World Kidney Day

Artificial intelligence (AI) and deep learning could have a transformative effect on healthcare. However, this technology has a high carbon footprint, requires the use of natural resources and generates electronic waste. Consideration of the environmental impact raises ethical questions that must be addressed to enable sustainable use of AI in medicine.

Low- and middle-income countries face a rapidly increasing prevalence of chronic kidney disease in a setting of limited resources and heightened environmental vulnerabilities. Disease prevention strategies, optimization of kidney replacement therapies, technological innovations and adaptation of health policies to local realities is required to enable resilient and sustainable kidney care.

An increasing body of evidence has highlighted direct and indirect health implications of oil and gas expansion. Nations that produce oil, gas and petrochemicals must stop placing short-term interests above the health and future of humanity.

Climate change is increasing the risk of acute kidney injury owing to heat stress, infectious and vector-borne diseases, food and water insecurity, pollution and nephrotoxins. Outdoor workers and underserved communities are most affected. Proactive prevention strategies, pathogen-specific care and climate-resilient kidney services can avert avoidable injury, narrow inequities and save lives.

Environmental sustainability movements have faced criticism for their often mechanical, anthropocentric approach that maintains standards of overconsumption within healthcare and has perpetuated planetary harm. Environmental stewardship, as practised within many Indigenous communities, instead focuses deeply on the interconnectedness of human and planetary health, and offers insights from which the health community can learn.

Chronic kidney disease of unknown origin (CKDu) has been reported in various tropical settings over the past 20 years, but clarity on key disease drivers is lacking. Several factors have slowed progress in understanding this disease or diseases, including low research funding, difficult case definition and multiple risk factors for kidney disease.

Chronic kidney disease (CKD) satisfies established criteria for screening. Although the economic burden of screening is substantial, many countries have adopted screening initiatives into their existing national programmes. Recognition of CKD as a major non-communicable disease by international bodies will help to improve global kidney care overall.

Improved awareness of chronic kidney disease (CKD) is vital to enable at-risk individuals to benefit from new therapies. Investment in primary care, improved recognition of CKD by primary care providers and public health approaches to increase CKD awareness are required to enhance CKD care delivery and improve kidney and cardiovascular outcomes.

The high global burden of kidney disease highlights an urgent need for early diagnosis and the implementation of interventions to prevent disease progression. Such an approach requires the identification and management of risk factors and equitable access to quality care.

Premature birth and low birth weight disrupt kidney development substantially, which leads to an increased risk of acute kidney injury, chronic kidney disease and hypertension. Broader awareness of these risks, implementation of preventive strategies and optimization of neonatal care are key to safeguarding kidney health and ensuring better long-term outcomes.

The late diagnosis of chronic kidney disease (CKD) is a global problem that limits the opportunity to initiate disease-modifying therapies. Artificial intelligence approaches using imaging or laboratory-based models can facilitate the early detection and risk stratification of CKD and thereby enable optimal treatment to reduce the burden of the disease.

Treatment of chronic kidney disease requires a comprehensive approach including universal access to early diagnosis and to medications that can slow disease progression. Such equitable access is not only an ethical requirement but can also reduce the financial and human costs of advancing kidney and cardiovascular disease.

Overcoming barriers to deliver high-quality care requires an assessment of the contribution of each barrier within a local context. Tools to identify early disease, knowledge of best therapies, access to care providers and medications, and an accountable and integrated health-care system are essential elements of quality care. Education of patients, providers and policy makers in conjunction with advocacy efforts and national policy frameworks are required to deliver high-quality care worldwide.

Many countries worldwide, particularly those with low or lower-middle incomes, do not have enough nephrologists to provide health services for patients with kidney disease. Increasing training opportunities, improving job satisfaction and using new technologies and advances in artificial intelligence could help to increase the nephrology workforce and improve patient outcomes.

All patients with kidney disease have the right to have a say in their own clinical care, the provision of health services and research into kidney disease. Patient empowerment and advocacy, especially for those whose views are seldom heard, can be enhanced by working together in communities.

The theme of World Kidney Day 2024 is “kidney health for all — advancing equitable access to care and optimal medication practice”. To mark this event, Nature Reviews Nephrology invited five researchers from different geographical regions worldwide to discuss the impact of new and emerging therapies for diabetic kidney disease on patient care as well as the barriers that must be overcome to ensure equitable access to these therapies.

Addressing the burden of non-communicable diseases is a global public health priority. In this joint Consensus Statement, the American Society of Nephrology, the European Renal Association and the International Society of Nephrology highlight the need to recognize kidney disease as a key driver of premature mortality, in addition to other non-communicable diseases already prioritized by the World Health Organization.

Global inequities and inequalities, human and health-care crises, transplantation successes in the face of limited organ availability, and desperate donors and recipients underlie the backstory of organ trafficking, namely the exploitation of the most vulnerable. Despite the framework set out by the Declaration of Istanbul for the ethical donation and transplantation of organs, organ trafficking remains a global challenge.

Several risk tools can accurately predict individual baseline risks of adverse events in people with chronic kidney disease. Here, the authors examine methods of assessing risk and discuss risk-directed patient management, whereby risk is aligned with care delivery to maximize the benefit of available therapeutic strategies.

The authors review the effect of chronic kidney disease (CKD) on female and male fertility and pregnancy outcomes. They also discuss the risk of pregnancy-associated CKD progression and the potential effect of maternal or paternal CKD on the offspring.

First Nations peoples in Australia face systemic inequities in access to kidney transplantation. The National Indigenous Kidney Transplant Taskforce was established to address these. It has provided support to clinicians to implement and evaluate innovative practices and developed strategies to address biases in the structures and models of care that create barriers to wait-listing.

Digital transformation offers unprecedented opportunities for advancing healthcare, but also raises complex ethical and legal challenges. Emerging drivers of health disparity termed ‘digital determinants of health’ call for purposeful, equity-focused strategies to ensure that technological innovation benefits all without exacerbating disparities.

Among global destabilizing events, natural disasters often receive widespread attention whereas protracted conflicts and economic crises fade into the background. Low- and middle-income countries bear the brunt of this indifference, resulting in severely weakened health systems. People who require dialysis are particularly vulnerable, necessitating urgent collaboration to ensure equitable and sustainable care during such crises.

Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of the disease. The authors of this Review describe the different inequities that affect kidney health and care worldwide, and consider potential solutions to help to mitigate these.