The global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5th most common cause of years of life lost globally by 2040. CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume up to 3% of the annual healthcare budget in high-income countries. However, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventions – be it primary, secondary, or tertiary. This article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney and urinary tracts, as well as exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimization and glycemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD, management of co-morbidities such as uremia and cardiovascular disease is a highly recommended preventative intervention to avoid or delay dialysis or kidney transplantation. Political efforts are needed to proliferate the preventive approach. While national policies and strategies for non-communicable diseases might be present in a country, specific policies directed toward education and awareness about CKD screening, management, and treatment are often lacking. Hence, there is an urgent need to increase the awareness of preventive measures throughout populations, professionals, and policy makers.

ABSTRACT There is limited data on community-acquired acute kidney injury (CA-AKI) in low/middle-income countries. This retrospective study focussed on the prevalence, severity and outcomes of CA-AKI at an institution in Jamaica. The selected population was patients who attended the University Hospital of the West Indies between January 2015 and June 2015. Acquired kidney injury was diagnosed and staged by KDIGO criteria. Four hundred and thirty-two patients (4.22%) met the diagnostic criteria of acute kidney injury (AKI). Of these, 171 (39.6%) had stage I AKI, 110 (25.5%) had stage II and 151 (35.0%) had stage III. Certain underlying causes such as volume depletion, various infections and cardiac failure were most prevalent causes of CA-AKI. Among the underlying causes, volume depletion remained as the leading cause of CA-AKI. Patients who had underlying causes which required urgent medical attention are likely to achieve recognition of CA-AKI at an early stage (95% CI: 1.884, 2.128, p < 0.001). Volume depletion and cardiac failure significantly increased the risk of CA-AKI (OR. 2.037, 95% CI: 1.130, 1.651, p = 0.004 and OR, 1.759, 95% CI: 1.827, 1.982, p = 0.03), respectively. Ninety-four patients (21.8%) had incomplete and 46 patients (10.6%) had no renal recovery at ≥ 90 days. The majority of patients who achieved complete renal recovery were patients who had stage I AKI (90.1%). Fifty-two patients with CAAKI (12%) required dialysis and most of them (86.5%) had stage III AKI. Stages I and II CA-AKI had better renal outcomes than stage III CA-AKI (95% CI: 1.566, 1.875, p < 0.001). The 30-day mortality and 90-day mortality among the patients with CA-AKI were 6.3% and 7.4%, respectively. The severity of CA-AKI varies with underlying cause. Earlier medical attention may link with better renal recovery. Volume depletion and cardiac failure are significant risk factors for CA-AKI and volume depletion remains as the leading cause of CA-AKI. Adverse outcomes are more likely to occur in patients with Stage III CA-AKI.

RESUMEN Los datos acerca de la lesión renal aguda adquirida en la comunidad (LRA-AC) en países de ingresos bajos y medios, son limitados. Este estudio retrospectivo se centró en la prevalencia, gravedad y resultados de LRA-AC en una institución en Jamaica. La población seleccionada estuvo formada por pacientes que acudieron al Hospital Universitario de West Indies entre enero de 2015 y junio de 2015. La lesión renal adquirida fue diagnosticada y dividida en etapas de acuerdo con los criterios de la organización KDIGO (siglas en inglés de “Enfermedad Renal: Mejorando los Resultados Globales”). Cuatrocientos treinta y dos pacientes (4.22%) cumplieron los criterios de diagnóstico de LRA. De estos, 171 (39.6%) estaban en la etapa I de LRA, 110 (25.5%) en la etapa II, y 151 (35.0%) en la etapa III. Ciertas causas subyacentes tales como la depleción del volumen, varias infecciones, y la insuficiencia cardíaca fueron las causas más prevalentes de LRA-AC. Entre las causas subyacentes, la depleción del volumen permaneció como la principal causa de LRA-AC. Los pacientes con causas subyacentes que requerían atención médica urgente tenían mayor probabilidad de reconocimiento de LRA-AC en una etapa temprana (IC de 95%: 1.884, 2.128, p < 0.001). La depleción del volumen y la insuficiencia cardíaca aumentaron significativamente el riesgo de LRA-AC (OR. 2.037, IC de 95%: 1.130, 1.651, p = 0.004 y OR. 1.759, IC de 95%: 1.827, 1.982, p = 0.03), respectivamente. Noventa y cuatro pacientes (21.8%) tuvieron una recuperación renal incompleta y 46 pacientes (10.6%) no tuvieron recuperación ninguna a los ≥ 90 días. La mayoría de los pacientes que lograron una recuperación renal completa eran pacientes en la etapa I de LRA (90.1%). Cincuenta y dos pacientes con LRA-AC (12%) requirieron diálisis y la mayor parte de ellos (86.5%) se encontraban en la etapa III de LRA. Las etapas I y II de LRA-AC tuvieron mejores re-sultados renales que la etapa III de LRA-AC (IC de 95%: 1.566, 1.875, p < 0.001). La mortalidad a los 30 días y a los 90 días entre los pacientes con LRA-AC fue de 6.3% y 7.4%, respectivamente. La gravedad de la LRA-AC varía según la causa subyacente. La atención médica temprana puede asociarse con una mejor recuperación renal. La depleción del volumen y la insuficiencia cardíaca son factores de riesgo significativos en la LRA-AC, y la depleción del volumen sigue siendo la causa principal de LRA-AC. Los resultados adversos son más probables en pacientes de la etapa III de LRA-AC.

The increased burden of chronic kidney disease (CKD) in disadvantaged populations is due to both global factors and population-specific issues. Low socioeconomic status and poor access to care contribute to health care disparities and exacerbate the negative effects of genetic or biological predisposition. Provision of appropriate renal care to these populations requires a two-pronged approach: expanding the reach of dialysis through development of low-cost alternatives that can be practiced in remote locations, and implementation and evaluation of cost-effective prevention strategies. Kidney transplantation should be promoted by expansion of deceased donor transplant programs and use of inexpensive, generic immunosuppressive drugs. The message of World Kidney Day 2015 is that a concerted attack against the diseases that lead to end-stage renal disease, by increasing community outreach, better education, improved economic opportunity, and access to preventive medicine for those at highest risk, could end the unacceptable relationship between CKD and disadvantage in these communities.