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Three international nephrology societies have issued a statement asking for the World Health Organization (WHO) to add chronic kidney disease (CKD) to its list of noncommunicable disease (NCD) public health priorities.

In 2015, the United Nations issued a Sustainable Development Goal of reducing premature mortality from NCDs by a third by 2030. To that end, the WHO recognized cancer, heart disease, stroke, chronic lung disease, and diabetes — but not CKD — as the major NCD drivers of premature mortality.

Leaving out CKD was an oversight, according to a new joint consensus statement from the International Society of Nephrology, the European Renal Association, and American Society of Nephrology, and supported by three other regional nephrology societies. Global mortality from all kidney diseases likely ranges between 5 million and 11 million per year, and kidney dysfunction is currently the seventh leading risk factor for death, they point out. 

"Failure to include kidney disease in this initiative misses the opportunity to address a major contributor to premature and preventable mortality. Changing population dynamics and evolving risk accumulation mean that the global burden of kidney disease is increasing relentlessly to become the fifth most common NCD driver of mortality by 2040," according to the statement published online April 3, 2024, in Nature Reviews Nephrology. The lead author was Anna Francis, MD, a pediatric nephrologist at Queensland [Australia] Children's Hospital.

In addition to increasing premature mortality, kidney disease also promotes morbidity and disability, reduces quality of life, and "has profound individual- and health-system-level economic consequences, as well as dire environmental impacts," the authors said.

According to an accompanying editorial, "despite kidney disease being common, deadly and costly, public awareness of it remains low. This lack of awareness reflects a failure of global public health agendas to adequately acknowledge the burden of kidney disease and undermines efforts to mitigate risk factors and improve early diagnosis." 

The editorial noted that the financial burden of kidney disease is high even in many high-income countries, with approximately 2%-4% of the healthcare budget spent on the 0.1%-0.2% of the population with kidney failure. And in regions without universal health coverage, treatment — including newer therapeutics that can delay CKD progression — is unaffordable for many.

The societies say that recognition by WHO as a major driver of NCD-related early mortality would raise global awareness of CKD while furthering the development of CKD guidelines and standards of care, evidence-based prevention approaches, and new therapies. The move could also improve surveillance and allocation of current resources.

The statement calls for the following measures as "a path to developing sustainable patient-centered kidney care services to achieve Sustainable Development Goal targets": 

• Improved access to care by integrating kidney care services into routine primary care and restructuring care pathways away from hospitals and into community settings.
• A staged approach to understanding and responding to kidney disease, with a focus on region-specific risk factors, comorbidity, and multimorbidity.
• Task-sharing of integrated preventive, diagnostic and management interventions for kidney disease with nonspecialized workers in the overall context of noncommunicable disease care.
• Adoption of technological solutions, such as digital platforms and point of care tests, to facilitate the delivery of interventions across the continuum of care.
• Development of a continuum of care pathway by integrating primary preventive care with specialist care.
• Commitment to involving patients and family members in planning and providing services.
• Implementation of community-based interventions to enhance the demand for preventive care.

According to the editorial, "Such strategies could improve and save millions of lives every year."

Francis had no disclosures. Three coauthors declared funding from several pharmaceutical companies, all "unrelated to the submitted work." 

Miriam E. Tucker is a freelance journalist based in the Washington DC area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR's Shots blog, and Diatribe. She is on X @MiriamETucker.