Thursday, March 9, 2006

World Kidney Day Statement from the American Society of Nephrology

From the American Society of Nephrology:
"World Kidney Day" is a concept developed by the International Federation of Kidney Foundations and the International Society of Nephrology to draw attention to the increasing global pandemic of kidney and associated cardiovascular diseases. The American Society of Nephrology joins with our colleagues in the ISN and IFKF in support of World Kidney Day to be launched on March 9, 2006 and fully inaugurated by March 8, 2007. The ASN wishes to participate by sharing this important message to federal agencies, government health officials, general physicians, applied health professionals, patients, and their families.

The incidence of chronic kidney diseases is increasing worldwide and these conditions are emerging as major public health problems. Progression to end stage kidney disease (ESRD) is common in numerous types of kidney diseases and often culminates in sclerosis and ESRD, regardless of the initial etiology. The number of new cases of ESRD in the United States is projected to be 650,000 by 2010, with accompanying Medicare expenditures of $28 billion. Although a major goal of "Healthy People 2010" is to reduce the incidence of ESRD, recent evidence has suggested that the incidence of ESRD is increasing faster than the prevalence of CKD.

Moreover, it has been appreciated recently that mild to moderate kidney disease is a risk factor for the development of cardiovascular disease and that many patients with Stage I or II kidney disease succumb to cardiovascular disease before progression to ESRD. In the United States, chronic kidney disease continues to grow to epidemic proportions, with some studies estimating that approximately 10 million Americans have some degree of renal insufficiency. The renal protective effects of reduction in proteinuria is a theme developed from seminal fundamental observations that has recurred in clinical trials in non-diabetic nephropathy, and in Type I and Type II diabetes mellitus.

Since in many underdeveloped nations renal replacement therapy is either scarce or non-existent, patients with CKD face a bleak future. Paradoxically, in developing nations, the incidence of metabolic syndrome and Type II diabetes is increasing rapidly. Programs which provide assistance to these countries to demonstrate that inexpensive treatment is efficacious for the prevention of CKD prevention are clearly needed.

Closer to home, the evidence for slowing progression appears not to have gained wide acceptance in the practicing community. Several studies have demonstrated that proven strategies to slow progression are not being widely applied and early referral to nephrologists for evaluation and management of kidney disease, also associated with improved outcomes, have not gained wide acceptance.

Therefore, beginning with World Kidney Day, nephrology societies, international medical organizations, and individual nephrologists should help to draw attention to the necessity for early detection and for deployment of effective strategies to slow progression of chronic kidney disease. The public health mandate, to address chronic kidney disease at the level of early detection and prevention as the most cost effective method to address this problem, will require concerted advocacy. The strategy behind World Kidney Day, to enlist national and local societies and foundations to help achieve a better understanding of kidney disease is sound, but only a beginning. It is anticipated that through recognition of a special awareness day, there will follow an appreciation of the need for a more concerted effort worldwide. The American Society of Nephrology is eager to join with the International Society of Nephrology and other organizations to resolve that by working together, we can attempt to achieve a major reduction in the burden of kidney and cardiovascular disease.

Sincerely yours,
Thomas D. DuBose, Jr., MD, FASN
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