You cannot fix it when you don’t know there is a problem

In this blog post, Dr. Sumeska Thavarajah, looks at the 2022 theme for World Kidney Day and the challenges faced by the nephrology community.

The 2nd Thursday of March is designated as World Kidney Day.  Starting in 2006, the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations established this with the intention of reducing the frequency of kidney disease and associated conditions. Over the years, the themes have highlighted the impact of obesity, the importance of a healthy lifestyle to reduce the development of risk factors for kidney disease, the role of diabetes, and the lack of recognition of pregnancy complications as a marker of future kidney disease.   This year there was a shift in theme from a focus on a risk factor or a population at risk to an acknowledgement of the biggest challenge facing kidney disease:  the knowledge gap. 
The last 2 to 3 years have been marked by the use of SGLT2 inhibitors with the potential of improving renal and cardiovascular outcomes, the signing of the American Kidney Health initiative for the promotion of transplantation and home dialysis modalities, and the final report by the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases recommending incorporation the CKD-EPI Creatinine formula that did not incorporate a race modifier and support of finding newer markers for improved estimation of kidney function. All of these have contributed to moving forward in nephrology care through new treatment options and expanding access to care but don’t address the biggest challenge to kidney care which is awareness of the prevalence, the scope of those at risk, and the downstream impact to financial and socioeconomic parameters.

The concept of ‘ bridging the knowledge gap’ should not stop with the development of patient education programs but needs to be expanded to target caregivers, health care providers and government organizations.  This approach validates the effects of kidney disease not being limited to physical changes.  The diagnosis of kidney disease and the need for renal replacement therapy, either dialysis or transplantation, are life-changing with potential losses of vocation, income, socioeconomic status, and functional status.  Consideration for the caregiver role and challenges needs to be part of the discussions about kidney disease management.  Kidney disease screening and early intervention have to be prioritized for primary care providers given the rising health care costs associated with late presentation, and the risk of cardiovascular complications.   Advocacy efforts are also part of the strategy to hopefully have renal disease be more visible to public policymakers.   This will be particularly important to advocate for the needs of those without traditional risk factors of kidney disease such as chronic kidney disease of unknown etiology/uncertain cause (CKDu) and those that developed acute kidney injury in the setting of COVID infections where those without many resources are disproportionately affected.   

Bridging this knowledge gap will be essential to improving kidney care for all worldwide. 

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