NDT Advance Access originally published online on January 9, 2008
Nephrology Dialysis Transplantation 2008 23(2):471-473; doi:10.1093/ndt/gfm854
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The third World Kidney Day: looking back and thinking forward
1Professor of International Medicine, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA and 2Professor of Renal Medicine, The John Walls Renal Unit, Leicester General Hospital, Leicester, UK
Correspondence and offprint requests to: Sudhir V. Shah, Division of Nephrology, UAMS College of Medicine, 4301 West Markham, Slot 501, Little Rock, AR 72205m, USA. E-mail: shahsudhirv{at}uams.edu
On behalf of the World Kidney Day Steering Committee: William G. Couser (ISN), John Davis (IFKF), Joel Kopple (IFKF), Thomas Reiser (ISN), Miguel Riella (ISN), Anne Wilson (IFKF).
‘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
13th March 2008 heralds the third annual World Kidney Day — 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.
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The beginnings of World Kidney Day |
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There have probably been many individuals who Author: The matter provided under ‘Acknowledgement section’ has been set below the author names and in the beginning of the text after corresponding author's details. Please check.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 also was persistent in persuading many in leadership positions to bring this notion–a World Kidney Day (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 World Kidney Day in the spring of 2003, recognizing that chronic kidney disease (CKD) is a global, public health threat, but is typically low on government health agendas; that it can be detected with simple and inexpensive tests yet national detection programs are rare and that, while it can be treated with existing, effective therapies, few people with CKD receive appropriate health care.
In September 2003 Kopple wrote to Warwick Prime, the then President of the IFKF, and proposed an annual World Kidney Day. In order to make it truly an international collaborative effort, representatives of IFKF and the International Society of Nephrology (ISN) met in November 2003, and at that meeting, Kopple presented a précis entitled ‘Proposal for the Establishment of a World Kidney Day’. A World Kidney Day ISN–IFKF liaison committee was established with the initial members being Bill Couser, John Dirks, Joel Kopple, Warwick Prime and Jan Weening. In 2004, both the IFKF Executive Committee and the ISN Council endorsed the World Kidney Day program, and ISN agreed in 2005 to commit sufficient resources to enable a first World Kidney Day to be held on 7 March 2006. An editorial about WKD was published that month in eight scientific journals. Despite being planned with short notice and few resources, kidney organizations in 45 countries enthusiastically embraced the first World Kidney Day and organized health screening events, road shows, walkathons, public lectures and press conferences. It was clear that World Kidney Day 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 World Kidney Day. A memorandum of understanding between IFKF and ISN for the planning and implementation of an annual World Kidney Day was signed in June 2006 by the two presidents, Bill Couser (ISN) and Sudhir Shah (IFKF). The document stated that, ‘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 IFKF and ISN.
A WKD steering committee was established with eight members—four members nominated by each organization—as well as a scientific advisory committee. ISN agreed to provide the initial funding necessary for the central operational management of a World Kidney Day project team.
The continued leadership of the ISN/IFKF Steering Committee in 2007 helped secure funding from global sponsors; create a World Kidney Day 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 8 March 2007 can be viewed on www.worldkidneyday.org. The WKD website will feature planned activities for 13 March 2008, which promises to be an even greater event, with continued emphasis on the message that ‘kidney disease is common, harmful and treatable’.
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The main challenges and aims of World Kidney Day |
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Public awareness
World Kidney Day offers a crucial, visible opportunity to inform and educate health policy makers, those at highest risk of CKD, and also 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. World Kidney Day offers an increasingly visible opportunity to tailor public awareness messages to the media for wide impact.
The importance of CKD
While each country and region may adopt different priorities for World Kidney Day from year to year—choosing, for example, to promote living donor kidney transplantation or to push for improvements in dialysis facilities—in many countries it is the detection and management of CKD that 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 new high-profile initiatives that will have an impact on CKD and seek the endorsement of agencies that can help to ensure such initiatives become embedded into routine healthcare.
Since the term CKD came into usage and its staging was defined [1], there have been numerous investigative activities and publications on its importance [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 GFR (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 so far no evidence that these are cost-effective.
