| | The Third World Kidney Day: Looking Back and Thinking Forward“Never doubt that a small group of thoughtful, committed citizens can change the world: indeed, it’s the only thing that ever has.” –Margaret Mead March 13, 2008, heralds the third annual World Kidney Day (WKD), an event that will be celebrated in more than 60 countries. We take this opportunity to recount how this concept has gained worldwide traction and momentum and to reflect on the challenges faced by its creators and supporters. The Beginnings of WKD  There probably have been many individuals who conceived of marking one calendar day in which to call attention to the seriousness of kidney disease globally; many may even have shared their thoughts with others. But there is one individual who not only conceived the idea, but was persistent in persuading many in leadership positions to bring this notion, a WKD, to fruition. This individual is also the founder of the International Federation of Kidney Foundations (IFKF): Joel Kopple. He first conceived the idea of WKD in spring 2003, recognizing that chronic kidney disease (CKD) is a global public health threat, but typically is low on government health agendas; that it can be detected by using simple and inexpensive tests, yet national detection programs are rare; and although it can be treated with existing effective therapies, few people with CKD receive appropriate health care. In September 2003, Kopple wrote to Warwick Prime, then President of the IFKF, and proposed an annual WKD. To make it truly an international collaborative effort, representatives of the IFKF and the International Society of Nephrology (ISN) met in November 2003, and at that meeting, Kopple presented a précis titled, “Proposal for the Establishment of a World Kidney Day.” A WKD ISN-IFKF liaison committee was established; the initial members were Bill Couser, John Dirks, Joel Kopple, Warwick Prime, and Jan Weening. In 2004, both the IFKF Executive Committee and the ISN Council endorsed the WKD program, and ISN agreed in 2005 to commit sufficient resources to enable a first WKD to go ahead on March 7, 2006. An editorial about WKD was published that month in 8 scientific journals. Despite being planned with only short notice and few resources, kidney organizations in 45 countries enthusiastically embraced the first WKD and organized health screening events, road shows, walkathons, public lectures, and press conferences. It was clear that WKD was responding to an urgent need and tapping the tremendous energy and motivation of kidney health professionals, patients, and their friends and relatives across the globe. That success was recognized by those from ISN and IFKF who met in April 2006 and agreed on a formal organizational structure for WKD. A memorandum of understanding between the IFKF and ISN for the planning and implementation of an annual WKD was signed in June 2006 by the 2 presidents, Bill Couser (ISN) and Sudhir Shah (IFKF). The document stated: “Based on a proposal and invitation by IFKF, IFKF and ISN jointly agree to declare an annual World Kidney Day to increase awareness, detection, prevention, and treatment of kidney and related diseases.” The “World Kidney Day” name and logo were trademarked and are now jointly owned by the IFKF and ISN. A WKD steering committee was established with 8 members: 4 members nominated by each organization, and a scientific advisory committee. ISN agreed to provide the initial funding necessary for the central operational management of a WKD project team. The continued leadership of the ISN/IFKF Steering Committee in 2007 helped secure funding from global sponsors; create a WKD logo, slogan, website, and “brand”; widely disseminate designs for posters, banners, T shirts, and other promotional materials that could be adapted for local use; gain the moral support of celebrities ranging from Tom Hanks to Jacques Rogge; and enlist the participation of 66 countries. The remarkable initiative and ingenuity of kidney organizations on March 8, 2007, can be viewed on www.worldkidneyday.org. The WKD website will feature planned activities for March 13, 2008, which promises to be an even greater event, with continued emphasis on the message that “kidney disease is common, harmful, and treatable.” The Main Challenges and Aims of WKD Public Awareness WKD offers a crucial visible opportunity to inform and educate health policy makers, people who are at highest risk of CKD, and the general public. One of our greatest challenges is general ignorance about the kidneys. Surveys made before the advent of WKD have shown that less than 5% of the general population knows where the kidneys are located and what they do. Therefore, the WKD 2008 international campaign theme—“Amazing Kidneys!”