A new Commission from The Lancet and the International Society of Nephrology reports on an initiative launched in 2013 calling for an end to preventable deaths from acute kidney injury within the next 10 years.
Although it affects around 13 million people annually worldwide and contributes to 1.7 million deaths per year, acute kidney injury (AKI) is preventable and treatable for a cost of just $150 per patient.
Prof. Giuseppe Remuzzi, president of the International Society of Nephrology (ISN), believes the provision of this treatment should be a universal standard:
“The ability to provide lifesaving treatments for acute kidney injury provides a compelling argument to consider therapy for it as much as a basic right as it is to give antiretroviral drugs to treat HIV, especially as care needs only be given for a short period of time in most patients,” he says.
AKI is becoming increasingly common throughout the world. It is a serious condition that causes abrupt or rapid decline in kidney function and can lead to chronic kidney disease and end-stage renal disease. Treatment for these complications, including dialysis and transplantation, can be expensive – more so than treatment for lung and skin cancer combined.
Estimates suggest that 1 in 5 adults admitted to hospital develop AKI, though the authors of the Commission believe that this is likely to be an underestimation of the disease’s true public health burden, given that most cases of AKI are not recorded in low- and middle-income countries.
The majority of avoidable deaths caused by AKI are also reported to occur in low- and middle-income countries, where the condition is predominantly a community-acquired disease affecting the young and otherwise healthy, and associated with diarrhea and infections such as malaria.
While at present, low- and middle-income countries may not have adequate resources to diagnose and treat AKI, the Commission demonstrates that most cases are preventable, can be detected early and are treatable with 1-2 weeks of inexpensive peritoneal dialysis – a form of dialysis that does not require electricity or water supplies.
In order to achieve their goal of no preventable deaths by 2025, the Commission sets out the following three-part strategy:
- Establish the true extent of AKI and include it on the global health agenda
- Raise awareness of AKI at all levels of national health systems and improve overall care
- Encourage stakeholders to invest in a sustainable infrastructure.
“We are confident that many of the preventive and therapeutic interventions against AKI can use existing infrastructure, advances in technology and human resources across different regions,” says Commission co-author Prof. Ravindra Mehta, from the University of California San Diego Medical Center.
According to another article published in The Lancet, there is a global shortage of treatment for kidney failure; it is estimated that only half of people that needed dialysis or transplantation to treat kidney failure in 2010 received it.
This estimate suggests that around 2.3 million people may have died prematurely on account of not receiving this life-saving treatment. “The high cost of current dialysis techniques ($20,000-100,000 per person each year) are unaffordable to most people who need it,” says lead author Prof Vlado Perkovic.
Prof. Perkovic and his colleagues conducted a systematic review of observational studies and renal registries while contacting national experts to collect data concerning the numbers of patients receiving dialysis and kidney transplantation in 123 countries. The data collected represent 93% of the world’s population.
The researchers found that 2.62 million people were treated with dialysis or kidney transplantation in 2010, with 92.8% of these patients living in high- or high-middle-income countries. However, they also calculated that between 4.9 million and 9.7 million patients needed these treatments worldwide during the same year, depending on how conservative the estimation model used was.
“These scenarios suggest that between 2.3 million and 7.1 million individuals who could have been kept alive with RRT [dialysis and kidney transplantation] in 2010 died prematurely because treatment was unavailable,” states Prof. Perkovic.
“The large number of deaths occurring because of poor access to treatment sets a demanding task for the nephrology community and the health-care and research communities in general.”
Due to this research, the ISN, George Institute and the Asian Pacific Society of Nephrology have set up together a worldwide competition calling for participants to design the world’s first truly affordable dialysis machine. A prize of $100,000 awaits the winner.
“If we can develop an affordable dialysis machine with low operating costs that runs on solar power and uses local water sources, many more people will have access to the treatment and millions of lives could be saved,” concludes Perkovic.
This week, one of Medical News Today’s Spotlight features takes a look at how drinking water is crucial for the health of the kidneys.