CKD detection programs
Based on current information, we recommend that all countries have targeted screening programs. Steps for establishing an effective program include:
- Reporting of eGFR by all laboratories measuring serum creatinine
- Measuring eGFR and proteinuria in those at the 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 with end-stage renal disease (ESRD).
- Regularly measuring blood pressure, eGFR and proteinuria in those identified with CKD.
- Establishing targets for blood pressure control in those with CKD, and appropriate use of drugs blocking the renin–angiotensin system
- Agreeing 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 over the last few years toward the establishment of such a program. The reporting of eGFR is now mandated in all UK clinical laboratories, and guidelines for the detection and management of CKD have been widely accepted [12]. This progress has been made more straightforward by a government-directed and funded healthcare system, which 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 where health care is provided by multiple independent agencies or in the developing world where resources available for health care are much less.
In advocating for these programs that are now proving successful and cost-effective, we favor small but sure-footed steps [5,10]; we must be careful that screening tests identify patients with true disease, for whom intervention will make a critical difference by delaying or avoiding ESRD, or by modifying risk factors for cardiovascular disease that is so closely linked with CKD. This may be particularly true in the elderly—those with the highest prevalence of CKD and in whom preventive therapy is less likely to improve survival or quality of life [5].
In parallel, we must emphasize 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 ESRD, and to test the efficacy of our new healthcare strategies for CKD.
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World Kidney Day is here to stay |
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The momentum of World Kidney Day is assured and we anticipate that many more than the 60 countries that participated previously will be reporting to us their initiatives and successes on 13 March 2008. The WKD Steering Committee and Project Team will continue to provide a toolkit of resources including messages, logos, posters and designs for other materials (available for downloading at http://www.worldkidneyday.org/) 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 healthcare 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 the government bodies that make health care policy, all unite to improve early detection programs and optimize medical care for those millions worldwide who can benefit from an improved awareness of CKD as a global health issue.
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Appendix |
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World Kidney Day 2007 scientific advisory board
Vittorio E. Andreucci, Italy
Rashad S. Barsoum, Egypt
Allan J. Collins, USA
David C. H. Harris, Australia
Bernardo Rodriguez Iturbe, Venezuela
Paul E. De Jong, The Netherlands
Robert W. Schrier, USA
Philip Kam Tao Li, China
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Acknowledgments |
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Conflict of Interest Statement. None declared.
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References |
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- KF: 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 Kid Dis (2002) 39:S46–S75.[CrossRef]
- Archibald G, Bartlett W, Brown A, et al. UK Consensus Conference on Early Chronic Kidney Disease—6 and 7 February 2007. In: Nephrol Dial Transplant (2007) 22:2455–2457.
[Free Full Text] - Vassalotti JA, Lesley AS, Levey AS. Testing for chronic kidney disease: a position statement from the National Kidney Foundation. Am J Kid Dis (2007) 50:169–180.[CrossRef][Web of Science][Medline]
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- Couser WG. CKD-the promise and the perils. J Am Soc Nephrol (2007) 18:2803–2805.
[Free Full Text] - Himmelfarb J. Chronic kidney disease and the public health. JAMA (2007) 297:2630–2633.
[Free Full Text] - Stevens PE, O’Donoghue DJ, S dL, et al. Chronic kidney disease management in the United Kingdom: NEOERICA project results. Kidney Int (2007) 72:92–99.[CrossRef][Web of Science][Medline]
- Coresh 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.
[Abstract/Free Full Text] - Schoolwerth 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.
- Kiberd B. The chronic kidney disease epidemic: stepping back and looking forward. J Am Soc Nephrol (2006) 17:2967–2973.
[Abstract/Free Full Text] - Kallen AJ, Patel PR. In search of a rational approach to chronic kidney disease detection and management [commentary]. Kidney Int (2007) 72:3–5.[CrossRef][Web of Science][Medline]
- Joint 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. (2006) London: Royal College of Physicians. http://www.renal.org/CKDguide.
Accepted in revised form: 10. 9.07
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