—stresses the positive message that kidneys are truly “amazing.” A focus for the general public is on simple facts about what kidneys do for us on a daily basis; for example, “Every day our kidneys filter and clean 200 liters of blood.” “Amazing kidney stories” can also be used: stories about kidney patients, kidney organ donors, and health professionals who are exceptional in some way. WKD offers an increasingly visible opportunity to tailor public awareness messages to the media for wide impact. The Importance of CKD Whereas each country and region may adopt different priorities for WKD from year to year, choosing, for example, to promote living donor kidney transplantation or push for improvements in dialysis facilities, in many countries, the detection and management of CKD will be the dominant kidney health issue. On WKD, we must aim to raise awareness about the heavy burden of CKD on human lives and health care budgets and put CKD on the agenda of governments and other institutions around the world that shape and reform health policy. It is an opportunity to launch high-profile new initiatives that will have an impact on CKD and seek the endorsement of agencies that can help ensure that such initiatives become embedded into routine health care. Since the term CKD came into use and its staging was defined,1 there has been a flurry of investigative activities and publications about its importance.2, 3, 4, 5, 6 Recently published studies confirmed that CKD is a common disorder globally, with as many as 90% of those who have CKD unidentified.7, 8 That CKD is a major public health issue is now beyond dispute,9 and it is obvious that an issue of this magnitude cannot be addressed by volunteer organizations alone. Two simple and inexpensive tests are available to detect CKD: urine for protein and blood for serum creatinine and hence estimated glomerular filtration rate (eGFR). Despite this, the task of developing widespread detection and management programs for CKD that produce improved outcomes at a reasonable cost is formidable. It is unlikely that even developed countries have adequate financial and human resources for whole-population screening programs for CKD, and in any case, there is no evidence to date that these are cost-effective. CKD Detection Programs Based on current information, we recommend that all countries have targeted screening programs. Steps to establishing an effective program include: •Report of eGFR by all laboratories measuring serum creatinine •Measurement of eGFR and proteinuria in people at highest risk of CKD, including all those with diabetes, hypertension, coronary heart disease, and cerebrovascular disease, who constitute the majority of patients with CKD and end-stage renal disease •Regular measurement of blood pressure, eGFR, and proteinuria in people identified with CKD •Establishment of targets for blood pressure control in people with CKD and appropriate use of drugs blocking the renin-angiotensin system •Agreement on guidelines for identifying the minority of people with CKD who benefit from the specialist advice of a nephrologist, as well as the routine care of a family physician In the United Kingdom, for example, there has been encouraging progress during the last few years toward the establishment of such a program. Reporting of eGFR is now mandated in all UK clinical laboratories, and guidelines for detection and management of CKD have been widely accepted.10 This progress has been made more straightforward by a government-directed and funded health care system that allows several aspects of the program to be linked to reimbursement for family physicians, who are already obliged to maintain computerized listings of all those with diabetes, hypertension, and coronary heart disease. There will be much greater challenges in countries in which health care is provided by multiple independent agencies or in the developing world, in which resources available for health care are much less. In advocating for these programs, which are now proving successful and cost-effective, we favor small, but sure-footed, steps5, 11; we must be careful that screening tests identify people with true disease, for whom intervention will make a critical difference by delaying or avoiding end-stage renal disease or by modifying risk factors for cardiovascular disease, which is so closely linked with CKD. This may be particularly true in the elderly, who have the greatest prevalence of CKD and for whom preventive therapy is less likely to improve survival or quality of life.5, 12 In parallel, we must press for research programs to address the many unanswered questions about CKD, not least to understand better the factors that predict the minority of those with stage 3 CKD who progress to end-stage renal disease and to test the efficacy of our new health