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Editorial

Burden, access, and disparities in kidney disease

Deidra C. Crews, Aminu K. Bello, and Gamal Saadi; for the World Kidney Day Steering Committee

Volume 91 (2019) p. 129 - 137

Abstract

Clinical Nephrology, Vol. 91 – No. 3/2019 (129-137)

Burden, access, and disparities in kidney disease

Deidra C. Crews¹#²#³, Aminu K. Bello⁴, and Gamal Saadi⁵; for the World Kidney Day Steering Committee⁶

¹Division of Nephrology, Department of Medicine, ²Welch Center for Prevention, Epidemiology and Clinical Research, ³Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, MD, USA, ⁴Division of Nephrology & Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Canada, and ⁵Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. In many settings, rates of kidney disease and the provision of its care are defined by socioeconomic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight that many countries still lack access to basic diagnostics, a trained nephrology workforce, universal access to primary health care, and renal replacement therapies. We point to the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is one of the World Health Organization’s Sustainable Development Goals. While universal health coverage may not include all elements of kidney care in all countries, understanding what is feasible and important for a country or region with a focus on reducing the burden and consequences of kidney disease would be an important step towards achieving kidney health equity.Correspondence to:
Deidra C. Crews, MD, ScM
Johns Hopkins University School of Medicine
301 Mason F. Lord Drive, Suite 2500
Baltimore, MD 21224, USA
Email: [email protected]

Kidney disease and poverty in disadvantaged populations

Food as medicine for CKD: Implications for disadvantaged populations

Deidra C. Crews

Volume 93 (2020) p. 36 - 41

Abstract

Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S36-S41)

Food as medicine for CKD: Implications for disadvantaged populations

Deidra C. Crews

Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Johns Hopkins Center for Health Equity,  Johns Hopkins University, Baltimore, MD, USA
Persons with or at risk for chronic kidney disease (CKD) and their healthcare clinicians seek ways to prevent adverse kidney outcomes. Recent studies highlight that specific healthful dietary patterns may lead to favorable kidney outcomes; these include dietary patterns rich in fruits and vegetables such as the Mediterranean diet, the Dietary Approaches to Stop Hypertension diet, and dietary patterns low in dietary acid load. However, for many socioeconomically disadvantaged individuals, healthful dietary patterns are inaccessible due to inability to afford or access healthful foods. Barriers may exist at multiple levels, including the individual level (e.g., knowledge and beliefs about healthful eating habits) and the institutional level (e.g., rules and regulations about healthy food availability and cost). In this review, recent studies are described that document dietary patterns that may promote kidney health. A framework for considering barriers and facilitators of healthful eating among disadvantaged individuals modified from the social ecological model is offered, and their potential impact on kidney diseases is discussed. Recent epidemiologic and intervention studies addressing dietary factors in the setting of chronic kidney disease and other conditions are detailed. Finally, knowledge gaps in intervention studies, evaluation of public programs, and advocacy efforts are discussed towards promoting “food as medicine” to support kidney health for all. Correspondence to:
Deidra C. Crews, MD, ScM
Division of Nephrology, Department of Medicine
Johns Hopkins University School of Medicine
301 Mason F. Lord Drive, Suite 2500
Baltimore, MD 21224, USA
Email: [email protected]

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