A nurse assisting patient undergoing renal dialysis in hemodialysis centre, Kuala Lumpur, Lamasya. ©Shutterstock

Everyone’s right to kidney health - achieving kidney health equity across the globe

12th March 2019

Despite the growing burden of kidney disease worldwide, kidney health disparity and inequity are still widespread. The World Kidney Day 2019 theme is highlighting these disparities and emphasises the role of public policies and organisational structures in addressing them. Unveiling the social construct of kidney health disparities and therefore giving rise to the opportunity for countries to mitigate these inequities, WKD 2019 urges its stakeholders to call upon their policy makers to devise better kidney care and to streamline efforts toward achieving kidney health equity across the globe.

This year, in its 14th reiteration, World Kidney Day will be marked on March 14. True to form and its objective of spreading awareness of risk factors for kidney disease and of the high and increasing burden of kidney diseases worldwide, the 2019 campaign spotlights the benefits of accessible, adequate, appropriate and affordable coverage for kidney diseases prevention and management.
850 million people worldwide are now estimated to have kidney diseases from various causes. There are many kinds of kidney disease all of which are characterised by a sudden or gradual loss of kidney function. Chronic Kidney Disease (CKD) causes at least 2.4 million deaths per year, half of which are cardiovascular related deaths due to low kidney function; and is now the 6th fastest growing cause of death. Acute kidney injury (AKI), an important driver of CKD, affects over 13 million people worldwide and 85% of these cases are found in low and middle-income countries. Around 1.7 million people are estimated to die annually because of AKI.  
In many settings, rates of kidney disease and the provision of its care are defined by socio-economic, cultural, environmental and political factors, leading to significant disparities in disease burden, even in developed countries. 
Disparities in kidney health and inequitable access can be linked to the social conditions in which people are born, grow, live, work and age including poverty, gender and racial discrimination, lack of education, occupational hazards and pollution among others. Persons of lower socioeconomic status bear the greatest burden as regards being at an increased risk of developing kidney disease and kidney failure. This can be scaled also to a macro level with gross domestic product being correlated with lower dialysis-to- transplantation ratios, suggesting greater rates of kidney transplantation in more financially solvent nations. However even in developed countries, persons with advanced CKD who have no or limited public or private sector funding for care shoulder a substantial financial burden thus experiencing inequitable access to kidney care. 
As for many non-communicable diseases, early diagnosis, prevention and delay of progression are sustainable options to reduce costs and consequences of kidney diseases for individuals and countries. Yet, barriers to available, accessible, adequate and quality kidney care persist.
Therefore, Kidney Health for Everyone Everywhere calls for universal health coverage (UHC) for prevention and early treatment of kidney disease. Specifically, WKD calls on everyone to advocate for concrete measures in every country to improve kidney care:
  • Encourage and adopt healthy lifestyles (access to clean water, exercise, healthy diet, tobacco control).
  • Make screening for kidney diseases a primary healthcare intervention including access to identification tools (e.g. urine and blood tests). 
  • Ensure kidney patients receive basic health services they need (e.g. blood pressure and cholesterol control, essential medications) to delay disease progression without suffering financial hardship.
  • Call for transparent policies governing equitable and sustainable access to advanced health care services (e.g. dialysis and transplantation) and better financial protection (e.g. subsidies) as more resources become available. 
The global push towards Universal Health coverage represents an opportunity for substantial reform of kidney disease care around the world.

About the Authors

Prof Philip KT Li is Chief of Nephrology at Prince of Wales Hospital, Chinese University of Hong Kong; President of the Asian Pacific Society of Nephrology; and Past President, International Society for Peritoneal Dialysis.
Prof. Guillermo Garcia Garcia is Director and Founder of the Nephology Department, Hospital Civil de Guadalajara; Director and Founder, of the Postgraduate Nephrology Fellowship, at the University of Guadalajara Health Sciences Center, in Guadalajara, Mexico; Past-President, of the International Federation of Kidney Foundations (IFKF); and Member of the Mexican National Council for Science and Technology’s (CONACYT's) National Researchers Network, Level III.
World Kidney Day (@worldkidneyday) takes place on the 14th of March, and is a joint initiative of the International Society of Nephrology and the International Federation of Kidney Foundations.