and others. 15–18 Th e four major United States renal societies, in celebration of World Kidney Day 2007, have jointly described and called for a comprehensive change in both funding and delivery of renal health care in the United States to emphasize early detection and prevention. 19 We strongly endorse their conclusions and recommendations and feel these could be adapted to …