care strategies for CKD. WKD is Here to Stay The momentum of WKD is ensured, and we anticipate that many more than the previous 66 countries will be reporting to us their initiatives and successes on March 13, 2008. The WKD Steering Committee and Project Team will continue to provide a toolkit of resources for each WKD, including messages, logos, posters, and designs for other materials. The power of WKD is generated by local action, led by those who understand the specific kidney health issues in their countries and who use this day to showcase successful initiatives already taken and launch positive changes in health care systems and practices. For meaningful progress to be made, activities related to kidney disease are needed throughout the year. Our vision is that WKD serves as an annual energizing and unifying event through which health care providers, the general public, and government bodies that make health care policy all unite to improve early detection programs and optimize medical care for the millions worldwide who can benefit from improved awareness of CKD as a global health issue. Acknowledgements Written on behalf of the World Kidney Day Steering Committee; Other members of the WKD Steering Committee are William G. Couser (ISN), John Davis (IFKF), Joel Kopple (IFKF), Thomas Reiser (ISN), Miguel Riella (ISN), and Anne Wilson (IFKF). The WKD 2007 Scientific Advisory Board members are Vittorio E. Andreucci, Italy; Rashad S. Barsoum, Egypt; Allan J. Collins, United States; David C.H. Harris, Australia; Bernardo Rodríguez Iturbe, Venezuela; Paul E. De Jong, The Netherlands; Robert W. Schrier, United States; and Philip Kam Tao Li, China. Support: None. Financial Disclosure: None. References 1. 1National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, classification, and stratification (Part IV: Definition and classification of stages of chronic kidney disease). Am J Kidney Dis. 2002;39(suppl 1):S46–S75. Full Text |
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2. 2Archibald G, Bartlett W, Brown A, et al. UK Consensus Conference on Early Chronic Kidney Disease—6 and 7 February 2007. Nephrol Dial Transplant. 2007;22:2455–2457.
CrossRef
3. 3Vassalotti JA, Stevens LA, Levey AS. Testing for chronic kidney disease: A position statement from the National Kidney Foundation. Am J Kidney Dis. 2007;50:169–180. Abstract | Full Text |
Full-Text PDF (200 KB)
|
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4. 4Levey AS, Atkins R, Coresh J, et al. Chronic kidney disease as a global public health problem: Approaches and initiatives—A position statement from Kidney Disease: Improving Global Outcomes. Kidney Int. 2007;72:247–259.
CrossRef
5. 5Couser WG. CKD—The promise and the perils. J Am Soc Nephrol. 2007;18:2803–2805.
CrossRef
6. 6Himmelfarb J. Chronic kidney disease and the public health. JAMA. 2007;297:2630–2633.
CrossRef
7. 7Stevens PE, O’Donoghue DJ, de Lusignan S, et al. Chronic kidney disease management in the United Kingdom: NEOERICA project results. Kidney Int. 2007;72:92–99. MEDLINE |
CrossRef
8. 8Coresh J, Byrd-Holt D, Astor BC, et al. Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000. J Am Soc Nephrol. 2005;16:180–188. MEDLINE |
CrossRef
9. 9Schoolwerth AC, Engelgau MM, Hostetter TH, et al. Chronic kidney disease: A public health problem that needs a public health action plan. Prev Chronic Dis (serial online). 2006;3:2. 10. 10Joint Specialty Committee on Renal Medicine of the Royal College of Physicians and Renal Association and the Royal College of General Practitioners. Chronic Kidney Disease in Adults: UK Guidelines for Identification, Management and Referral. London, UK: Royal College of Physicians; 2006;. 11. 11Kiberd B. The chronic kidney disease epidemic: Stepping back and looking forward. J Am Soc Nephrol. 2006;17:2967–2973. MEDLINE |
CrossRef
12. 12Kallen AJ, Patel PR. In search of a rational approach to chronic kidney disease detection and management. Kidney Int. 2007;72:3–5. MEDLINE |
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a University of Arkansas for Medical Sciences, Little Rock, Arkansas b Leicester General Hospital, Leicester, United Kingdom  Address correspondence to Sudhir V. Shah, MD, Professor of Medicine and Director, Division of Nephrology, UAMS College of Medicine, 4301 West Markham, Slot 501, Little Rock, AR 72205.
This article is reprinted with permission of the authors. It was originally presented online by the authors at www.worldkidneyday.org on October 24, 2007. A list of the members of the World Kidney Day Steering Committee appears at the end of this article. PII: S0272-6386(07)01603-4 doi:10.1053/j.ajkd.2007.12.007 © 2008 National Kidney Foundation, Inc. Published by Elsevier Inc All rights reserved. | |
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