Community focused primary prevention of risk factors of Chronic kidney diseases(CKD) : an unmet need in reducing the burden of ESRD in Low and middle income countries(LIMC) countries- a review and proposition

Abstract

Chronic kidney disease, is assuming the status of global pandemic, afflicting over 500 million people worldwide, of all ages, gender and racial groups. ESRD accounts for the 19^th commonest cause of death worldwide. The predominant modifiable risk factors being overweight &obesity, hypertension, diabetes mellitus, chronic glomerulopathies, toxic nephropathies and HIV,etc. The latter two especially in Low- and middle-income countries (LIMC).

Tremendous   amount of knowledge and developments have taken place in the past 150 years. In spite of these gigantic endeavours, which have indeed ameliorated the sufferings and prolonged survival of patients with CKD and ESRD, especially in the developed countries, CKD and ESRD seem to defile all measures at their containment in the communities globally.

While CKD and ESRD management processes have led to improved longevity and health related quality of life (HrQoL) in patients in the developed countries, the story is different for majority of patients in LIMC.

To reduce the burden of CKD and ESRD in the present circumstances therefore, focus should be on measures to reduce the burden of risk factors of CKD and an ERSD in the community.

A public health approach   for the Primary prevention of overweight/obesity, hypertension, type 2 diabetes, nephrotoxin exposures and HIV infection becomes inevitable and advocated.

Preventive nephrology as a body of knowledge and practice have not been given a place of prominence in contemporary nephrology practice and is an unmet need in the global management of CKD, especially in LIMC.

The Framingham heart and cardiovascular preventive studies in the United states of America in the 1950s is a classic example and pioneer in the application of primary preventive approach to prevention and control of heart and cardiovascular disease worldwide.

We therefor propose a Preventive nephrology program for LIMC jurisdiction modelled along the Framingham model for CKD prevention in LIMC jurisdictions. Incorporating the program into the WHO 2013-2018 NCD control program will be cost saving.

Keywords:  Chronic kidney disease, Risk factors, prevention, unmet need, LIMC