Blog entry by Meguid El Nahas

Anyone in the world

Prof Richard Glassock wrote in reference to the latest publication in the Lancet on the Global Burden of Disease Study 2013: (The Lancet On line 8th of June 2015)

It represents massive data collection and a complicated analysis but the main message is that except for diabetes related  CKD, most forms of CKD are decreasing (since 1990) in total prevalence and years lost to disability. 

The only "epidemic" of CKD is that related to diabetes, and indirectly to obesity. 

The public health authorities around the world should not be focusing on detection of CKD, per se, as a problem, but instead should be energetically trying to curtail diabetes, by focusing on its origins; diet (composition and energy content) and activity level. 

Claims that the world is trapped in an out-of-control epidemic of CKD represent mis-information at its worst, as these claims obfuscate the real issue; diabetes and its micro- and macro-vascular complications. 

Screening programs for CKD are socially irresponsible, if they detract from addressing the real problem- diabesity (diabetes due to obesity), a potentially preventable disorder-- easily detected but difficult to treat.

Food for thought!!!

My Comments:

The global "epidemic" of CKD has been an ill founded concept based on very poor epidemiology and/or rather poor biostatistics.

This had a number of consequences, that I condemn:

1. Raised awareness of CKD, but overinflated its scale...claiming to affect 1 in 2 individual over a lifetime…

2. Medicalised the ageing process, by falsely claiming that CKD affected millions over the age of 65...thus confusing true CKD with age-related decline in kidney function…

3. Generated an industry of lightweight biostatistical analyses based on poorly collected and seldom validated data…published as irrefutable facts…

4. Raised the profile of Nephrology as a subspeciality, but at the price of misinformation...or to be kind, an unfounded truth...

5. Increased “Nephrologists” income in countries where their income stems from recognising, diagnosing, and cashing on, false diseases in an alarmed and misinformed population…

6. Failed to distinguish true CKD from community based older individuals with reduced kidney function…

7. Overburdened Nephrologists worldwide by unnecessary referrals of older patients with mild to moderate, but stable, age-related impaired kidney function; thus distracting them from their true task of dealing with primary and progressive nephropathies!

8.  Increased prescription of potentially nephrotoxic agents such as ACE inhibitors in the elderly without a shred of evidence that it protected from early CKD progression or delayed ESRD, and in spite of evidence to the contrary:

9. Generated more diseases, namely AKI, in elderly individuals prescribed ACE inhibitors for dubious and ill founded indications…:

10. Overlooked the true burden of disease; namely Hypertension and Diabetes, thus leaving them significantly under-diagnosed and under-treated!

Shame on us as a professional body to have jumped uncritically on this bandwagon…

”Castles built on sand, soon collapse…”

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