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Kidney failure kills two million a year

Monday March 16th, 2015

More than two million people across the world die prematurely from kidney failure every year because they cannot access life-saving dialysis or transplantation.

Estimates published in The Lancet show that in 2010 only about half those needing kidney dialysis or transplantation to treat kidney failure received the treatment – meaning that at least 2.3 million people may have died prematurely.

Most of these preventable deaths occurred in China, India, Indonesia, Pakistan, and Nigeria, where less than one quarter of eligible patients receive treatment for kidney failure.

The figures were published following World Kidney Day last week.

Lead author Professor Vlado Perkovic of The George Institute for Global Health and The University of Sydney, Australia, said the high cost of current dialysis techniques – about US $20 000–$100 000 per person each year – are unaffordable to most people who need it.

“With the number of people receiving dialysis or kidney transplantation set to more than double to over five million by 2030, there is a dire need for low-cost dialysis techniques, as well as population-wide prevention programmes to tackle the key risk factors for end-stage kidney disease including diabetes, high blood pressure, and obesity,” he said.

Prof Perkovic and colleagues systematically reviewed observational studies, renal registries, and contacted national experts to collect data on the actual numbers of patients receiving renal replacement therapy (RRT; dialysis and kidney transplantation) in 123 countries.

They used mathematical modelling to develop both upper and lower estimates of the likely need for RRT in each country, and projected needs to 2030, finding that 2.62 million people were treated with RRT in 2010. A total of 92.8% of those treated in 2010 lived in high- or high-middle income countries, and just 7.2% in low- and low-middle income countries. Of the total number, 78% were given dialysis.

However, the researchers calculated that the number of patients needing RRT in 2010 was 4.9 million in a conservative model and 9.7 million if RRT access were high in all countries.

“These scenarios suggest that between 2.3 million and 7.1 million individuals who could have been kept alive with RRT in 2010 died prematurely because treatment was unavailable,” added Prof Perkovic.

They forecast that the number of people receiving RRT will more than double to 5.4 million by 2030, mostly in developing regions such as Asia and Africa.

Meanwhile, The Lancet also reports that preventable deaths caused by acute kidney injury (AKI) could be nearly eliminated in ten years.

A major new Commission from the publication and the International Society of Nephrology (ISN) reports on an ISN initiative, which was launched in 2013 and called for preventable deaths from acute kidney injury to be eliminated by 2025.

The injury, which causes an abrupt or rapid decline in kidney function, is a serious and increasingly common condition worldwide. Complications include chronic kidney disease and end-stage renal disease that need dialysis and transplantation, resulting in high long-term costs.

New estimates produced for the Commission suggest that one in five adults admitted to hospital worldwide develop acute kidney injury but because most low and middle-income countries (LMICs) do not record them, the true level in likely to be higher.

Despite most avoidable deaths occurring in LMICs where there are few resources to diagnose and treat the problem, the Commission shows that most cases are preventable, can be detected early, and are treatable with two weeks of peritoneal dialysis.

The Commission will be presented at the World Congress of Nephrology in Cape Town, South Africa on March 13-17, 2015.

Liyange T, Nimomia T et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. The Lancet 13 March 2015; doi: 10.1016/S0140-6736(14)61601-9 [abstract]

Mehta R, Cerdá J et al. International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. The Lancet 13 March 2015; doi:10.1016/S0140-6736(15)60126-X [abstract]

Tags: Australia | Internal Medicine | World Health

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