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• W2996172570 abstract "Chronic kidney disease (CKD) is an important public health concern in developed countries because of both the number of people affected and the high cost of care when prevention strategies are not effectively implemented. Prevention should start at the governance level with the institution of multisectoral polices supporting sustainable development goals and ensuring safe and healthy environments. Primordial prevention of CKD can be achieved through implementation of measures to ensure healthy fetal (kidney) development. Public health strategies to prevent diabetes, hypertension, and obesity as risk factors for CKD are important. These approaches are cost-effective and reduce the overall noncommunicable disease burden. Strategies to prevent nontraditional CKD risk factors, including nephrotoxin exposure, kidney stones, infections, environmental exposures, and acute kidney injury (AKI), need to be tailored to local needs and epidemiology. Early diagnosis and treatment of CKD risk factors such as diabetes, obesity, and hypertension are key for primary prevention of CKD. CKD tends to occur more frequently and to progress more rapidly among indigenous, minority, and socioeconomically disadvantaged populations. Special attention is required to meet the CKD prevention needs of these populations. Effective secondary prevention of CKD relies on screening of individuals at risk to detect and treat CKD early, using established and emerging strategies. Within high-income countries, barriers to accessing effective CKD therapies must be recognized, and public health strategies must be developed to overcome these obstacles, including training and support at the primary care level to identify individuals at risk of CKD, and appropriately implement clinical practice guidelines. Chronic kidney disease (CKD) is an important public health concern in developed countries because of both the number of people affected and the high cost of care when prevention strategies are not effectively implemented. Prevention should start at the governance level with the institution of multisectoral polices supporting sustainable development goals and ensuring safe and healthy environments. Primordial prevention of CKD can be achieved through implementation of measures to ensure healthy fetal (kidney) development. Public health strategies to prevent diabetes, hypertension, and obesity as risk factors for CKD are important. These approaches are cost-effective and reduce the overall noncommunicable disease burden. Strategies to prevent nontraditional CKD risk factors, including nephrotoxin exposure, kidney stones, infections, environmental exposures, and acute kidney injury (AKI), need to be tailored to local needs and epidemiology. Early diagnosis and treatment of CKD risk factors such as diabetes, obesity, and hypertension are key for primary prevention of CKD. CKD tends to occur more frequently and to progress more rapidly among indigenous, minority, and socioeconomically disadvantaged populations. Special attention is required to meet the CKD prevention needs of these populations. Effective secondary prevention of CKD relies on screening of individuals at risk to detect and treat CKD early, using established and emerging strategies. Within high-income countries, barriers to accessing effective CKD therapies must be recognized, and public health strategies must be developed to overcome these obstacles, including training and support at the primary care level to identify individuals at risk of CKD, and appropriately implement clinical practice guidelines. In recent decades, remarkable progress has been made that has deepened our understanding of the burden and consequences of chronic kidney disease (CKD) around the globe.1Thomas B. Matsushita K. Abate K.H. et al.Global cardiovascular and renal outcomes of reduced GFR.J Am Soc Nephrol. 2017; 28: 2167-2179Crossref PubMed Scopus (62) Google Scholar, 2Levin A. Tonelli M. Bonventre J. et al.Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy.Lancet. 2017; 390: 1888-1917Abstract Full Text Full Text PDF PubMed Scopus (192) Google Scholar, 3Levey A.S. Coresh J. Chronic kidney disease.Lancet. 2012; 379: 165-180Abstract Full Text Full Text PDF PubMed Scopus (859) Google Scholar Since its formal definition in 2002 and subsequent classification by the US National Kidney Foundation, the term CKD has been widely adopted in clinical practice and policy.3Levey A.S. Coresh J. Chronic kidney disease.Lancet. 2012; 379: 165-180Abstract Full Text Full Text PDF PubMed Scopus (859) Google Scholar In 2016, CKD was the ninth-leading cause of death in high-income countries.4World Health OrganizationThe top 10 causes of death. 