Conclusions: Promises and Pitfalls
Kidney disease and kidney failure, especially as a complication of type 2 diabetes mellitus and hypertension, are rising globally and are rising faster in developing countries. Kidney failure patients account for a small fraction of the disease burden but a disproportionately high cost. CKD, along with all chronic diseases, is placing long-term demands on health care. On a global scale, RRT is rising sharply in terms of costs and is usually unavailable in developing countries. Hemodialysis and peritoneal dialysis are life saving, but in the long term they require coupling with newer, proven, interventional pharmacological treatments that frequently delay or stop continuing progression to ESRD. Advances in the past decade have proven that primary and secondary prevention measures can now reduce the burden of ESRD, and if they are not widely disseminated, the need for RRT will increase along with the certainty that the requirements of kidney disease patients cannot be met.
The following guidelines for diseases of the kidney and urinary system are recommended:
-
Expand surveillance of the prevalence of various kidney and urological diseases in developing countries. Provide support for further epidemiological studies in selected countries for assessing the prevalence of kidney disease and interventions to address it and for establishing an international kidney disease data center.
-
Promote public awareness in developing countries about the nature and early signs of kidney disease along with knowledge of prevention measures and therapies.
-
Focus more attention on the increasing prevalence of diabetes and hypertension, and develop kidney disease programs in that context. Measures of kidney function and protein excretion should be taken. The implementation of primary and secondary prevention to reduce the prevalence of ESRD should be expanded.
-
Increase coordination and resources for efficient and timely distribution of supplies and equipment, assessment of patients, and frequent dialysis for acute renal failure patients caused by crush injuries during such major disasters as earthquakes. Countries in earthquake-prone regions should develop emergency policies and practices and be linked with the appropriate international agencies.
-
Have the World Bank and the World Health Organization establish a policy advisory group with relevant international groups, such as the International Society of Nephrology, to address and advise national and regional health ministries on kidney and urological strategies as requested.
-
Make major health and medical education programs available on an annual basis through existing societies and agencies to train and update physicians, nurses, technicians, and other relevant health professionals.
-
Develop selected centers of excellence for education, training, clinical care, and prevention of kidney and urological disease and clinical care of renal failure. At least 10 such centers should be developed in the next decade and located in the countries of the former Soviet Union, Africa, Asia, Eastern Europe, and Latin America. Funds should be provided by international and national agencies and national government organizations and be sustained for up to 10 years.
