Global kidney disease

Global kidney disease The Lancet Series on Global Kidney Disease is an important and timely contribution, highlighting the increasing burden of chronic kidney disease worldwide. The UN High-Level Panel on the Post-2015 Development Agenda recently released its report,1 which identifies reducing the burden of priority non-communicable diseases (NCDs). Although the 2011 report of the WHO General Assembly on NCDs identified chronic kidney disease as posing a major health burden,2 it is absent from the WHO priority NCDs: heart disease, diabetes, chronic respiratory disease, and cancer. Instead, chronic kidney disease is included within the cardiovascular disease grouping. Hence, it is often lost and not given the priority it deserves as a cause, consequence, and risk multiplier of all four priority NCDs.3 We believe that the Lancet Series provides compelling evidence for the inclusion of chronic kidney disease in national NCD programmes, particularly in low-income and middle-income countries, where the disproportionate costs of managing end-stage kidney disease have dire consequences for health-care expenditure and for patients who continue to die of kidney failure despite proven prevention strategies and life-saving treatments in dialysis or transplantation. Serious global inequities exist in the provision of renal replacement therapy. In India, less than 10% of people who require renal replacement therapy receive it, while 70% of those fortunate enough to start dialysis discontinue because of cost, or die, within the first 3 months.4 80% of people receiving renal replacement therapy globally live in North America, Europe, or Japan, which collectively represent less than 20% of the population of the world.4 This situation highlights the urgent need for chronic kidney disease www.thelancet.com Vol 382 October 12, 2013

prevention. The huge costs associated with providing renal replacement therapy also provide a powerful economic imperative. Priority documents have the potential to direct national agendas to combat NCDs, and kidney disease should be included in an integrated approach to chronic diseases. While it is unnecessary to further silo NCDs or create unnecessary division, the issue of chronic kidney disease cannot afford to be lost or be a secondary agenda. We declare that we have no conflicts of interest.

*Brendon L Neuen, Georgina E Taylor, Alessandro R Demaio, Vlado Perkovic [email protected] School of Medicine and Dentistry, James Cook University, Cairns, QLD 4870, Australia (BLN); School of Medicine, University of Tasmania, Hobart, TAS, Australia (GET); Copenhagen School of Global Health, University of Copenhagen, Copenhagen, Denmark (ARD); Harvard Global Equity Initiative, Harvard Medical School, Harvard University, Boston, MA, USA (ARD); and The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia (VP) 1

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UN High-Level Panel of Eminent Persons on the Post-2015 Development Agenda. A new global partnership: eradicate poverty and transform economies through sustainable development. http://www.un.org/sg/ management/pdf/HLP_P2015_Report.pdf (accessed June 1, 2013). UN General Assembly. Political declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases. http://www. who.int/nmh/events/un_ncd_summit2011/ political_declaration_en.pdf (accessed June 1, 2013). Tonelli M, Agarwal S, Cass A, et al. How to advocate for the inclusion of chronic kidney disease in a national noncommunicable chronic disease program. Kidney Int 2013; published online Feb 13. DOI:10.1038/ki.2012.488. White SL, Chadban SJ, Jan S, et al. How can we achieve global equity in provision of renal replacement therapy? Bull World Health Organ 2008; 86: 229–37.

We read with interest the Lancet Series on Global Kidney Disease. Valerie Luyckx and colleagues describe the economics and medical management of chronic kidney disease in sub-Saharan Africa.1 We note clear similarities with patients in Peru. Indeed, in Peru, the Ministry of Health (MINSA)—which covers 70% of the population—does not have a comprehensive programme

for the management of patients with chronic kidney disease, including renal replacement therapies. However, the Social Security System (Essalud)— which covers 20% of the population— has a chronic kidney disease programme. Through MINSA, the care of patients requiring renal transplantation is limited to general hospitals and haemodialysis is provided by hospitals with self-initiated dialysis centres with limited capacity, mostly in the capital, Lima. There are several remote regions that do not have dialysis centres or nephrologists. 2 The financing of dialysis therapy is covered by the Comprehensive Health System (SIS) for patients in extreme poverty, up to a maximum of €10 700 per patient. In practice, the funding is limited by the shortage of dialysis centres or places in MINSA hospitals, and some patients cannot receive dialysis therapy. The main problem for planning a comprehensive programme for patients with chronic kidney disease in Peru is the absence of studies evaluating the number of patients with chronic kidney disease, including those requiring renal replacement therapies. Likewise, there are no official data on mortality, nor on abandonment of therapy, in these patients. Given the scarcity of centres and nephrologists, we anticipate that abandonment of therapy might be important. Health coverage in Peru is still insufficient, and is not in line with the economic growth of the country.

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Correspondence

For the Lancet Series on Global Kidney Disease see http://www. thelancet.com/series/globalkidney-disease

We declare that we have no conflicts of interest.

*Percy Herrera-Anazco, Edward Mezones-Holguín, Adrian V Hernandez [email protected] Nephrology, Hospital Nacional 2 de Mayo, Lima 11, Peru (PH-A); School of Medicine, Universidad Científica del Sur Lima, Peru (PH-A); UNAGESP, Instituto Nacional de Salud, Lima, Peru (EM-H, AVH); School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (EM-H); and Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA (AVH)

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