Editor's Note: This year's World Kidney Day campaign is focusing on the importance of high blood pressure. To illustrate this, the following was written jointly by Eberhard Ritz representing the International Society of Nephrology (ISN) and George Bakris representing the International Federation of Kidney Foundations (IFKF), the two organizations that co-sponsor WKD.
The kidney is both a cause and victim of hypertension. High blood pressure is a key pathogenetic factor that contributes to deterioration of kidney function. Presence of kidney disease is a common and underappreciated pre-existing medical cause of resistant hypertension.1 Therefore, treatment of hypertension has become the most important intervention in the management of all forms of chronic kidney disease (CKD). For this reason, the forthcoming World Kidney Day (WKD) on March 12th 2009 will emphasize the role of hypertension for renal disease.
How does one recognize the presence of chronic kidney disease?
In contrast to a decade ago, today most laboratories around the world report estimated glomerular filtration rate (eGFR) instead of or in addition to serum creatinine. This now provides the physician with information about kidney function that is, in general, more informative. As a result, a greater percentage of patients with diabetes or hypertension and their physicians have a better knowledge of their kidney function.
Assessment of eGFR as an index of kidney function should be complemented by assessing urine for protein or albumin (preferred).
In spite of these laboratory updates, recent data demonstrate that a given patient’s knowledge that he or she has CKD is very low. In a recent analysis of almost half a million people in Taiwan who took part in a standard medical screening program, 12 percent had CKD.2 It was noteworthy that less than four percent of those with CKD were aware of their condition. People with CKD are several times more likely to die from cardiovascular(CV) causes than those without CKD, thus, hypertension is a major risk factor in this context.3 The combination of CKD and hypertension, therefore, is a major public health issue; because of the costly treatments necessary for end-stage renal disease (ESRD), end-stage CKD has also become a substantial burden to health budgets.
What is the worldwide frequency of chronic kidney disease?
The frequency of CKD continues to increase worldwide as does the prevalence of end-stage renal disease (ESRD).4,5 The most common, but not only, causes of CKD are hypertension and diabetes. The presence of CKD is associated with a large increase in cardiovascular (CV) risk. Moreover, CV risk increases proportionally as eGFR falls below 60 ml/min. Lastly, death from CV causes is higher in CKD and much higher than is cancer in CKD; as a result the identification and reduction of CKD has become a public health priority.6
