The Burden of Chronic Kidney Disease on Developing Nations: A 21st Century Challenge in Global Health

Chronic diseases present a significant challenge to 21st century global health policy. In developing nations, the growing prevalence of chronic diseases such as chronic kidney disease has severe implications on health and economic output. The rapid rise of common risk factors such as diabetes, hypertension, and obesity, especially among the poor, will result in even greater and more profound burdens that developing nations are not equipped to handle. Attention to chronic diseases, chronic kidney disease in particular, has been lacking, largely due to the global health community’s focus on infectious diseases and lack of awareness. There is a critical need for funding in and to developing countries to implement more comprehensive, cost-effective, and preventative interventions against chronic diseases. This paper examines the epidemiology of chronic diseases, the growing prevalence of chronic kidney disease and its implications for global public health, and the associated health and economic burdens. Finally, a summary review of cost-effective interventions and funding needs is provided. Copyright © 2011 S. Karger AG, Basel Published online: January 7, 2011 Rachel A. Nugent, PhD Center for Global Development 1800 Massachusetts Ave NW, 3rd Floor Washington, DC 20036 (USA) Tel. +1 202 416 4047, Fax +1 202 416 0500, E-Mail rnugent @ cgdev.org © 2011 S. Karger AG, Basel 1660–2110/11/1183–0269$38.00/0 Accessible online at: www.karger.com/nec 1 In this context, CDs are defined as noncommunicable diseases that persist for long durations of time, such as CKD and CVD. The WHO describes CDs as type 2 diseases. 2 Developing countries, also referred to as lowand middle-income countries, are defined by criteria established by the World Bank. D ow nl oa de d by : 54 .7 0. 40 .1 1 11 /2 3/ 20 17 2 :4 4: 51 A M Nugent /Fathima /Feigl /Chyung Nephron Clin Pract 2011;118:c269–c277 c270 tional health, economic improvement, and urbanization have resulted in a major surge in life expectancy and improvement in quality of life. These advances are countered by increased exposure to risk factors associated with CDs, such as unhealthy diets and lack of physical activity [5] . Among CDs, chronic kidney disease (CKD) is of particular significance and contributes heavily to the global CVD and end-stage renal disease (ESRD) [6, 7] . CKD ultimately progresses to ESRD, the rate of which is dependent on coexisting pathologies and risk factors [6] . Jungers et al. [8] found that the incidence of de novo CVD events in a non-ESRD cohort of CKD patients was 41% in men and 19% in women over a 10-year span. As documented by Foley et al. [9] , the prevalence of CVD in ESRD and end-stage CKD patients increases to 74%. CKD is a burden not just for renal replacement therapy (RRT) demands but also for overall population health. Currently, CKD is the 12th highest cause of death and 17th highest cause of disability worldwide [6] . However, the rapid surge in diabetes and hypertension (HT), both of which are predicted to drive epidemics in CKD and CVD, will dramatically escalate this burden. CKD is expected to be a profound 21st century medical challenge [10] . As the global health paradigm shifts towards CDs, the current development aid for health focus on infectious diseases [3] is no longer a sustainable approach in developing countries. The impact of CDs is overwhelming and there is a dire need for a greater alignment of funding with the burden of CDs. Coordinated and integrated action to target the growing prevalence of CDs will become essential in 21st century global public health policy. Chronic Kidney Disease CKD 3 , 4 is a complex and progressive condition [11] that arises from both noncommunicable diseases 5 ( fig. 1 ) and infectious diseases, such as malaria, schistosomiasis, DM, HT, GN GN DM, GN, HT, UD DM, HT DM GN, HT, DM, UD DM, GN, HT DM, HT GN, DM, MS, HT GN – Glomerulonephritis DM – Diabetes Mellitus