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Progress and opportunities in measuring the burden of Chronic Kidney Disease

Measurement

timely detection of CKD cases (e.g. assessing feasibility and diagnostic yield of screening for CKD among highrisk populations) and effective management of CKD and risk factors of CKD (e.g. interventions targeting physicians to improve prescription of nephroprotective medications).
The study by Sundstrom et al improves understating of CKD prevalence by presenting contemporary data from the general population. In future studies estimation of CKD prevalence can be further improved. An accurate assessment of CKD prevalence requires two measurements of glomerular filtration rate (GFR) and albuminuria at least 90 days apart. 6 Unfortunately, data on both these measures at least 90 days apart is often not available for the general population. Consequently, CKD prevalence estimates for the general population largely come from one-time measurement of estimated GFR and albuminuria, and when estimates are available based on formal CKD definition that often comes from high-risk populations such as those recorded in health systems database. Remarkably, the estimate for CKD prevalence in the present study which used a health systems database was similar to the estimate for CKD prevalence in the Global Burden of Disease (GBD) study 7 which relied mainly on population-based cohort studies (that are often over-represented with healthy individuals). Similar estimates in the two studies could be due to the sampling of high-risk individuals from a low-risk population in the present study and the sampling of low-risk individuals from a comparatively high-risk population in the GBD study. Integration of CKD into national screening programs for other chronic diseases and the development of methods that can correct prevalence estimates based on a one-time assessment of CKD markers may help to improve the accuracy of CKD prevalence estimates for the general population.
The present study comprehensively describes kidney and cardiovascular outcomes in patients with CKD. Unfortunately, CKD patients also suffer from other consequences including social, psychological, and financial which remain severely underreported. Stress from chronic symptoms and treatment of the disease, and changes in family dynamics can have severe negative consequences on the psychosocial health of CKD patients and their caregivers. 8,9 Moreover, during the course of CKD patients experience diminished functional capacity and endurance which often results in reduced workability and consequently, work absence due to sickness, and work disability. 10 Involving experts from social and occupational science and developing a methodological framework for measuring social, psychological, and work-related outcomes in patients with CKD can improve assessment of CKD consequences.
A multinational assessment of the CKD prevalence, outcomes, and costs, as presented in this study, is certainly relevant in highlighting the significance of CKD globally and enabling learnings from different public health policies and health care systems for handling CKD. However, these results should also be used to encourage a detailed assessment of the CKD burden in each region/country since public health policies are also driven by regional needs. Such regional effort should take into account regional demographics and social factors, health behaviors, and healthcare structure. This information can not only be instrumental in generating actionable information for local policymakers but can also better inform the assessment of the global burden of CKD.

Contributors
PV wrote the draft. HLH critically reviewed the contents.

Declaration of interests
No relevant disclosures to make.