Over 2 million preventable deaths from gaps in kidney failure treatment

Researchers call for immediate global action as prevalence of kidney failure set to rise sharply by 2030:

  • Increase government awareness of the numbers of preventable deaths from kidney failure 
  • Emphasis on the prevention of kidney disease and reducing risk factors
  • Make dialysis treatment affordable and accessible to all in need  
  • Implement innovative preventative care programs especially where access to physicians is low

Research published today in The Lancet shows that each year more than two million people globally die unnecessarily because they cannot access treatment for kidney failure (dialysis or a kidney transplant).

Kidney disease is a leading cause of death and disability and rapidly growing yet under recognised health problem. Each year, over 2.5 million people receive renal replacement therapy (RRT; dialysis or kidney transplant), yet double the amount of patients need this life-saving treatment.

By 2030 the number of people receiving treatment is predicted to double to about 5.5 million, with the most growth of 0.968 million to 2.162 million in Asia, creating an urgent need for affordable dialysis (currently US$ 20,000 – $100,000 per person per year) and population-wide prevention strategies for kidney disease.

This study collected data on the actual numbers of patients receiving RRT in 123 countries, including China and other 27 Asian countries, which represents 93% of the world population.

Lead author, Professor Vlado Perkovic of The George Institute and The University of Sydney, said the findings present a grim picture of the prevalence of kidney failure which is worse than previously thought.

“The sad reality is that most of these deaths are preventable and the biggest burden lies in low to middle income countries where there are instances of less than a quarter of patients receiving treatment for kidney failure,” says Professor Perkovic. “This could get worse - over coming decades kidney failure rates are projected to grow rapidly and millions of people appear doomed to die without access to dialysis without specific action, with Asia being hit the hardest,” he said. 

“We urgently need to find ways to get people the treatment they need by making dialysis affordable, and by implementing preventative measures so fewer people develop kidney failure in the first place” he says. “Effective kidney disease prevention strategies include controlling blood pressure and glucose levels, taking proven protective medications and managing key risk factors like diabetes and obesity, but archaic and inconsistent models of care and gaps in treatment such as lack of access to local health professionals stop people from getting these.”

An even worse situation in China

“China, the biggest developing country in the world, bears enormous burden of kidney disease.” said Professor Minghui ZHAO from the Renal Division at Peking University First Hospital, the collaborating partner of the study in China, “Around 120 million adult people in China have chronic kidney disease. It is estimated that about ~2% of these patients will develop to end-stage kidney disease, i.e., 1.5-2.5 million people will need RRT. According to the renal registries, however, the number of patients who actually received dialysis treatment was only 0.3 million.”

The cost of dialysis is a major barrier, especially in low and middle income countries like China, and the impact on health expenditure is vastly disproportionate to the numbers of people who use it. In the US for example, dialysis provision costs over $US40 billion, consuming over 6% of health expenditure for treating a fraction of a percent of the population.

Doctor Jicheng Lv, who was also involved in the study from the Renal Division at Peking University First Hospital, said that the average cost of dialysis was around RMB 100,000 per person per year in China. “That surely adds great economic burden to the patients and their family and unaffordable to most people who need it.”

“As China has more and more people with hypertension and diabetes, which are independently associated with kidney damage, it leads to a high increase in kidney disease prevalence, and the trend is likely to continue. And since the cost of end-stage kidney disease is so high, the priority work is to prevent and reduce the risk factors.”Doctor LV continued.

“There is also a pressing need to develop low-cost and simplified dialysis machines and policies to reduce the cost of the therapy. Besides, peritoneal dialysis should also be promoted especially in the resource-constrained areas. ”

“Dialysis has been around for half a century, yet the technology hasn’t evolved substantively, remaining hugely expensive despite its simplicity,” added Professor Perkovic, “Computers have shrunk from the size of buildings to that of a watch in this time; that’s the kind of radical overhaul needed.”

As a result of this research, a world-wide competition is being launched today to design the world’s first affordable dialysis machine, attracting a prize of $US100,000.

“Dialysis machines purify the blood, replacing an essential function of the kidneys. If we can develop an affordable dialysis machine with low operating costs, that runs on solar power and uses local water sources, many more people will have access to the treatment and millions of lives could be saved.”

The competition is sponsored by The George Institute, the International Society of Nephrology and the Asian Pacific Society of Nephrology, with the support of the Farrell Family Foundation.

Incoming president of the International Society of Nephrology, Professor Adeera Levin of the University of British Columbia said that the International Society of Nephrology is proud to support the Affordable Dialysis Prize.

“We hope it will attract interest around the world, particularly in those countries where kidney patients stand to benefit the most from creative, innovative approaches to treatment at a price everyone can afford,” says Professor Levin.

The new findings provide evidence for setting global targets and are an incentive for industry to invest in low cost technologies for dialysis; and suggest the increasing gap in treatment demands a combined advocacy, health-care delivery and research action plan:

  1. AWARENESS: Governments should be made aware of the number of preventable deaths in their jurisdictions and lobbied to increase access to dialysis for affected individuals where possible as part of their broader health planning activities
  2. PREVENTION: Innovative models of preventative care should be piloted in low- and middle-income countries, especially in areas where access to physicians is low. Effective kidney disease prevention strategies could include blood pressure control, renin angiotensin system blockade and management of key risk factors including diabetes, obesity and acute kidney injury. 
  3. AFFORDABILITY: More cost-effective dialysis techniques must be developed and made available. Current dialysis treatment will remain unaffordable for many of the countries where access to renal replacement therapy is lowest. Considering the increase in the expected number of patients requiring treatment, dialysis provision will also represent a substantial financial burden for even the most high income countries in the years ahead.