Primary functions of kidneys are to maintain body’s extracellular fluid homeostasis. These include but not limited to regulation of fluid volume, osmolarity, ion concentration, pH and excretion of wastes and toxins. There are two kidneys, each has about 1 million nephrons , which is composed of glomerulus and bowman’s capsule filled with complex capillaries system to perform filtration.
Modern diet and lifestyle related chronic degenerative diseases have been single out to be major caused of kidney failure, otherwise known as chronic kidney disease (CKD). Other contributing factors impairing kidney function such as autoimmune and autosomal gene expression has been on the rise.
Chronic kidney disease (CKD) is characterized as progressive loss of kidney function with chronic reduction in Glomerular Filtration Rate (GFR) and the presence of protein uria or albumin uria.
The ultimate outcome of Chronic Kidney Disease (CKD) is End-Stage Renal Disease (ESRD), and the only two available treatment options now are:
a) Renal Replacement Therapy of Dialysis
b) Kidney Transplantation.
The current mainstream medical treatment objectives for Chronic Kidney Disease (CKD) is to:
1) Maintain condition
2) Slow & delay progression to end-stage renal diseases (ESRD). Once reaching end-stage renal disease (ESRD), dialysis is imminent when the glomerular filtration rate (GFR) dropping to critical low level.
Chronic kidney disease (CKD) being a global economic burden is unfortunate not listed in the prioritized in the Global Non-communicable Diseases (NCD) Action Plan by the World Health Assembly in 2008.
DIALYSIS
(Photo courtesy: Wikimedia Common)
Globally, ESRD has become a major cost driver for health-care system. The annual growth rate for dialysis program ranging between 6% and 12% over the past decades an expected to grow continuously, particularly in developing countries.
On individual basis, annual dialysis treatment cost is ranging between USD$15,000 in China to USD$89,000 in the USA. These exorbitant fees have denied millions from seeking dialysis treatment.
(Photo courtesy: Wikimedia Common)
Kidney transplantation method on the other hand is not any better either. Aside from transplantation fee of USD$35,000, patient has to spend post-transplantation medical fees of USD$25,000 annually to maintain kidney compatibility. This is despite the endless waiting for availability of kidney donors.
It is estimated over 2 million people worldwide currently receiving dialysis treatment to sustain life, yet this number may only represent 10% of those who needing it. As a result of this costly treatment or unavailable access to dialysis treatment, over 1 million people died annually from untreated kidney failure.
The U.S.Renal Data System, USRDA 2018 Annual Data Reports stated there are 730,000 patients on dialysis. The Chinese Renal Data System on the other hand recorded 340,000 patients on dialysis, and this figure is only a fraction of total 2 million over patients who actually needed dialysis.
Scenario in Malaysia is not any better either. The 24th Report of The Malaysian Dialysis & Transplant Registry 2016 recorded 50,000 dialysis patients, with annual increment rate of 7,000 patients, which is about 10‐15% annual growth rate, one of the highest in the world.
The outlook for CKD is even gloomier. The following statistics give an overview estimation of CKD across the globe:
Country |
No Of Patients |
References |
|---|---|---|
Global |
850 million |
www.kidneynews.org/kidney-news/features/hidden-epidemic-more-than-850-million-suffer-from-kidney-diseases-worldwide-organizations-report#B |
China |
120 million |
Liu, Z.-H. Nat. Rev. Nephrol. advance online publication 23 July 2013; doi:10.1038/nrneph.2013.146 |
USA |
37 million |
https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html |
These numbers are expected to rise further. Besides delaying progression to end-stage renal disease (ESRD), there are currently no other solutions for chronic kidney disease (CKD). This simply means that dialysis or transplantation is unavoidable, the only issue is timing.
REFERENCE
https://www.kidney.org/atoz/content/about-chronic-kidney-disease
https://lifeoptions.org/learn-about-kidney-disease/causes-and-stages/
https://www.niddk.nih.gov/health-information/professionals/advanced-search/explain-kidney-test-results
https://www.who.int/nmh/publications/ncd_report_full_en.pdf
https://www.kidney.org/kidneydisease/global-facts-about-kidney-disease
www.kidneynews.org/kidney-news/features/hidden-epidemic-more-than-850-million-suffer-from-kidney-diseases-worldwide-organizations-report#B
Liu, Z.-H. Nat. Rev. Nephrol. advance online publication 23 July 2013; doi:10.1038/nrneph.2013.146
https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html
https://www.davita.com/education/kidney-disease/stages/what-is-end-stage-renal-disease