The chronic kidney disease epidemic: stepping back and looking forward

Area of Science:

• Nephrology
• Epidemiology
• Public Health

Background:

• Estimating chronic kidney disease (CKD) prevalence is complex, with challenges in testing precision and accessibility to certain populations.
• While CKD prevalence appears stable, associated risk factors like obesity and diabetes are increasing, contrasting with decreasing hypertension and smoking rates.
• End-stage renal disease (ESRD) rates may be stabilizing, suggesting potential benefits from interventions in high-risk groups.

Purpose of the Study:

• To analyze the complexities in estimating CKD prevalence and identify barriers to reducing ESRD.
• To evaluate the impact of changing epidemiologic factors on CKD and ESRD trends.
• To explore strategies for reducing ESRD, including improved detection and management of high-risk patients.

Main Methods:

• Review of epidemiologic data and trends in CKD and ESRD.
• Analysis of factors influencing CKD prevalence and progression.
• Discussion of clinical inertia and treatment strategies.

Main Results:

• CKD prevalence estimation is hindered by imprecise diagnostic tests and survey limitations.
• Discrepancies exist between stable CKD prevalence and rising ESRD, with speculative explanations.
• High-risk groups (e.g., diabetics, Black individuals) remain undertreated, and clinical inertia is a significant barrier.

Conclusions:

• Reducing ESRD requires addressing clinical inertia and controlling precipitating causes like diabetes and hypertension.
• Expanding CKD definition and detection may be necessary, but evidence for low-risk patient treatment is needed.
• Further research is required to determine the cost-effectiveness and target populations for new CKD interventions.