2018.https://www.who.int/en/news-room/fact-sheets/detail/the-top-10-causes-of-deathDate accessed: November 30, 2019Google Scholar Although death rates due to ischemic heart disease, stroke, and lower respiratory infections are anticipated to decrease, years of life lost (YLLs) due to CKD are forecasted to more than double globally by 2040.5Foreman K.J. Marquez N. Dolgert A. et al.Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016—40 for 195 countries and territories.Lancet. 2018; 392: 2052-2090Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar These facts are alarming when one considers demographic trends of aging and lifestyle patterns in developed nations, which are associated with increased CKD risk.6Vanholder R. Annemans L. Brown E. et al.Reducing the costs of chronic kidney disease while delivering quality health care: a call to action.Nat Rev Nephrol. 2017; 13: 393-409Crossref PubMed Scopus (55) Google Scholar Large-scale public health investments must therefore be made across the health system to support CKD prevention and management. The prevalence of CKD in high-income countries has been reported to be around 8.6% in males and 9.6% in females over age 20 years.7Mills K.T. Xu Y. Zhang W. et al.A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010.Kidney Int. 2015; 88: 950-957Abstract Full Text Full Text PDF PubMed Scopus (228) Google Scholar Those with CKD have a reduced life expectancy compared with that of the general population, beginning at an estimated glomerular filtration rate (eGFR) of <60 ml/min per 1.73 m2, in large part due to the associated increased risk of cardiovascular disease (CVD).8Neild G.H. Life expectancy with chronic kidney disease: an educational review.Pediatr Nephrol. 2017; 32: 243-248Crossref PubMed Scopus (25) Google Scholar CKD and its comorbidities are also important drivers of health care costs.9van Oosten M.J.M. Logtenberg S.J.J. Leegte M.J.H. et al.Age-related difference in health care use and costs of patients with chronic kidney disease and matched controls: analysis of Dutch health care claims data.Nephrol Dial Transplant. 2019; (pii: gfz146)PubMed Google Scholar Traditional and nontraditional risk factors for CKD span a broad range; they include developmental, physical, social, cultural, structural, environmental, and genetic factors.2Levin A. Tonelli M. Bonventre J. et al.Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy.Lancet. 2017; 390: 1888-1917Abstract Full Text Full Text PDF PubMed Scopus (192) Google Scholar It is likely that an substantial proportion of CKD can be prevented at various levels through primordial (early, upstream), primary, and secondary interventions.10Luyckx V.A. Tuttle K.R. Garcia-Garcia G. et al.Reducing major risk factors for chronic kidney disease.Kidney Int Suppl (2011). 2017; 7: 71-87Abstract Full Text Full Text PDF PubMed Google Scholar Effective interventions to prevent and delay progression of CKD are well recognized, but many barriers exist that limit their widespread implementation, including cost, gender, age, race, and socioeconomic status, even in high-income settings.11Norton J.M. Moxey-Mims M.M. Eggers P.W. et al.Social determinants of racial disparities in CKD.J Am Soc Nephrol. 2016; 27: 2576-2595Crossref PubMed Scopus (34) Google Scholar,12Caskey F. Dreyer G. Kidney Research UKKidney health inequalities in the UK. An agenda for change.https://kidneyresearchuk.org/wp-content/uploads/2019/09/Health_Inequalities_lay_report_FINAL_WEB_20190311.pdfDate accessed: November 30, 2019Google Scholar Diabetes, hypertension, and obesity are important contributors to the global burden of disease and are the most common traditional risk factors for CKD.13Xie Y. Bowe B. Mokdad A.H. et al.Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016.Kidney Int. 2018; 94: 567-581Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar Nontraditional CKD risk factors include developmental and gestational factors; kidney stones; exposure to nephrotoxic medications, climate change, and air pollution; infections; and AKI.2Levin A. Tonelli M. Bonventre J. et al.Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy.Lancet. 2017; 390: 1888-1917Abstract Full Text Full Text PDF PubMed Scopus (192) Google Scholar,14Garcia-Garcia G. Jha V. World Kidney Day Steering CommitteeCKD in disadvantaged populations.Kidney Int. 2015; 87: 251-253Abstract Full Text Full Text PDF PubMed Google Scholar The burden of CKD attributable to these risk factors is likely considerable, given that many coexist with the more traditional risk factors.15Bowe B. Xie Y. Li T. et al.Estimates of the 2016 global burden of kidney disease attributable to ambient fine particulate matter air pollution.BMJ Open. 2019; 9e022450Crossref PubMed Scopus (0) Google Scholar, 16Lazarus B. Chen Y. Wilson F.P. et al.Proton pump inhibitor use and the risk of chronic kidney disease.JAMA Intern Med. 2016; 176: 238-246Crossref PubMed Scopus (312) Google Scholar, 17Shang W. Li L. Ren Y. et al.History of kidney stones and risk of chronic kidney disease: a meta-analysis.PeerJ. 