Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy

TLDR: An action plan and performance framework based on ten themes to strengthen CKD surveillance, tackle major risk factors for CKD, and enhance understanding of the genetic causes of CKD is presented.

About: This article is published in The Lancet.The article was published on 2017-10-21 and is currently open access. It has received 624 citations till now. The article focuses on the topics: Action plan.

Figures

Table 2 Action Plan: Tackle Major Risk Factors, Control AKI, and Identify the Genetic Causes of CKD

Table 3 Action Plan: Improve Diagnosis, Prognosis, and Treatment of CKD

Table 5 Performance Framework

Table 4 Action Plan: Develop novel interventions and increase the quantity and quality of clinical trials

Frequently asked questions

Q1. What contributions have the authors mentioned in the paper "Lancet commission" ?

Joseph Bonventre MD, Brigham and Women ’ s Hospital, Harvard Medical School, Massachusetts Institute of Technology Josef Coresh MD, George W. Comstock Center for Public Health Research and Prevention, Welch Center for Prevention, Epidemiology and Clinical Research Jo-Ann Donner, International Society of Nephrology Agnes B. Fogo MD, Vanderbilt University Medical Center Caroline Fox MD, Merck Research Labs, Brigham and Women ’ s Hospital Ron Gansevoort MD, University Medical Center Groningen Meg Jardine MD, The George Institute for Global Health, The University of Sydney Bert Kasiske MD, Hennepin County Medical Center, University of Minnesota Anna Köttgen MD, Medical Center University of Freiburg, Johns Hopkins Bloomberg School of Public Health Matthias Kretzler MD, University of Michigan Hiddo JL Heerspink PhD, University Medical Center Groningen Andrew S. Levey MD, Tufts Medical Center, Tufts University School of Medicine Valerie Luyckx MD, University of Zurich, Brigham and Women ’ s Hospital Ravindra Mehta MD, University of California San Diego Orson Moe MD, University of Texas Southwestern Medical Center Gregorio Obrador MD, Universidad Panamericana School of Medicine Neesh Pannu MD, University of Alberta Chirag Parikh MD, Yale University, Veteran ’ s Administration Connecticut Healthcare System Vlado Perkovic MD, George Institute for Global Health, University of Sydney, Royal North Shore Hospital Carol Pollock MD, University of Sydney, Royal North Shore Hospital Peter Stenvinkel MD, Karolinska Institutet Katherine Tuttle MD, Providence Health Care, University of Washington David C. Wheeler MD, University College London Kai-Uwe Eckardt MD * ( co first authorship shared ), University of Erlangen-Nürnberg 

Q2. What is the main reason for the use of electronic prompting and prescription tracking?

Since long-term medication use is a key risk factor for CKD, it seems likely that electronic prompting and prescription tracking can be used to reduce medication errors, reduce medication overuse and nephrotoxicity, in HICPage 25 of 83especially. 

Q3. What are the main treatments used to prevent CKD?

These include medications for controlling BP and blood sugar as well as interrupting the renin-angiotensin system (to slow the progression of CKD) and statins (for preventing CV events in the CKD population). 

Q4. What are the main ways to increase the feasibility of trials in CKD?

Randomised-registry trials, cluster randomised trials, adaptive trials, and other approaches should be considered as methods to dramatically increase the feasibility of trials in CKD. 

Q5. What are the main factors that should be considered in preventing CKD?

Activities to reduce the risk of kidney stones (e.g., ensuring adequate intake of clean water, healthy diet, and work conditions that avoid dehydration) and appropriate follow-up of people with prior stones to evaluate for CKD should be considered, and may prevent long-term complications such as kidney failure. 

Q6. What is the key barrier to greater investment in CKD trials?

A key barrier to greater investment in kidney disease trials generally (but especially by smaller biotechnology companies) is the long-term nature of trials required to generate regulatory approvals and allow revenue to be generated. 

Q7. What are some examples of drugs that have shown potential in the attenuation of CK?

Examples include allopurinol and metformin, both of which demonstrate potential in the attenuation of progression of CKD through mechanisms related to oxidative stress and fibrosis. 

Q8. What is the need for research programs to evaluate the benefits of standard treatment approaches in kidney populations?

There is an urgent need for focused research programs that rigorously evaluate the benefits of standard treatment approaches (e.g., ARB for heart failure; implantable defibrillators to prevent sudden cardiac death) in kidney populations – as well as novel interventions that might reduce the risk of CV events in people with kidney disease (e.g., intradialytic potassium profiling). 

Q9. What is the way to study and validate established and novel biomarkers?

The renal community should take advantage of existing large observational cohort studies with stored biomarkers and long-term follow-up to study and validate established and novel biomarkers. 

Q10. What is the main reason for the lack of knowledge about kidney disease?

Despite substantial efforts from basic, translational, and clinical scientists, optimal care of kidney patients is hampered by insufficient knowledge about mechanisms causing progressive loss of kidney function and its complications. 

Q11. What are the main factors that impact the incidence and prevalence of CKD?

mycobacterial, fungal, and viral infections have all been shown to impact the incidence and prevalence of AKI and CKD. 

Q12. What is the importance of evaluating the candidates for treatment?

Summarizing what is known about available treatments and evaluating the best candidates in well-designed clinical trials should be a high priority: this could include treatments for similar symptoms associated with other conditions (e.g., chemotherapy-associated nausea) as well as treatments targeted at uremic-specific conditions (e.g., phototherapy for pruritus). 

Q13. What is the first step to making progress in improving CKD monitoring activities?

The first step to making progress in improving CKD monitoring activities (see Table 1) is to fully engage stakeholders by making sure the rationale for monitoring programs is clear and tailored appropriately for different settings.