Kidney disease is a major health care burden in both the developing and the developed world, with a global prevalence of approximately 850 million people worldwide. The global burden of Chronic Kidney Disease (CKD) is increasing and is projected to become the fifth most common cause of deaths globally by 2040.
The costs of dialysis and transplantation consume 2-3 per cent of the annual healthcare budget in high-income countries, and is spent on less than 0.03 per cent of the total population of these countries.
In low-income and middle-income countries, most people with kidney failure have insufficient access to dialysis and kidney transplantation.
Disease like Diabetes, Obesity and Hypertension are on the rise and in many centres, more so in the developing world, are not adequately treated and monitored, leading to a rise in the incidence and also in the acceleration of kidney disease in select populations.
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Use of native and alternate forms of medicines to treat non-kidney ailments and use of pain killers and kidney toxic antibiotics often results in kidney disease, which adds tremendously to the global burden.
Tertiary prevention translates to management of mortality and morbidity by treating advanced disease like early and timely institution of renal replacement therapies in the form of dialysis and kidney transplant respectively.
Primary prevention of kidney disease requires modification of risk factors, including diabetes mellitus and hypertension, unhealthy diets, structural abnormalities of the kidney and urinary tracts, or nephrotoxicity levels.
Preventative primary interventions include promoting of healthy lifestyles including physical activity and healthy diets, screening for patients at higher CKD risk with the aid of urine and blood tests and keeping screening data in a CKD registry.
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In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimisation and glycemic control, is the main goal of education and clinical interventions which can be achieved by low salt, protein, as well as plant- and pharmacotherapy.
In patients with advanced CKD, management of co-morbidities, such as uremia and cardiovascular disease, is of high priority.
By Dr Partha Pradeep Shetty
The author is consultant – nephrologist transplant physician, Vikram Hospital
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