CKD affects an estimated one in ten adults across Europe, claims millions of lives prematurely each year and costs European healthcare systems around €140bn.1-3
The challenge is that few people know they have the disease because its early stages are usually asymptomatic.4 If detected early and countered with preventive care and therapeutic interventions, its progression can be slowed and complications minimised, helping people live longer, healthier lives and reducing the socioeconomic impact of CKD.5-7
Early detection of CKD should be a priority and an essential component of government health plans and public health programmes across Europe. This report investigates why it is not and how Europe’s approach to CKD can be improved.
For policymakers, early detection of CKD is the most cost-effective strategy in their arsenal
First, public awareness could be increased through population-wide campaigns. Second, awareness and knowledge of CKD among the primary healthcare workforce could be increased via clinical education programmes. Third, patient advocacy groups can be supported to communicate more widely with clear messaging around the issue. Fourth, policymakers can add balance to existing national health policies so that CKD awareness and education is prioritised by multiple stakeholders.
Implement targeted screening for at-risk individuals
Early detection and monitoring strategies for at-risk populations should be introduced. In addition to this, CKD testing could be integrated into health checks in countries that have these. Incentives could also encourage testing of at-risk patients.
€80,000 annually per patient250,000 people in Europe rely on dialysis for survival, a number that is rising by 5-8% per year.9 The most common form of dialysis, haemodialysis, costs approximately €80,000 annually per patient.10
Integrate CKD management strategies into those of other non-communicable diseases (NCDs)
When trying to reduce the burden of CKD, it should not be isolated from other NCDs, especially since CKD is commonly comorbid with heart disease, diabetes and hypertension. Policymakers should look to address CKD both separately and alongside heart disease and diabetes strategies.
We all know heart disease is killing people, but the population is not aware that kidney disease can kill people with heart disease and stroke
Expand renal registries to include the earlier stages of CKD
This will foster better understanding of the epidemiology of the disease and outcomes. It will provide countries with data on how many individuals are in the early stages of CKD and monitor the results of disease management programmes.
Adapt international guidelines for national use
The Kidney Disease Improving Global Outcomes (KDIGO) is a global organisation that develops evidence-based clinical practice guidelines. These guidelines are well respected globally and should be locally tailored for both patients and clinicians. Targeted and simplified tools could be developed from guidelines and aimed at primary care providers. Teaching of guideline-based care could be included in medical school curriculums.15
Foster the development of digital solutions
Countries should continue to invest in electronic health records and develop long-term plans for maximising the data collected by renal registries. Standards are required for the exchange of data, for example, ensuring better structuring of data for interoperability and ensuring timely, complete data reporting.
Having a label of CKD is the single most powerful predictor of a worse outcome for any disease
Chronic kidney disease
This virtual event programmed by Economist Impact and supported by AstraZeneca examines the need to respond to CKD and consider what industry and policymakers can do to accelerate care.
References
- EKHA. The decade of the kidney [Internet]. Brussels: European Kidney Health Alliance. Available from: https://ekha.eu/the-decade-of-the-kidney/.
- Sundström J, Bodegard J, Bollmann A, et al. Prevalence, outcomes, and cost of chronic kidney disease in a contemporary population of 2.4 million patients from 11 countries: the CaReMe CKD study. The Lancet Regional Health - Europe. 2022;20:100438.
- Vanholder R, Annemans L, Bello AK, et al. Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney. Clin Kidney J. 2021;14(7):1719-30.
- Berns J. Routine screening for CKD should be done in asymptomatic adults... selectively. Clin J Am Soc Nephrol. 2014;9(11):1988-92.
- NIH. Slow progression & reduce complications [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases. Available from: https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/kidney-disease/identify-manage-patients/manage-ckd/slow-progression-reduce-complications.
- National Kidney Foundation. Self-management, diabetes and chronic kidney disease: a teching tool for diabetes educators. New York (NY): National Kidney Foundation, 2007. Available from: https://www.kidney.org/sites/default/files/12_10_2095_SelfManagement.pdf.
- Molina P, Gavela E, Vizcaíno B, et al. Optimizing diet to slow CKD progression. Frontiers in Medicine. 2021;8.
- Chu CD, Chen MH, McCulloch CE, et al. Patient awareness of CKD: a systematic review and meta-analysis of patient-oriented questions and study setting. Kidney Med. 2021;3(4):576-85.e1.
- Biebuyck GKM, Neradova A, de Fijter CWH, et al. Impact of telehealth interventions added to peritoneal dialysis-care: a systematic review. BMC Nephrology. 2022;23(1):292.
- EKHA. Recommendations for sustainable kidney care [Internet]. Brussels: European Kidney Alliance. Available from: https://ekha.eu/wp-content/uploads/2016/01/EKHA-Recs-for-Sustainable-Kidney-Care-25.08.2015.pdf.
- Bochud M. On the rationale of population screening for chronic kidney disease: a public health perspective. Public Health Reviews. 2015;36(1):11.
- Drawz PE, Rosenberg ME. Slowing progression of chronic kidney disease. Kidney Int Suppl (2011). 2013;3(4):372-6.
- MacRae C, Mercer SW, Guthrie B, et al. Comorbidity in chronic kidney disease: a large cross-sectional study of prevalence in Scottish primary care. British Journal of General Practice. 2021;71(704):e243-e9.
- Pesce F, Pasculli D, Pasculli G, et al. “The disease awareness innovation network” for chronic kidney disease identification in general practice. Journal of Nephrology. 2022;35(8):2057-65.
- Shlipak MG, Tummalapalli SL, Boulware LE, et al. The case for early identification and intervention of chronic kidney disease: conclusions from a kidney disease: improving global outcomes (KDIGO) controversies conference. Kidney International. 2021;99(1):34-47.
Veeva ID: Z4-55190
Date of Preparation: November 2023
Date of Preparation: November 2023