Kidney health for everyone everywhere-from prevention to detection and equitable access to care.

The global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5th most common cause of years of life lost globally by 2040. Aggravatingly, CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplant consume up to 3% of the annual healthcare budget in high-income countries. However, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventions - be they primary, secondary or tertiary. This complementing article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney, urinary tracts, as well as the exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimization and glycaemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD, the management of co-morbidities such as uraemia and cardiovascular disease is a highly recommended preventive intervention to avoid or delay dialysis or kidney transplantation. Political efforts are needed to proliferate this preventive approach. While national policies and strategies for non-communicable diseases might be in place in all or every country. Also, specific policies directed toward education and awareness about CKD screening, management and treatment are often lacking. Hence, there is an urgent need to increase the awareness and importance of preventive measures among populations, professionals and policy makers.

Kidney Health for Everyone Everywhere - from Prevention to Detection and Equitable Access to Care.

Author(s): Li, Philip Kam-Tao; Garcia-Garcia, Guillermo; Lui, Siu-Fai; Andreoli, Sharon; Fung, Winston Wing-Shing; Hradsky, Anne; Kumaraswami, Latha; Liakopoulos, Vassilios; Rakhimova, Ziyoda; Saadi, Gamal; Strani, Luisa; Ulasi, Ifeoma; Kalantar-Zadeh, Kamyar; World Kidney Day Steering Committee

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Kidney Health for Everyone Everywhere—From Prevention to Detection and Equitable Access to Care

Cisplatin (CP) is nephrotoxic, and this side effect is used as an animal model for acute kidney injury (AKI). Earlier research has been focused on CP-induced AKI, with relatively little attention being paid to its ability to progress to chronic kidney disease (CKD) on repeated administration. We aimed here to test the dose dependency of its nephrotoxic actions by comparing various physiological, biochemical, molecular, and histopathological indices using repeated increasing doses of CP in rats. Furthermore, we investigated whether these doses of CP would result in the development of CKD. Biochemical, molecular, and histopathological measurements were conducted in plasma, urine, and/or kidneys of rats treated with increasing doses of CP at 1.6, 3.2, and 4.8 mg kg−1 weekly for four consecutive weeks. These doses induced significant and dose-dependent elevations in most of the measured renal indices. These included increased renal fibrosis, as suggested histopathologically and biochemically by the significant increase in transforming growth factor-β1, significant decrease in actin alpha 2, and variable actions of collagen I and IV. CP also dose-dependently increased nuclear factor (erythroid-derived 2)-like 2 and caspase-3. Multiple repeated doses of CP (1.6 to 4.8 mg kg−1) induced multiple episodes of AKI, leading to CKD after the 4th weekly dose and confirmed that this dosage regimen could be used as an experimental animal model of AKI progressing to CKD. These actions were driven by inflammation, oxidative, and nitrosative stress.

Effects of repeated increasing doses of cisplatin as models of acute kidney injury and chronic kidney disease in rats.

Cyanotoxins uptake and accumulation in crops: Phytotoxicity and implications on human health.

Epidemiology, molecular, and genetic methodologies to evaluate causes of CKDu around the world: report of the Working Group from the ISN International Consortium of Collaborators on CKDu.

WCN23-1191 EARLY MORTALITY (120 days) AMONGST INCIDENT HEMODIALYSIS WITH END STAGE KIDNEY DISEASE IN A SYSTEM OF OUT OF POCKET PAYMENT: A 5 YEAR RETROSPECTIVE STUDY

Chronic kidney disease (CKD) has a high prevalence in Cameroon and will become an important public health problem. Its management must be comprehensive, starting with CKD prevention to the implementation of renal replacement therapies best suited to the needs of patients and resources available in Cameroon. Practical interventions involving nephrology departments in both Africa and Europe can contribute to an improved management of CKD in Africa. The current collaboration between the Geneva University Hospitals and the Yaoundé teaching hospitals is a convincing example. It includes a clinical trial on the treatment of metabolic acidosis linked to CKD, assistance with the placement of hemodialysis catheters by sonography and the initiation of a kidney transplantation program with living donors.

Francois Kaze

Papers

Epidemiology, molecular, and genetic methodologies to evaluate causes of CKDu around the world: report of the Working Group from the ISN International Consortium of Collaborators on CKDu.

WCN23-1191 EARLY MORTALITY (120 days) AMONGST INCIDENT HEMODIALYSIS WITH END STAGE KIDNEY DISEASE IN A SYSTEM OF OUT OF POCKET PAYMENT: A 5 YEAR RETROSPECTIVE STUDY

[Collaboration in nephrology between Geneva and Yaoundé: a convincing example].