Visualizing the rise of chronic kidney disease worldwide

Relatives mourn the death of Segundo Zapata Palaces in Chichigalpa, Nicaragua. Zapata, who worked as a sugar cane cutter for 20 years, died of chronic kidney disease at age 49. Many parts of Central America are experiencing chronic kidney disease at rates unseen virtually anywhere else and the cause is often unknown. AP

By Lauren Hashiguchi, special to Humanosphere

Non-communicable diseases today account for nearly 70 percent of all deaths globally, according to the latest results from the Global Burden of Disease study, an ongoing project to measure the impact of disabling and deadly conditions across the world.

Among the major non-communicable killers such as chronic obstructive pulmonary disease, diabetes, and stroke, one of the lesser-recognized but increasingly significant causes of death is chronic kidney disease.

In 2013, nearly one million people died from chronic kidney disease. While this represents less than 2 percent of all deaths globally, it is a 135 percent increase from the number of chronic kidney disease-related deaths in 1990.

While the global increase in chronic kidney disease-related deaths is driven in part by people living to older ages, there is no scientific consensus on what is making this increasingly prominent among younger adults, with a near doubling of chronic kidney disease-related deaths among people ages 15 to 49 since 1990.

Probability of death from chronic kidney disease among both sexes, ages 15 to 49, 2013

Chronic Kidney Disease younger

Source: Global Burden of Disease Study 2013. To explore the data visualization online, go to http://ihmeuw.org/2u5i

Certain regions are more greatly affected. Central America is experiencing notable declines in life expectancy because of the rise of chronic kidney disease, which causes 6 percent of all deaths in this region. Some of these regional and age-based differences are even more clear in the following graphic, which shows the global probability of death from chronic kidney disease among older adults (as compared to the graph above focused on those between 15 and 49 years old).

Probability of death from chronic kidney disease among both sexes, ages 50 to 74, 2013

ChronicKidneyDiseaseGBD

Source: Global Burden of Disease Study 2013. To explore the data visualization online, go to http://ihmeuw.org/2u5k

Called out as a “forgotten non-communicable disease” by Global Burden of Disease collaborator Alan Lopez, this condition causes considerable disability and is fatal if untreated. The disease affects populations in many low- and middle-income countries where the expensive treatments required – dialysis and kidney transplant – are not available.

A survey of 122 countries estimated that more than 80 percent of those receiving treatment live in Europe, North America or Japan; with the heavy burden of  chronic kidney disease in low- and middle-income countries and the severely limited access to treatment, it is likely most patients do not receive therapy. In places where treatment is available, the disease is a main driver of high costs associated with non-communicable diseases.

Globally, the increase in chronic kidney disease is partly driven by a complex interaction of the disease with type 2 diabetes and hypertension, two diseases responsible for major worldwide increases in death and disability. While this holds true across high- and low-income countries, people living in poor countries face additional factors that contribute to chronic kidney disease that are not typically encountered in high-income countries.

These factors include HIV, tuberculosis, hepatitis B and C, sickle cell anemia, and in certain places, exposure to pollution, pesticides and other chemicals, and certain herbal medicines. Additionally, while those diagnosed with HIV, hepatitis B and tuberculosis are surviving longer thanks to advances in treatment and screening, some drugs associated with the treatments are toxic to the kidneys and contribute to the development of chronic kidney disease.

As chronic kidney disease continues to grow as a major cause of death and disability, so will the unmet need for prevention and treatment, especially in low-income settings. To reduce the impact of chronic kidney disease, health systems will face the complex challenge of expanding capacity for screening and education programs, introducing preventive interventions, and examining the financing and feasibility of establishing treatment programs.

lauren

This is a guest post by Lauren Hashiguchi, MSPH, a policy translation specialist at the University of Washington’s Institute for Health Metrics and Evaluation.


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