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Sustainable Development Goals relevant to kidney health: an update on progress

Nature Reviews Nephrology volume 17, pages 15–32 (2021)Cite this article

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A Publisher Correction to this article was published on 02 August 2021

This article has been updated

Abstract

Globally, more than 5 million people die annually from lack of access to critical treatments for kidney disease — by 2040, chronic kidney disease is projected to be the fifth leading cause of death worldwide. Kidney diseases are particularly challenging to tackle because they are pathologically diverse and are often asymptomatic. As such, kidney disease is often diagnosed late, and the global burden of kidney disease continues to be underappreciated. When kidney disease is not detected and treated early, patient care requires specialized resources that drive up cost, place many people at risk of catastrophic health expenditure and pose high opportunity costs for health systems. Prevention of kidney disease is highly cost-effective but requires a multisectoral holistic approach. Each Sustainable Development Goal (SDG) has the potential to impact kidney disease risk or improve early diagnosis and treatment, and thus reduce the need for high-cost care. All countries have agreed to strive to achieve the SDGs, but progress is disjointed and uneven among and within countries. The six SDG Transformations framework can be used to examine SDGs with relevance to kidney health that require attention and reveal inter-linkages among the SDGs that should accelerate progress.

Key points

  • Each Sustainable Development Goal (SDG) has the potential to improve kidney health and prevent kidney disease by improving the general health and well-being of individuals and societies, and by protecting the environment.

  • Achievement of each SDG is interrelated to the achievement of multiple other SDGs; therefore, a multisectoral approach is required.

  • The global burden of kidney disease has been relatively underestimated because of a lack of data.

  • Structural violence and the social determinants of health have an important impact on kidney disease risk.

  • Kidney disease is the leading global cause of catastrophic health expenditure, in part because of the high costs of kidney replacement therapy.

  • Achievement of universal health coverage is the minimum requirement to ensure sustainable and affordable access to early detection and quality treatment of kidney disease and/or its risk factors, which should translate to a reduction in the burden of kidney failure in the future.

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Fig. 1: Multiple structural factors influence kidney health in children.
Fig. 2: Availability of resources to detect kidney disease at primary, secondary or tertiary care levels across country income categories.

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Acknowledgements

The authors are grateful to B. Bikbov (Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy) for clarifications regarding data from the Global Burden of Disease studies.

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Authors and Affiliations

  1. Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Valerie A. Luyckx

  2. Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa

    Valerie A. Luyckx

  3. Institute of Biomedical Ethics and the History of Medicine, University of Zürich, Zürich, Switzerland

    Valerie A. Luyckx

  4. Department of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA

    Ziyad Al-Aly

  5. Clinical Epidemiology Center, Veterans Affairs Saint Louis Health Care System, Saint Louis, MO, USA

    Ziyad Al-Aly

  6. Division of Nephrology & Immunology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada

    Aminu K. Bello

  7. Division of Nephrology, Saint Louis University, Saint Louis, MO, USA

    Ezequiel Bellorin-Font

  8. Sección de Investigación, Servicio de Nefrología y Trasplante Renal, Hospital Universitario de Caracas, Caracas, Venezuela

    Raul G. Carlini

  9. Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand, South Africa

    June Fabian

  10. Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital, 278, Guadalajara, Mexico

    Guillermo Garcia-Garcia

  11. Department of Paediatric Nephrology, St. John’s National Academy of Health Sciences, Bangalore, India

    Arpana Iyengar

  12. Nephrology and Hypertension Associates, Bluefield, WV, USA

    Mohammed Sekkarie

  13. Renal Division, Ghent University Hospital, Ghent, Belgium

    Wim van Biesen

  14. Renal Unit, Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria

    Ifeoma Ulasi

  15. Division of Nephrology, Department of Medicine, Queen’s University, Kingston, Ontario, Canada

    Karen Yeates

  16. Munson Nephrology, Munson Healthcare, Traverse City, MI, USA

    John Stanifer

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Contributions

V.A.L., Z.A.-A., A.K.B., J.F., G.G.-G., A.I., W.v.B. and J.S. researched data for the article. V.A.L., A.I., W.v.B. and J.S. made substantial contributions to discussions of the content. V.A.L., Z.A.-A., A.K.B., E.B.-F., R.G.C., J.F., G.G.-G., A.I., M.S., W.v.B. and J.S. wrote the manuscript. V.A.L., Z.A.-A., A.K.B., J.F., G.G.-G., A.I., M.S., W.v.B., I.U., K.Y. and J.S. reviewed or edited the manuscript before submission.

Corresponding author

Correspondence to Valerie A. Luyckx.

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Competing interests

V.A.L. is an executive Committee Member of the International Society of Nephrology and an editor for Brenner and Rector’s “The Kidney” (Elsevier). G.G.-G. has received grant support from CloudCath Inc. and consulting fees from Ellen Medical Devices Pty Ltd. W.v.B. has received speaker fees from Fresenius Medical Care, Baxter Healthcare, Nippro and Gambro, and is vice-chair of EuroPD. The other authors declare no competing interests.

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Nature Reviews Nephrology thanks A. Niang and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Related links

Millennium Development Goals: https://www.undp.org/content/undp/en/home/sdgoverview/mdg_goals.html

Sustainable Development Goals: https://www.un.org/sustainabledevelopment/

World Kidney Day: https://www.worldkidneyday.org

Supplementary information

Glossary

Vertical programmes

Disease-specific programmes that may not be integrated within the health system, are often driven independently by external funding and may undermine the health system.

Horizontal approaches

Programmes that incorporate multiple diseases or programmes within the health system, which are generally integrated into and paid for by the health system.

Ayurvedic medicine

An Indian alternative therapeutic method that incorporates mind, body and spirit in healing practices using physical treatments (for example, massage and medicinal products).

Opportunity costs

Health gains that might have been obtained if the money had been allocated to a different intervention.

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Luyckx, V.A., Al-Aly, Z., Bello, A.K. et al. Sustainable Development Goals relevant to kidney health: an update on progress. Nat Rev Nephrol 17, 15–32 (2021). https://doi.org/10.1038/s41581-020-00363-6

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