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Chronic Kidney Disease

Chronic Kidney Disease

Goal 

Reduce new cases of chronic kidney disease (CKD) and its complications, disability, death, and economic costs.

Overview

CKD and end-stage renal disease (ESRD) are significant public health problems in the United States and a major source of suffering and poor quality of life for those afflicted. They are responsible for premature death and exact a high economic price from both the private and public sectors.

Why Is Chronic Kidney Disease Important?

Meeting the Healthy People 2020 objectives for CKD may lead to:

  • A reduction in the kidney disease burden
  • Longer lives and improved quality of life for people with CKD
  • Elimination of disparities among kidney disease patients

CKD and ESRD are very costly to treat. Nearly 25 percent of the Medicare budget is used to treat people with CKD and ESRD.1

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Understanding Chronic Kidney Disease

Genetic determinants have a large influence on the development and progression of CKD. It is not possible to alter a person’s biology and genetic determinants; however, environmental influences and individual behaviors also have a significant influence on the development and progression of CKD. As a result, some populations are disproportionately affected. Successful behavior modification is expected to have a positive influence on the disease.

Over the past decade, several studies have shown that proteinuria (too much protein in the urine) predicts faster progression of kidney disease to ESRD.2, 3, 4, 5, 6, 7, 8, 9 This is especially true in people with diabetes. Furthermore, these and other studies have shown that drugs that reduce proteinuria can also slow the progression of established kidney disease. These drugs include angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs).

Diabetes is the most common cause of kidney failure. The results of the Diabetes Prevention Program (DPP) funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) show that moderate exercise, a healthier diet, and weight reduction can prevent development of type 2 diabetes in persons at risk.10, 11 These initiatives, community programs, and guidelines are consistent with the Chronic Kidney Disease 2020 objectives. Furthermore, all racial and ethnic groups have benefited equally from these lifestyle modification programs. Based on these results, voluntary organizations and many communities around the country have also launched programs aimed at healthier lifestyles to prevent diabetes.* These initiatives, community programs, and guidelines are consistent with the Chronic Kidney Disease 2020 objectives.

Emerging Issues in Chronic Kidney Disease

The proportion of ESRD patients receiving a kidney transplant within 3 years of registration on the waitlist has been on the decline over the past decade. In 1999, the proportion of patients who received a transplant within 3 years was about 19 percent, which is lower than the approximately 25 percent transplanted in 1990. This downward trend is observed in all racial and ethnic groups, and in both men and women. The declining trend is due to the lack of available organs for transplantation. The critical shortage of organs for transplantation has prompted the formation of an advisory group by the U.S. Department of Health and Human Services to address the issue.

References

1Friedman EA, Friedman AL. Payment for donor kidneys: Pros and cons. Review. Kidney Int. 2006;69(6):960-2.

2US Renal Data System. USRDS 2009 annual data report: Atlas of end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2009.

3Peralta CA, Kurella M, Lo JC, et al. The metabolic syndrome and chronic kidney disease. Curr Opin Nephrol Hypertens. 2006 Jul;15(4):361-5.

4Coppo R, Andrulli S, Amore A, et al. Predictors of outcome in Henoch-Schonlein nephritis in children and adults. Am J Kidney Dis. 2006 Jun;47(6):993-1003.

5Osawa H, Nakamura N, Shirato K, et al. Losartan, an angiotensin II receptor antagonist, retards the progression of advanced renal insufficiency. Tohoku J Exp Med. 2006;209(1):7-13.

6Weinberg AJ, Zappe DH, Ramadugu R, et al. Long-term safety of high-dose angiotensin receptor blocker therapy in hypertensive patients with chronic kidney disease. J Hypertens. 2006;24(suppl 1):S95-9.

7Ravera M, Re M, Deferrari L, et al. Importance of blood pressure control in chronic kidney disease. J Am Soc Nephrol. 2006;17(4 suppl 2):S98-103.

8Barnett A. Prevention of loss of renal function over time in patients with diabetic nephropathy. Review. Am J Med. 2006;119(5 suppl 1):S40-7.

9Ishimitsu T, Kameda T, Akashiba A, et al. Effects of valsartan on the progression of chronic renal insufficiency in patients with nondiabetic renal diseases. Hypertens Res. 2005;28(11):865-70.

10Nakayama Y, Nonoguchi H, Kiyama S, et al. Long-term renoprotective effect of combination therapy with prostaglandin E1 and angiotensin-converting enzyme inhibitor in patients with chronic renal failure. Hypertens Res. 2005 Sep;28(9):733-9.

11Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or Metformin. New Engl J Med. 2002;346(6):393-403.

Footnote

*For more information, visit the National Institutes of Health and Centers for Disease Control and Prevention. National Diabetes Education Program [Internet home page]. Available from: http://ndep.nih.gov/

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