Blog entry by Meguid El Nahas
Anyone in the world
I have argued for years that the so called CKD epidemic is no more or less the result of a number of factors:
1. Increased awareness of reduced GFR through automatic eGFR reporting in many countries since the mid-2000.
2. Flawed screening and analysis methodologies; including the use of microalbuminuria to define CKD and eGFR formulas that underestimated true GFR in the general population.Most often tested once and define as chronic....
3. The fact that it is mostly the aged who seem to have CKD in the communities.
I used the label Cardio-Kidney-Damage (C-K-D) to explain this so-called epidemic and based it on the rise of Non-Communicable Disease (NCD); mainly hypertension and Diabetes and their impact on endorgans over a lifetime explaining reduced kidney function along with CVD in the elderly..
I argued that NCD are the main problem that needs to be tackled; namely HYPERTENSION & DIABETES to prevent CKD, CVD, CAD, Strokes, etc....
I argued that DETECTION & PREVENTION Programs should focus on detection of HYPERTENSION & DIABETES rather than CKD.
I argued that BP measurement should be generalised in the communities before sCr or urinalysis.
I argued that such an approach would be much more effective and cost-effective worldwide including in developing countries.
This week in the Lancet, Ibrahim and Damasceno highlight the plight of hypertension in developing countries. They state that by 2025 3/4 of those suffering from hypertension will live in developing countries. They highlight the very high prevalence of hypertension in developing countries varying from 15 to 40%. They also draw attention to the differential prevalence of hypertension with higher rate in rural regions compared to urban conglomerations.
Alarmingly, Ibrahim and Damasceno draw attention to the very low awareness rates of hypertension in developing countries and the fact that control of BP is achieved in an appalling low (<10%) of those treated.
They stress in their excellent articles the importance of salt restrictions and its impact on BP control in some countries drawing attention to national government initiatives to reduce salt consumption and its impact.
Ernesto Schiffrin in an accompanying editorial reiterate these facts and call for global action.
So...it is HYPERTENSION....HYPERTENSION....and HYPERTENSION that we need to focus on in our communities if we want to reduce the burden of CVD including CKD.
It is high time the Nephrology community puts aside its professional egocentric approach to CKD and acknowledge that the main problem with CKD in communities is primarily one of NCDs: HYPERTENSION, HYPERTENSION, HYPERTENSION, OBESITY-DIABETES.
[ Modified: Thursday, 1 January 1970, 1:00 AM ]