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A WORLDWIDE HEALTH PROBLEM?

With the gradual change in demographics, the increase in affluence and the advent of more sedentary lifestyles, many lifestyle related ailments and disorders have surfaced in the domain of public health. This trend has most perceptibly led to an increase in prevalence of non-communicable lifestyle diseases like diabetes mellitus, obesity, hypertension, cardiovascular disease and chronic kidney disease (CKD).

CKD is today fast on the way to becoming one of the world’s most serious health problems. It affects the global burden of death, causing premature morbidity and mortality which is due to the disease’s interaction with other non-communicable illness and malnutrition, which increases with disease progression.

The burden of chronic kidney disease is not restricted to its effect on demands for renal replacement therapy; the disease has other major ill-effects on the overall population. High blood pressure, anaemia, malnutrition, bone disease, neuropathy, hyper-para-thyroidism, hyper-phosphatemia, metabolic acidosis and decreased overall functioning and well being are few complications associated with CKD. As per Kidney Disease Improving Global Outcomes (KDIGO), CKD is defined as abnormalities of kidney structure or function, present for >3 months, with implications for health.

Causative factors like western diets and high sodium intake are significantly associated with increased micro albuminuria and rapid decrease in kidney function. Other causative factors such as environmental toxins including residual pesticides, fluoride, aluminium, cadmium and cyanobacteria in drinking water could also lead to kidney disease.

Risk Factors of CKD: A risk factor is defined as an attribute that is associated with increased risk of an outcome. There are four types of risk factors significantly associated with CKD. These are :

  1. Susceptibility factors which can increase the susceptibility to kidney damage such as older age, family history of chronic kidney disease, reduction in kidney mass, low birth weight, U.S. racial or ethnic minority status, low income or educational level.
  2. Initiation factors which directly initiate kidney damage such as diabetes mellitus, high blood pressure, autoimmune diseases, systemic infections, urinary stones, obstruction of lower urinary tract, drug toxicity.
  3. Progression factors worsening kidney damage and faster decline in kidney function such as higher level of proteinuria, higher blood pressure level, poor glycemic control in diabetes, smoking.
  4. End stage factors which increase morbidity and mortality in kidney failure such as anemia, low serum albumin level and late referral for dialysis.

Global facts of CKD: Worldwide projection showed that at the end of 2004, among 1,783,000 end stage renal disease (ESRD) patients, 77% were on dialysis, 23% had a functioning renal transplant (RT), and this number is increasing at a rate of 7% every year. In 1990, CKD ranked 27th in the causes of deaths, which increased to 18th in 2010.

Prevalence of CKD is estimated to be 10.2% in Europe, 13.1% in the USA, and 13.7% in Korea among volunteers aged ≥ 20 years. More recent figures show that nearly 10% of the population globally is affected and mortality among these are very high. Prevalence of CKD is very high even in developing countries, where Asians are on the higher risk side.

With increase in diabetics worldwide, and with the projected figure of 57.2 million cases in 2025 especially in Asian countries like India, and the expected increase in hypertension to double from 2000 to 2025, CKD prevalence in India is likely to increase and there is likely to be serious socio economic and public health consequences.

Outcome of CKD: Malnutrition is highly prevalent in CKD patients, which sets in much before the end stage renal disease (ESRD). Various factors responsible for malnutrition in CKD are hormonal disturbances, increased resting energy expenditure (REE), inflammation, gastrointestinal disorders, metabolic acidosis, polypharmacy, psychosocial and socio economic factors, treatment modalities, alcoholism and poor in utero conditions. Once malnutrition appears, it progresses and results in increased sensitivity to infection, altered wound healing, low energy, poor quality of life and hence poor outcome of the disease. Research indicates that when patients receive intensive nutrition therapy and monitoring while the GFR is declining, nutrition status can be maintained.

Incorporation of detection and management of chronic kidney disease in the sustained global strategy is thus crucial to combat the major non-communicable diseases.

Anjani Bakshi RD, M.Sc., Dr. Kalyani Singh, Ph.D.

Food and Nutrition Department, Lady Irwin College, Delhi University, New Delhi, India

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