Act now to address the silent epidemic of chronic kidney disease

Chronic kidney disease should be a health and policy priority in Europe¹

Around 30-40 percent of Europeans are predicted to be at risk of chronic kidney disease (CKD), many of whom may not realize it.^1,2 In fact, according to a new Economist Impact report – one of the deliverables in a broader project, designed and conducted by Economist Impact, which was funded and initiated by AstraZeneca – CKD has a higher prevalence in the EU than the estimated 52 million for diabetes and 17 million for cancer.¹

Given the high numbers — up to 100 million Europeans are estimated to already be affected by CKD — awareness is crucial if early detection is to improve patient outcomes.¹ And not just within medical communities either. Policymakers, many of whom may not recognize the urgency of CKD, must increase their understanding of what Belgian MEP Hilde Vautmans recently called “the most neglected chronic disease”.³ For example, the EU noncommunicable diseases initiative Healthier Together,launched in 2022 by the European Commission, did not include CKD as a priority area. CKD is not a priority for the World Health Organization either, which focuses on noncommunicable diseases like heart disease, stroke, cancer, diabetes and chronic lung disease.⁴

CKD is incurable and gets worse with time. Once stage 5 disease is reached, treatment options are limited to invasive dialysis and kidney transplants.

With the European Parliament elections approaching in June next year, and with an own-initiative report on Non-Communicable Diseases currently being drafted in the European Parliament’s new health subcommittee, this is an opportune moment for the CKD community to elevate the importance of the disease burden within the EU policy agenda.

Chronic kidney disease is incurable, with great cost to many¹

CKD is incurable and gets worse with time.¹ Once late stage disease is reached, treatment options are limited to invasive dialysis and kidney transplants which require a donor, surgery and lifelong drugs.¹ The impact extends socially and psychologically too, with those living with CKD reporting depression, anxiety, cognitive decline and social exclusion.¹ The burden of dialysis and transplants, as well as other comorbidities, can mean advanced CKD patients are vulnerable to unemployment, with rates of up to 75 percent reported.⁵ The impact on caregivers can be overwhelming.¹

It is of utmost importance to inform EU citizens and policymakers of the growing impact of chronic kidney disease on EU society and national budgets.

CKD is estimated to cost health care systems around €140 billion in Europe, with patients impacted financially too. ⁵ Based on data from 2015, the most common form of dialysis costs approximately €80,000 annually per person.¹ Late-stage disease can mean significant expense for patients in European countries like France, the Netherlands and Sweden, where patients must cover between 1 and 25 percent of costs out-of-pocket.¹ These patients may delay, reduce or stop treatment because of cost.The problem is far-reaching. A 2022 study of 2.4 million CKD patients obtained from digital health care systems from 11 countries found CKD-related care was the foremost driver of healthcare costs in most countries. ⁶ Atherosclerotic cardiovascular disease, which generally receives more political and health care focus, did not accrue health care costs at the level associated with CKD and heart failure, which together with diabetes is an important comorbidity.⁶

“It is of utmost importance to inform EU citizens and policymakers of the growing impact of chronic kidney disease on EU society and national budgets. Promotion of prevention and research incentives are crucial to ensure future sustainability of our health caresystems and improvement of patients’ daily lives,” said MEP Ondřej Knotek, co-chair of the MEP group for kidney health.

Even the planet is impacted. It’s worth noting that dialysis consumes around 75,000 liters of water a year per patient and generates over 900,000 tons of mainly plastic waste.¹ Early detection can delay the need for end-stage dialysis, which could reduce the environmental footprint of CKD too.¹  

So why is early detection and awareness of CKD a problem?

There’s an intangibility to kidney function, so it’s not surprising that up to 82 percent of individuals living with stage 3 CKD, a stage at which they’re estimated to have lost 41-70 percent of kidney function already, are undiagnosed.¹ Additional research claims half of affected individuals remain undiagnosed even at stages 4 and 5.¹ There are simple solutions. A 2022 study in Italy found when primary care physicians were made aware of the need for early testing and prompted to screen for early-stage CKD, a 102 percent increase in the diagnosis of people at stages 3 to 5 was seen after six months.¹

“Early intervention is needed if we want to decrease the burden of kidney disease.