2017; 5e2907Crossref PubMed Scopus (5) Google Scholar, 18Crump C. Sundquist J. Winkleby M.A. et al.Preterm birth and risk of chronic kidney disease from childhood into mid-adulthood: national cohort study.BMJ. 2019; 365: l1346Crossref PubMed Scopus (9) Google Scholar, 19Vikse B.E. Pre-eclampsia and the risk of kidney disease.Lancet. 2013; 382: 104-106Abstract Full Text Full Text PDF PubMed Google Scholar, 20Eriksson J.G. Salonen M.K. Kajantie E. et al.Prenatal growth and CKD in older adults: longitudinal findings from the Helsinki Birth Cohort Study, 1924-1944.Am J Kidney Dis. 2018; 71: 20-26Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar, 21Sykes L. Asar O. Ritchie J. et al.The influence of multiple episodes of acute kidney injury on survival and progression to end stage kidney disease in patients with chronic kidney disease.PloS One. 2019; 14e0219828Crossref PubMed Scopus (1) Google Scholar A comprehensive approach to CKD prevention begins with understanding the breadth of CKD risk factors, their frequency and distribution, identifying populations at risk, and subsequently implementing mitigation strategies. Screening for kidney disease has been shown to be cost-effective in high-income countries.22Komenda P. Ferguson T.W. Macdonald K. et al.Cost-effectiveness of primary screening for CKD: a systematic review.Am J Kidney Dis. 2014; 63: 789-797Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar It is imperative that such activities include vulnerable and disenfranchised populations within these settings. This article discusses major strategies to tackle traditional and nontraditional CKD risk factors and implement CKD prevention in high-income countries, where health system barriers should be surmountable. Population-based studies from high-income countries have demonstrated an association between low birth weight (birth weight < 2.5 kg), being born small for gestational age (birth weight < 10th percentile for gestational age), and preterm birth (birth before 37 weeks of gestation) and subsequent risk of CKD or end-stage kidney disease (ESKD).18Crump C. Sundquist J. Winkleby M.A. et al.Preterm birth and risk of chronic kidney disease from childhood into mid-adulthood: national cohort study.BMJ. 2019; 365: l1346Crossref PubMed Scopus (9) Google Scholar,20Eriksson J.G. Salonen M.K. Kajantie E. et al.Prenatal growth and CKD in older adults: longitudinal findings from the Helsinki Birth Cohort Study, 1924-1944.Am J Kidney Dis. 2018; 71: 20-26Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar,23Ruggajo P. Skrunes R. Svarstad E. et al.Familial factors, low birth weight, and development of ESRD: A nationwide registry study.Am J Kidney Dis. 2016; 67: 601-608Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar These associations are stronger in children and adolescents but continue up to an advanced age.20Eriksson J.G. Salonen M.K. Kajantie E. et al.Prenatal growth and CKD in older adults: longitudinal findings from the Helsinki Birth Cohort Study, 1924-1944.Am J Kidney Dis. 2018; 71: 20-26Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar,24Khalsa D.D. Beydoun H.A. Carmody J.B. Prevalence of chronic kidney disease risk factors among low birth weight adolescents.Pediatr Nephrol. 2016; 31: 1509-1516Crossref PubMed Scopus (17) Google Scholar,25Hirano D. Ishikura K. Uemura O. et al.Association between low birth weight and childhood-onset chronic kidney disease in Japan: a combined analysis of a nationwide survey for paediatric chronic kidney disease and the National Vital Statistics Report.Nephrol Dial Transplant. 2016; 31: 1895-1900Crossref PubMed Scopus (0) Google Scholar The link between developmental circumstances and risk of CKD appears, at least in part, to be mediated by altered renal development in utero or shortly after birth, which is associated with a reduced nephron number, subsequent hyperfiltration, and predisposition to hypertension.26Brenner B.M. Lawler E.V. Mackenzie H.S. The hyperfiltration theory: a paradigm shift in nephrology.Kidney Int. 1996; 49: 1774-1777Abstract Full Text PDF PubMed Scopus (540) Google Scholar Globally, approximately 10% of babies are born preterm, a proportion that is similar across income regions,27Chawanpaiboon S. Vogel J.P. Moller A.B. et al.Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis.Lancet Glob Health. 