The burden of CKD

An estimated 100 million people in Europe live with chronic kidney disease and a further 300 million individuals are at risk.1, 2 The challenge is that few people know they have the disease because its early stages are usually asymptomatic.3

Policies that support raising awareness and educational campaigns—for the public and healthcare professionals—are effective tools in assisting with the early detection of CKD.

1

CKD is growing globally

CKD prevalence is outpacing other, more recognised non-communicable diseases.4 Therefore, it poses a significant threat to the sustainability of healthcare systems. As society ages, the impact, in terms of a lower quality of life, is felt by more people.

More people than ever before are living with CKD

Global prevalence of CKD compared to other diseases
CKD
Cardiovascular diseases
Diabetes (type 1 and type 2)
Chronic respiratory diseases
Source: Institute for Health Metrics Evaluation. Used with permission. All rights reserved.5
Graphic insight: Economist Impact
2

CKD in Europe

Despite millions of people being directly affected by the condition, public awareness of CKD remains low. Our analysis of ten European countries found that it is a low priority in national policy.

Estimates of Europe’s undiagnosed CKD population vary, which, given the difficulties in early detection, is not surprising. Rates of CKD prevalence, disability-adjusted life years (DALYs) and deaths per 100,000 people in selected European countries in 2019 can be explored in the section below.

Prevalence

Estimates suggest that across the EU the age-standardised prevalence rate of CKD was 6,086 per 100,000 people in 2019.5 In the ten countries shown here, that rate was thought to be highest in Poland, Romania and Greece with more than 7,000 cases per 100,000 population in each country.5

Prevalence of CKD

Rate per 100,000 people*, selected countries, 2019
BelgiumFranceGermanyGreeceItalyNetherlandsPolandPortugalRomaniaSpain5,0005,5006,0006,5007,0007,500
Source: Institute for Health Metrics Evaluation. Used with permission. All rights reserved.5
Graphic insight: Economist Impact
*Age-standardised
CKD is present among all age groups, however the proportion of people living with the disease increases considerably with age.5

EU

Across the EU in 2019, 12% of the population aged 60–64 years were thought to be affected by CKD. This rose to 25% of those aged 70–74 years, and 51% of those aged 80–84 years.5

With the majority of Europeans now expected to live until their 80th birthday, a high proportion should also expect to live with CKD at some point in their lifetime.7

EU, prevalence of CKD by age group

% of population, 2019
Source: Economist Impact calculation based on Institute for Health Metrics and Evaluation data. Used with permission. All rights reserved.5
Graphic insight: Economist Impact
3

The socio-economic burden of dialysis

CKD is an incurable, long-term condition in which kidney function declines with time.8 It is broken into five stages, each of which is associated with progressive damage.9 Early-stage symptoms (stage 1–3) are often absent or nonspecific, and include muscle cramps, fatigue, nausea, and changes to sleep, appetite and urination. Kidney functionality is reduced by around half in stage 3.9-11

Stage 1
Mild kidney damage
90% of normal kidney functionality
Stage 2
Mild kidney damage
60–89% of normal kidney functionality
Stage 3
Mild to severe kidney damage
30–59% of normal kidney functionality
Stage 4
Severe kidney damage
15–29% of normal kidney functionality
Stage 5
Most severe kidney damage
Less than 15% of normal kidney functionality
Source: World Kidney Day; American Kidney Fund10,11
Graphic insight: Economist Impact

By stage 4, kidney function is severely impacted. Stage 5 end-stage kidney disease is fatal without treatment because there is less than 15% kidney function. Treatments include dialysis—which replaces the normal blood-filtering function of the kidneys—or a kidney transplant.10

If CKD is not detected early and managed properly it becomes very expensive and burdensome for all stakeholders.12 A prospective, multicentre study conducted across 11 centres and four countries (Australia, Canada, Spain and New Zealand) found that two-thirds of the patients on dialysis (68%) said that their quality of life was reduced by their illness, severely impacting their ability to work, socialise and live a normal life.13

Dialysis patients experience a reduced quality of life

% reporting condition, by CKD patient study group*
Patients receiving dialysis
Transplant recipients
CKD stage 3–5 patients not receiving dialysis or transplant

Pain

50403020100Patients receiving dialysisTransplant recipientsCKD stage 3–5 patients not receiving dialysis or transplant

Anxiety/depression

50403020100Patients receiving dialysisTransplant recipientsCKD stage 3–5 patients not receiving dialysis or transplant

Decreased mobility

50403020100Patients receiving dialysisTransplant recipientsCKD stage 3–5 patients not receiving dialysis or transplant

Problems performing daily activities

50403020100Patients receiving dialysisTransplant recipientsCKD stage 3–5 patients not receiving dialysis or transplant
*CKD stage 3–5 patients not receiving dialysis or transplant (n = 787), Transplant recipients (n = 494), Patients receiving dialysis (n = 415)

