The 14th of March is World Kidney Day. This year’s theme is Kidney Health For Everyone Everywhere.
Your kidneys are responsible for removing waste products from your system by filtering your blood. According to the International Federation of Kidney Foundations, in just one day as much as 180 liters of your blood gets filtered and is cleaned by your kidneys up to 50 times.
It is now estimated that 850 million people worldwide suffer from kidney disease brought about by various causes. Chronic kidney disease (CKD) is the 6th fastest growing cause of death, causing at least 2.4 millions deaths per year. CKD will be the 5th leading cause of Years of Life Lost by 2040 if policy change continues to be stagnant. Over 13 million people worldwide suffer from acute kidney injury (AKI), which is also a driver of CKD.
In 2010, 2.6 million people worldwide with end-stage kidney disease or ‘kidney failure’ received dialysis or kidney transplantation. It is projected that by 2030, this number will rise to 5.4 million people.
Despite the considerable human and economic cost of kidney disease, it is still not one of the prioritised non-communicable diseases (NCD) in international health-making policy. However, kidney disease is a contributing factor to other NCDs such as diabetes and cardiovascular disease (which is the number 1 cause of deaths worldwide). Failing to address kidney disease is failing to address a common root cause of morbidity and mortality worldwide.
World Kidney Day (WKD) started in 2006 as a campaign to raise global awareness about the importance of our kidneys and the prevalence of chronic kidney disease (CKD). It is a joint initiative between the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations.
Previous WKD campaigns concentrated on preventative behaviours, awareness of risk factors and awareness of people that live with a kidney disease.
This year’s theme aims to highlight the growing global burden of kidney disease and how kidney health disparity and inequity affects populations worldwide. For many, there are overwhelming barriers affecting their access to adequate kidney care, if it’s available at all.
The UN held a High-level Meeting in September 2018 where it addressed NCDs. Target 3.4 of the UN’s Sustainable Development Goals (SGDs) aims to “by 2030 reduce by one-third pre-mature mortality from non-communicable diseases (NCDs) through prevention and treatment, and promote mental health and wellbeing.” However, in that September meeting, the UN recognised that actions to address NCDs have been inadequate and investment insufficient. Despite this declaration, the next High-level Meeting on NCDs is not scheduled until 2025.
The mission of WKD 2019 is to advocate for both making kidney disease a priority NCD and for “universal health coverage (UHC) for prevention and early treatment of kidney disease as sustainable options to reduce costs and consequences of kidney diseases for individuals and countries.”
The European Kidney Health Alliance (EKHA) launched Recommendations for Sustainable Kidney Care in 2015. The centerpieces of these recommendations were large-scale surveys in EU Member States. Their goal is to get a real-time snapshot of how much choice kidney disease patients have when choosing treatment.
One survey aimed to study the issues of how dialysis dependence impacts patients’ ability to continue their work or studies, the time lost at dialysis including traveling to and from, health implications, implications for personal and family life and the inability to be mobile or travel.
This survey discovered great disparities between the participating Member States but no country offered all renal replacement therapy options and there is a lack of patient education about all sustainable options. Preliminary results from a larger, ongoing survey have found a similar trend.
The findings of these recent surveys highlights the continuing need to address the inequalities to access that exist between and within countries in the realm of kidney disease and health.
I have a personal connection to what life is like living with chronic kidney disease.
My father was diagnosed with kidney disease at the age of 29 and, to the surprise of my parents and his doctors, he lived with it for next 35 years. He was on dialysis for a short time before having a kidney transplant at the age of 48. After going through several months of rejection, he recovered and enjoyed his new kidney for the next 7 years. He was back on dialysis for the last 9 years of his life.
The most likely cause of my father's kidney disease was glomerulonephritis - inflammation of the kidney's tiny filtering units called the glomeruli - following a case of undiagnosed strep throat but my father and his doctor were never quite sure why he developed it.
My father’s documented cause of death was peripheral artery disease (PAD), a narrowing of the arteries that serve the legs, stomach, arms and head, the areas that are “peripheral” or away from the heart.
If you read his medical file further, you would see he had diabetes and might assume that was the cause of the PAD. However, my father developed steroid-induced diabetes during the rejection phase of his kidney transplant. Steroid therapy is commonly used to modulate the immune system in patients who have receive a solid organ transplant. My father was given steroid therapy again when he began to lose the transplanted kidney.
So while my father did have these more recognized NCDs (diabetes, cardiovascular disease), the root cause of these later medical issues was kidney disease.
My father was fortunate to have a job that provided health insurance but also to live in a country where dialysis is covered by a federal program. In 1972, an End Stage Renal Disease (ESRD) benefit was established within Medicare and this legislation provided federal government financing for nearly all Americans with kidney failure. It continues to be the only definitive coverage for any disease in the United States.
My father made the most of life despite his condition but one thing he wanted to do was travel internationally. Unfortunately, this was restricted by his health and then access to dialysis as his treatments were only covered in the United States. My father chose to live through me vicariously, encouraging and enabling me to travel abroad and then grilling me when I returned - about what the country smelled like, how the food tasted, what were the people like. My father was a social worker and always curious about other people and cultures.
However, as medical travel has increased, more high-quality hospitals are offering opportunities for dialysis patients on to travel beyond their home countries without having to worry as much about the financial burden of paying for dialysis treatments out-of-pocket, previously often costing more than the trip itself.
BIMC Nusa Dua, one of Qunomedical's partner clinics in Bali, offers Holiday Dialysis Packages that include 3 dialysis treatments, 6-night villa stay for 2 or 4 people, pool, breakfast, and airport transfers - all for less than it would have cost my family to go on a 4-day international trip in 2004.
Medical providers like BIMC Nusa Dua have opened up more of the world to those on dialysis by allowing them to combine their trip with high-quality treatment. A trip my father never would have thought was possible but I would have loved to take him on.
Wondering what you can do? Here are some actions you can take to bring awareness to kidney health:
Treatment options for kidney disease have come a long way but not all have access. There is still a long way to go in recognising the public health challenge that kidney disease poses worldwide.
This World Kidney Day, Qunomedical continues to do its part in advocating for access for all to quality, affordable healthcare.
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