2019; 7: e37-e46Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar with the risk factors in developed countries including preeclampsia, prior preterm birth, advanced maternal age, chronic maternal illness, assisted reproduction, and multiple gestations.28Ferrero D.M. Larson J. Jacobsson B. et al.Cross-country individual participant analysis of 4.1 million singleton births in 5 countries with very high human development index confirms known associations but provides no biologic explanation for 2/3 of all preterm births.PloS One. 2016; 11e0162506Crossref PubMed Scopus (43) Google Scholar The incidence of low birth weight in high-income countries has been stable at 7% for >20 years, and is most commonly associated with preterm birth.29Blencowe H. Krasevec J. de Onis M. et al.National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis.Lancet Glob Health. 2019; 7: e849-e860Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar Both preterm birth and low birth weight occur more frequently among socioeconomically disadvantaged populations and indigenous communities within high-income countries, where structural, environmental, social, and physical factors impact fetal and maternal health throughout gestation and early childhood.30Low Birth Weight and Nephron Number Working GroupThe impact of kidney development on the life course: a consensus document for action.Nephron. 2017; 136: 3-49Crossref PubMed Scopus (53) Google Scholar Additional developmental exposures include preeclampsia,31Geelhoed J.J. Fraser A. Tilling K. et al.Preeclampsia and gestational hypertension are associated with childhood blood pressure independently of family adiposity measures: the Avon Longitudinal Study of Parents and Children.Circulation. 2010; 122: 1192-1199Crossref PubMed Scopus (118) Google Scholar which is associated with higher blood pressure in childhood, and maternal overweight/obesity and/or diabetes, which are associated with increased odds of pediatric kidney disease, dysplasia, and later-life diabetic nephropathy.32Hsu C.W. Yamamoto K.T. Henry R.K. et al.Prenatal risk factors for childhood CKD.J Am Soc Nephrol. 2014; 25: 2105-2111Crossref PubMed Scopus (42) Google Scholar,33Pavkov M.E. Hanson R.L. Knowler W.C. et al.Effect of intrauterine diabetes exposure on the incidence of end-stage renal disease in young adults with type 2 diabetes.Diabetes Care. 2010; 33: 2396-2398Crossref PubMed Scopus (11) Google Scholar In high-income countries, gestational hypertension/preeclampsia occurs in around 3% of pregnancies,34Abalos E. Cuesta C. Carroli G. et al.Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health.BJOG. 2014; 121: 14-24Crossref PubMed Scopus (166) Google Scholar diabetes in around 16% of pregnancies,35International Diabetes FederationIDF Diabetes Atlas.https://diabetesatlas.org/en/Date accessed: November 30, 2019Google Scholar and obesity (body mass index > 30 kg/m2) in 5%–30% of pregnant women.36Poston L. Caleyachetty R. Cnattingius S. et al.Preconceptional and maternal obesity: epidemiology and health consequences.Lancet Diabetes Endocrinol. 2016; 4: 1025-1036Abstract Full Text Full Text PDF PubMed Scopus (193) Google Scholar These rates are also generally higher among indigenous, minority, and disadvantaged populations in these countries. Mothers who experience preeclampsia or gestational diabetes are themselves at increased risk of future kidney disease and diabetes. Developmental programming of CKD risk is relevant in high-income settings, and especially so among indigenous, African American, and lower socioeconomic–level populations who have an established increased risk of CKD.14Garcia-Garcia G. Jha V. World Kidney Day Steering CommitteeCKD in disadvantaged populations.Kidney Int. 2015; 87: 251-253Abstract Full Text Full Text PDF PubMed Google Scholar Primordial prevention of CKD therefore includes optimization of maternal health prior to and during pregnancy and ensuring healthy growth and adherence to healthy lifestyles for children born with low birth weight, small for gestational age, or preterm (Figure 137United NationsSustainable development goals.http://www.un.org/sustainabledevelopment/news/communications-material/Date accessed: November 30, 2019Google Scholar). Healthy mothers begin with healthy girls who receive good nutrition as children, grow up in safe environments with adequate resources permitting healthy and productive lives, are educated, and live in equitable societies. Such circumstances are fostered by the United Nations Sustainable Development Goals, requiring health in all policies, and multisectoral action.38Luyckx V.A. Tonelli M. Stanifer J.W. The global burden of kidney disease and the sustainable development goals.Bull World Health Organ. 