Source: Krishnan A, Teixeira-Pinto A, Lim WH, et al.13
Graphic insight: Economist Impact
While often less top of mind, the healthcare sector is a significant contributor to climate change.12 Dialysis has a big environmental impact as it requires around 160 billion litres of water each year (equating to about 75,000 litres per patient) and generates over 900,000 tonnes of mainly plastic waste.14,15


Source: European Parliament14
Graphic insight: Economist Impact
Dialysis is largely broken down into two forms: haemodialysis and peritoneal dialysis. Haemodialysis requires the patient to use an artificial kidney machine.17 This is a 3–5 hour process that can take place in a hospital or dialysis centre three times a week.17,18 Peritoneal dialysis uses the lining of the abdomen as a filter and can be carried out at home on a daily basis through a catheter permanently inserted in the abdomen.17 Both treatments are highly expensive, with costs per CKD patient far exceeding the overall health expenditure cost per person across Europe.20-22

Dialysis costs far exceed overall health expenditure per person

Annual cost per country, 2016, US$
Overall health expenditure per person
Hemodialysis, per patient receiving treatment
Source: World Bank; International Society of Nephrology18-20
Graphic insight: Economist Impact
As CKD progresses, it becomes more costly and burdensome for patients and healthcare systems. Our research indicates that early detection of CKD should be a priority for government health policies and public health programmes across Europe. However, few countries in Europe have introduced early detection programmes, even among at-risk populations.21

It is time for a rethink

CKD health interventions largely focus on late-stage treatments which are expensive and invasive. However, if CKD is detected early, its progression can be slowed and complications minimised through preventative care and therapeutic interventions. Such early intervention helps individuals to live longer, healthier lives with reduced social and economic impacts.
It is time for a rethink
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References

  1. 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.
  2. 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.
  3. Berns JS. Routine screening for CKD should be done in asymptomatic adults... selectively. Clin J Am Soc Nephrol. 2014;9(11):1988-92.
  4. Neuen BL, Chadban SJ, Demaio AR, et al. Chronic kidney disease and the global NCDs agenda. BMJ Glob Health. 2017;2(2):e000380.
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  6. CEVR. The DALY [Internet]. Boston (MA): Center for the Evaluation of Value and Risk in Health. Available from: http://ghcearegistry.org/orchard/the-daly.
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  8. Mayo Clinic. Acute kidney failure [Internet]. Scottsdale (AZ): Mayo Foundation for Medical Education and Research (MFMER); Available from: https://www.mayoclinic.org/diseases-conditions/kidney-failure/symptoms-causes/syc-20369048.
  9. Vaidya S, Aeddula N. Chronic Renal Failure [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535404/.
  10. World Kidney Day. What happens? [Internet]. Available from: https://twitter.com/worldkidneyday/status/1370027468753633281/photo/1.
  11. AKF. Stages of kidney disease [Internet]. Rockville (MD): American Kidney Fund. Available from: https://www.google.com/url?q=https://www.kidneyfund.org/all-about-kidneys/stages-kidney-disease&sa=D&source=docs&ust=1669731078198449&usg=AOvVaw1PFcCLUcc5HmseuHruPk90.
  12. Luyckx VA, Tonelli M, Stanifer JW. The global burden of kidney disease and the sustainable development goals. Bull World Health Organ. 2018;96(6):414-22d.
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  16. European Parliament. A systematic EU approach to chronic kidney disease [Internet]. Strasbourg: European Parliament. Available from: https://www.europarl.europa.eu/doceo/document/O-9-2022-000005_EN.html.
  17. NIH. Hemodialysis [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases. Available from: https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis.
  18. Cleveland Clinic. Dialysis [Internet]. Cleveland (OH) Available from: https://my.clevelandclinic.org/health/treatments/14618-dialysis#:~:text=With%20hemodialysis%2C%20a%20machine%20removes,also%20do%20hemodialysis%20at%20home.
  19. Mayo Clinic. Peritoneal dialysis [Internet]. Rochester (MN): Mayo Foundation for Medical Education and Research. Available from: https://www.mayoclinic.org/tests-procedures/peritoneal-dialysis/about/pac-20384725.
  20. World Bank. Current health expenditure per capita (current US$) [Internet]. Washington (DC): World Bank. Available from: https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD.
  21. ISN. The global kidney health atlas: Western Europe. Brussels: International Society of Nephrology, 2018. Available from: https://www.theisn.org/wp-content/uploads/media/gkha/Western%20Europe/2.%20GKHA%202019%20regional%20slides_Western%20EU%20v1.2.pdf.
  22. ISN. The global kidney health atlas: Central & Eastern Europe. Brussels: International Society of Nephrology, 2018. Available from: https://www.theisn.org/wp-content/uploads/media/gkha/Eastern%20and%20Central%20Europe/2.%20GKHA%202019%20regional%20slides_East%20Cent%20EU%20v1.2.pdf.
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