While many can be heading for CKD without symptoms, the interplay between comorbidities entangles the cause-and-effect relationship between CKD and other diseases. For example, heart disease can increase the progression of kidney damage while, at the same time, poor kidney function can make heart disease worse. CKD is also closely comorbid with hypertension and diabetes.¹

CKD comorbidity presents a unique opportunity to help those most at-risk through testing and early intervention. The issue of early detection is inextricably linked to CKD awareness in patients and health care professionals.

“Early intervention is needed if we want to decrease the burden of kidney disease, which unfortunately is unknown to many, because late intervention cannot turn around the clock,” said Professor Raymond Vanholder, president of the European Kidney Health Alliance and chair of the European Chronic Disease Alliance.

Drive change through policy and awareness

European-level changes to health care policy need to be made so guidelines and policies can be implemented at a national level. Economist Impact’s report found that many European countries don’t have national CKD guidelines or policies, limiting effective referral pathways, tools or care arrangements that could positively impact CKD.¹

“Chronic kidney disease is not a priority for policymakers. It’s time for real actions, international and national health strategies to tackle kidney disease urgently. Prevention, early detection and slowing down the progression of disease are crucial,” said Daniel Gallego, president of the European Kidney Patient’s Federation.

Policy changes can help make early and targeted screening a habit among physicians, with CKD tackled both as a standalone disease as well as a component of comorbidity strategies when managing heart disease and diabetes. Crucially, early detection through screening can give patients and physicians the time to make therapy decisions or lifestyle changes, which can be facilitated by greater public awareness for those at high risk.¹

What’s more, because so many people have undetected stage 3, or more advanced CKD, management can be improved by using data sets covering stages 3 to 5.¹ This data can inform research into treatment, predict decline and slow progression.¹ Notably, Europe has not implemented a uniform approach to the adoption of digital health tools, although there is opportunity with the upcoming European Health Data Space.¹

While a lack of action on CKD will undoubtedly make things worse rather than better, the urgency of the challenge also presents a unique and engaging opportunity for European health providers and policymakers to work together to transform lives. New multistakeholder projects like PREVENTCKD, designed to support EU countries and policymakers to take earlier action on CKD, have been initiated by invested communities with support from EU4Health.⁷ While these projects are still too few to make the impact needed, they represent a change in thinking and new momentum.

CKD impacts quality of life, is a financial burden, and contributes to climate change. It needs a greater prominence on the EU policy agenda in the next political cycle. Working together can mean saving European health care systems and patients money, helping protect the future of the planet and giving back valuable time and quality of life to everyone CKD affects. The solutions will have far-reaching consequences for us all.

Read the full report at: https://impact.economist.com/perspectives/health/chronic-kidney-disease

References

1. Economist Impact: Chronic kidney disease: driving change to address the urgent and silent epidemic in Europe. March 2023. Available at:  https://impact.economist.com/projects/chronic-kidney-disease/. Last accessed March 2023.
2. Statista: Estimated population of Europe from 1950 to 2022. Available at: https://www.statista.com/statistics/1106711/population-of-europe/. Accessed April 2023.  
3. Nierstichting Nederland. Webinar on Need for Innovation in Renal Replacement Therapy (RRT), Hilde Vautmans. Available at: https://www.youtube.com/watch?v=fP-cmDZy7ac. Accessed March 2023.
4. World Health Organization: Reducing noncommunicable diseases: a signature roadmap for the WHO European Region. Available at: https://www.who.int/europe/publications/i/item/WHO-EURO-2022-6620-46386-67147. Accessed March 2023.
5. Vanholder R et al. Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney. Clin Kidney J. 2021;14(7):1719-1730.
6. Sundström J et al. Prevalence, outcomes, and cost of chronic kidney disease in a contemporary population of 2·4 million patients from 11 countries: The CaReMe CKD study. Lancet Reg Health Eur. 2022;20:100438. Available at: https://pubmed.ncbi.nlm.nih.gov/36090671/ Accessed June 2023
7. European Kidney Patients Federation: PREVENTCKD Kick off meeting. Available at: https://ekpf.eu/preventckd-kick-off-meeting/ Accessed April 2023.