2018; 96: 414-422DCrossref PubMed Scopus (58) Google Scholar For maximal effectiveness and efficiency, strategies to reduce CKD risk should be integrated into a broad approach to noncommunicable disease prevention, especially given the high frequency of comorbidities with CKD (Figure 2).39Tonelli M. Wiebe N. Manns B.J. et al.Comparison of the complexity of patients seen by different medical subspecialists in a universal health care system.JAMA Netw Open. 2018; 1e184852Crossref PubMed Scopus (27) Google Scholar Strategies to tackle lifestyle-related noncommunicable disease risk factors are most effective when they are implemented at both the patient and community levels, are supported by regulation and legislation, and incorporate a multi-component approach.40World Health OrganizationHealth in all policies.http://apps.who.int/iris/bitstream/10665/112636/1/9789241506908_eng.pdf?ua=1Date accessed: November 30, 2019Google Scholar, 41Hyseni L. Elliot-Green A. Lloyd-Williams F. et al.Systematic review of dietary salt reduction policies: evidence for an effectiveness hierarchy?.PloS One. 2017; 12e0177535Crossref PubMed Scopus (28) Google Scholar, 42McGill R. Anwar E. Orton L. et al.Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact.BMC Public Health. 2015; 15: 457Crossref PubMed Scopus (68) Google Scholar Successful public health approaches include introduction of economic incentives to reduce prices of healthy food and beverages and increase taxation on unhealthy products, restriction of food advertising, regulation of food composition (salt, trans fats, sugar), support for education and physical activity programs in schools, provision of public recreation facilities, and campaigns to limit advertising and sales of harmful products.43Mozaffarian D. Afshin A. Benowitz N.L. et al.Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association.Circulation. 2012; 126: 1514-1563Crossref PubMed Scopus (327) Google Scholar,44Gupta R. Wood D.A. Primary prevention of ischaemic heart disease: populations, individuals, and health professionals.Lancet. 2019; 394: 685-696Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar Policies aimed at reducing air pollution are also required.13Xie Y. Bowe B. Mokdad A.H. et al.Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016.Kidney Int. 2018; 94: 567-581Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar,44Gupta R. Wood D.A. Primary prevention of ischaemic heart disease: populations, individuals, and health professionals.Lancet. 2019; 394: 685-696Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar The World Health Organization, endorsed by member states, has developed multiple packages to guide countries in developing and implementing such strategies.45World Health OrganizationTackling NCDs: Best buys and other recommended interventions for the prevention and control of noncommunicable diseases.http://www.who.int/ncds/management/best-buys/en/Date accessed: November 30, 2019Google Scholar,46World Health OrganizationWHO PEN Protocol 1. Prevention of heart attacks, strokes and kidney disease through integrated management of diabetes and hypertension.http://www.who.int/ncds/management/Protocol1_HeartAttack_strokes_kidneyDisease.pdf?ua=1Date accessed: November 30, 2019Google Scholar Implementation of population-level approaches to prevent CKD requires engagement, action, and commitment across multiple sectors of government and society.40World Health OrganizationHealth in all policies.http://apps.who.int/iris/bitstream/10665/112636/1/9789241506908_eng.pdf?ua=1Date accessed: November 30, 2019Google Scholar The burden of CKD has risen since 1990 in high-income settings, and despite generally good access to primary health care in most developed countries, attributable to ongoing exposure to risk factors, population aging, and population growth.13Xie Y. Bowe B. Mokdad A.H. et al.Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016.Kidney Int. 2018; 94: 567-581Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar,47Bowe B. Xie Y. Li T. et al.Changes in the US burden of chronic kidney disease from 2002 to 2016: an analysis of the Global Burden of Disease Study.JAMA Netw Open. 2018; 1e184412Crossref PubMed Scopus (0) Google Scholar Within developed countries, the burden of CKD is variable as is the distribution of predisposing risk factors, which tend to be more prevalent in more socioeconomically disadvantaged populations.47Bowe B. Xie Y. Li T. et al.Changes in the US burden of chronic kidney disease from 2002 to 2016: an analysis of the Global Burden of Disease Study.JAMA Netw Open. 2018; 1e184412Crossref PubMed Scopus (0) Google Scholar,48Bruck K. Stel V.S. Gambaro G. et al.CKD prevalence varies across the European general population.J Am Soc Nephrol. 