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Semin Nephrol. 2017 May;37(3):234-244. doi: 10.1016/j.semnephrol.2017.02.004.

The Potential Impact of Public Health Interventions in Preventing Kidney Disease.

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The George Institute for Global Health, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.
The George Institute for Global Health India, New Delhi, India.
The George Institute for Global Health India, New Delhi, India; Department of Nephrology, University of Oxford, Oxford, United Kingdom. Electronic address:


The years of life lost and years lived with disability resulting from chronic kidney disease (CKD) increased globally by 90% and 49.5%, respectively, between 1990 and 2013. In addition to the traditional factors, infections, low birthweight, environmental factors, and low socioeconomic status contribute to the CKD burden in low- and middle-income countries. System-level challenges such as poor appreciation of the burden, insufficient human resources, high health care costs, poor referral pathways, unreliable health information systems, and inadequate medicine supply pose barriers to CKD control. In this article, we present evidence that the CKD burden in low- and middle-income countries is related to system-wide issues, which could be reduced effectively using innovative, affordable, and scalable interventions. A multipronged approach is required including improving socioeconomic determinants of health, enabling the environment for healthy decision making, and sustainable interventions. Innovative approaches include promoting healthy behaviors, counseling, and education in primary care, task-sharing between physicians and nonphysicians, using technology to train nonphysicians to screen, diagnose, refer, follow-up, and educate patients, and ensuring quality. Stronger political will and system-level change are needed to prevent and manage CKD if the sustainable development goals of reducing premature mortality from noncommunicable diseases by 2030 are to be attained.


Chronic kidney disease prevention; health system change; low and middle income countries; public health interventions

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