Int Urol Nephrol (2015) 47:873–874 DOI 10.1007/s11255-015-0942-z

NEPHROLOGY - LETTER TO THE EDITOR

CKD in disadvantaged populations Guillermo Garcia‑Garcia1,5 · Vivekanand Jha2,3,4 

Received: 22 January 2015 / Accepted: 28 February 2015 / Published online: 27 March 2015 © Springer Science+Business Media Dordrecht 2015 Of all of the forms of inequality, injustice in health is the most shocking and inhumane. Dr. Martin Luther King, Jr.

Disadvantaged communities have disproportionate burden of chronic kidney disease (CKD) [1]. Poverty negatively influences healthy behaviors, healthcare access and environmental exposure; and reduces access to goods and services, information about preventive behaviors and adequate nutrition [2] (Table 1). Disadvantaged populations in the developed countries, such as native populations in north America, Australia and New Zealand as socioeconomically deprived (in particular minorities), experience end stage renal disease (ESRD) at rates 1.5–4 times higher than the general population [3–5]. Poverty-related factors contribute to the burden of CKD in On behalf of the World Kidney Day Steering Committee. Members of the World Kidney Day Steering Committee are: Philip Kam Tao Li, Guillermo Garcia-Garcia, William G. Couser, Timur Erk, Elena Zakharova, Luca Segantini, Paul Shay, Miguel C. Riella, Charlotte Osafo, Sophie Dupuis, Charles Kernahan. * Guillermo Garcia‑Garcia [email protected] 1

Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Jal., Mexico

2

Postgraduate Institute of Medical Education and Research, Chandigarh, India

3

George Institute for Global Health, New Delhi, India

4

University of Oxford, Oxford, UK

5

World Kidney Day, International Society of Nephrology, Rues de Fabriques 1B, 1000 Brussels, Belgium





low-income countries. Examples include high prevalence of HIV-associated nephropathy in Africa, the use of herbal medicines in Taiwan and Africa and CKD of unknown etiology in agricultural communities around the world [6]. Maternal malnutrition, leading to low birth weight (LBW) deliveries, is more frequent in disadvantaged populations. A correlation between LBW and development of CKD later in life has been described in these populations [7]. The relationship between income and access to RRT is almost linear in low-income countries. In some parts of the world, less than 10 % of eligible ESRD patients receive RRT [8]. Transplant rates are low because of a combination of poor infrastructure; geographical remoteness; lack of legislation governing brain death; cultural and social constraints; and commercial incentives that favor dialysis [9]. Socioeconomic and healthcare disparities have significant impact on the delivery of RRT in developing countries. ESRD treatment costs are often met by out-of-pocket expenditure, which leads families deeper into poverty [10]. Overall, RRT outcomes are relatively poor among disadvantaged populations. [11, 12]. The aforementioned places a burden on society to provide appropriate renal care to disadvantaged communities. This requires expanding the reach of dialysis through lowcost alternatives, and implementation of CKD-prevention strategies. Kidney transplantation should be promoted by expanding deceased donor transplant programs and use of inexpensive, generic immunosuppressive drugs. The message of WKD 2015 is that a concerted attack against the diseases that leads to ESRD, by increasing community outreach, better education, improved economic opportunity, and access to preventive medicine for those at highest risk, could end the unacceptable relationship between CKD and disadvantage in these communities.

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Int Urol Nephrol (2015) 47:873–874

Table 1  Possible mechanism by which poverty increases the burden of disease Health behavior

Access to health care

Biological factors

Environmental factors

Lack of information on preventive Lack of access to health care behaviors

Low birth weight

Increased exposure to pollutants

Lack of knowledge on how best to Greater distance from healthcare respond to an episode of illness providers Health beliefs and unhealthy Lack of out-of-pocket resources behaviors

Genetic predisposition

Increased exposure to communicable diseases Cumulative biological risk profiles Lack of clean water and sanitation Inadequate nutrition

Conflict of interest None.

References 1. Pugsley D, Norris KC, Garcia-Garcia G, Agodoa L (2009) Global approaches for understanding the disproportionate burden of chronic kidney disease. Ethn Dis 19(Suppl. 1):S-1–S-2 2. Sachs JD (2001) Macroeconomics and health: investing in health for economic development. Report of the Commission on Macroeconomics and Health. WHO, Geneva 3. Norris K, Nissenson AR (2008) Race, gender, and socioeconomic disparities in CKD in the United States. J Am Soc Nephrol 19:1261–1270 4. Gao S, Manns BJ, Culleton BF, Tonelli M, Quan H, Crowshoe L, Ghali WA, Svenson LW, Hemmelgarn BR (2007) Prevalence of chronic kidney disease and survival among Aboriginal people. J Am Soc Nephrol 18:2953–2959 5. McDonald S (2010) Incidence and treatment of ESRD among indigenous peoples of Australasia. Clin Nephrol 74(Suppl 1):S28–S31 6. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, Saran R, Wang AYM, Yang CW (2013) Chronic kidney disease: global dimension and perspectives. Lancet 382:260–272

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7. Hoy WE, Samuel T, Mott SA, Kincaid-Smith PS, Fogo AB, Dowling JP, Hughson MD, Sinniah R, Pugsley DJ, Kirubakaran MG, Douglas-Denton, Bertram JF (2012) Renal biopsy findings among Indigenous Australians: a nationwide review. Kidney Int 82:1321–1331 8. Cusumano AM, Garcia-Garcia G, Gonzalez-Bedat MC, Marinovich S et al (2013) Latin American dialysis and transplant registry: 2008 prevalence and incidence of end-stage renal disease and correlation with socioeconomic indexes. Kidney Int Suppl 3:153–156 9. Garcia Garcia G, Harden PN, Chapman JR, World Kidney Day (2012) The global role of kidney transplantation. Lancet 2012(379):e36–e38 10. Ramachandran R, Jha V (2013) Kidney Transplantation is associated with catastrophic out of pocket expenditure in India. PLoS ONE 8:e67812 11. Chou SH, Tonelli M, John S, Bradley JS, Gourishankar S, Hemmelgarn BR (2006) Quality of care among aboriginal hemodialysis patients. Clin J Am Soc Nephrol 1:58–63 12. Rodriguez RA, Sen S, Mehta K, Moody-Ayers S, Bacchetti P, O’Hare AM (2007) Geography matters: Relationships among urban residential segregation, dialysis facilities, and patient outcomes. Ann Intern Med 146:493–501

CKD in disadvantaged populations.

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