2016; 27: 2135-2147Crossref PubMed Google Scholar Risk factor distribution may also differ between men and women and tends to increase with age; therefore, local epidemiology is relevant in development of strategies to address local risk factor burdens.49Lv J.C. Zhang L.X. Prevalence and disease burden of chronic kidney disease.Adv Exp Med Biol. 2019; 1165: 3-15Crossref PubMed Scopus (0) Google Scholar,50Chen H.Y. Lu F.H. Chang C.J. et al.Metabolic abnormalities, but not obesity per se, associated with chronic kidney disease in a Taiwanese population.Nutr Metab Cardiovasc Dis. 2019; Abstract Full Text Full Text PDF Scopus (0) Google Scholar In many regions, metabolic risk factors are the major drivers of CKD risk,47Bowe B. Xie Y. Li T. et al.Changes in the US burden of chronic kidney disease from 2002 to 2016: an analysis of the Global Burden of Disease Study.JAMA Netw Open. 2018; 1e184412Crossref PubMed Scopus (0) Google Scholar,50Chen H.Y. Lu F.H. Chang C.J. et al.Metabolic abnormalities, but not obesity per se, associated with chronic kidney disease in a Taiwanese population.Nutr Metab Cardiovasc Dis. 2019; Abstract Full Text Full Text PDF Scopus (0) Google Scholar and indeed, diabetes remains the most common cause of CKD globally.13Xie Y. Bowe B. Mokdad A.H. et al.Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016.Kidney Int. 2018; 94: 567-581Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar The contribution of hypertension to the burden of CKD in developed countries is more variable but remains significant.13Xie Y. Bowe B. Mokdad A.H. et al.Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016.Kidney Int. 2018; 94: 567-581Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar The contribution of environmental and other nontraditional causes of CKD, including air pollution, smoking, kidney stones, infections, AKI, and other factors are increasingly being recognized.15Bowe B. Xie Y. Li T. et al.Estimates of the 2016 global burden of kidney disease attributable to ambient fine particulate matter air pollution.BMJ Open. 2019; 9e022450Crossref PubMed Scopus (0) Google Scholar,51Noborisaka Y. Ishizaki M. Yamada Y. et al.The effects of continuing and discontinuing smoking on the development of chronic kidney disease (CKD) in the healthy middle-aged working population in Japan.Environ Health Prev Med. 2013; 18: 24-32Crossref PubMed Scopus (0) Google Scholar A holistic approach to disease prevention, as highlighted by the United Nations Sustainable Development Goals, is therefore likely to have a positive impact on the CKD burden from diverse causes (Figure 1).38Luyckx V.A. Tonelli M. Stanifer J.W. The global burden of kidney disease and the sustainable development goals.Bull World Health Organ. 2018; 96: 414-422DCrossref PubMed Scopus (58) Google Scholar In 2019, in high-income countries, 10.4% of people aged 20–79 years are living with diabetes, which translates into 95.2 million individuals, 38.2% whom are undiagnosed.35International Diabetes FederationIDF Diabetes Atlas.https://diabetesatlas.org/en/Date accessed: November 30, 2019Google Scholar A further 11.4% of the population have impaired glucose tolerance and are therefore at risk of diabetes.35International Diabetes FederationIDF Diabetes Atlas.https://diabetesatlas.org/en/Date accessed: November 30, 2019Google Scholar Data from country surveys in 12 high-income countries reported prevalence rates of hypertension (defined as blood pressure >140/90 mm Hg) ranging from 33% to 59% in women and 34% to 59% in men aged 40–79 years.52NCD Risk Factor CollaborationLong-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys.Lancet. 2019; 394: 639-651Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Overall, across the 12 countries, awareness of hypertension ranged from 56% to 84%, treatment from 39% to 81%, and control from 17% to 69%.52NCD Risk Factor CollaborationLong-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys.Lancet. 2019; 394: 639-651Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar In 2014, rates of overweight (body mass index > 25) in adults over 18 years in high-income countries were 61.5% in men and 52.2% in women.53World Health OrganizationGlobal report on diabetes.https://apps.who.int/iris/bitstream/handle/10665/204874/WHO_NMH_NVI_16.3_eng.pdf;jsessionid=4FF2FE97F5DC497A6168D6F8605E3709?sequence=1Date accessed: November 30, 2019Google Scholar In 2018, 7.2% of children in high-income countries were overweight, amounting to 5 million children, a 21% increase since 2000.54World Health OrganizationJoint child malnutrition estimates—levels and trends (2019 edition).https://www.who.int/nutgrowthdb/estimates2018/en/Date accessed: November 30, 2019Google Scholar Obesity is a major co" @default.
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• W2996172570 title "Preventing CKD in Developed Countries" @default.
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