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Nat Rev Nephrol. 2017 Jul;13(7):393-409. doi: 10.1038/nrneph.2017.63. Epub 2017 May 30.

Reducing the costs of chronic kidney disease while delivering quality health care: a call to action.

Author information

Nephrology Section, Department of Internal Medicine, Ghent University Hospital 0K12, De Pintelaan 185, B9000, Ghent, Belgium.
Ghent University, Faculty of Medicine, Department of Public Health, De Pintelaan 185, B9000, Ghent, Belgium.
Imperial College Renal and Transplant Centre, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.
Department of Nephrology, University Medical Center Groningen, University Hospital Groningen, Hanzeplein, 1, 9713 GZ Groningen, Netherlands.
Unit of Pharmacotherapy, Epidemiology &Economics (PTE2), Department of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, Netherlands.
NHMRC Clinical Trials Centre, Sydney Medical School, University of Sydney, 92-94 Parramatta Road, Camperdown, NSW 2050, Australia.
Department of Nephrology 6J, Internal Medicine III, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9713 GZ Groningen, Netherlands.
Insitute for Science in Healthy Aging &Healthcare (SHARE), University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, 9713 GZ Groningen, Netherlands.
University of Calgary, 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.
CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, 89124 Reggio Calabria, Italy.


The treatment of chronic kidney disease (CKD) and of end-stage renal disease (ESRD) imposes substantial societal costs. Expenditure is highest for renal replacement therapy (RRT), especially in-hospital haemodialysis. Redirection towards less expensive forms of RRT (peritoneal dialysis, home haemodialysis) or kidney transplantation should decrease financial pressure. However, costs for CKD are not limited to RRT, but also include nonrenal health-care costs, costs not related to health care, and costs for patients with CKD who are not yet receiving RRT. Even if patients with CKD or ESRD could be given the least expensive therapies, costs would decrease only marginally. We therefore propose a consistent and sustainable approach focusing on prevention. Before a preventive strategy is favoured, however, authorities should carefully analyse the cost to benefit ratio of each strategy. Primary prevention of CKD is more important than secondary prevention, as many other related chronic diseases, such as diabetes mellitus, hypertension, cardiovascular disease, liver disease, cancer, and pulmonary disorders could also be prevented. Primary prevention largely consists of lifestyle changes that will reduce global societal costs and, more importantly, result in a healthy, active, and long-lived population. Nephrologists need to collaborate closely with other sectors and governments, to reach these aims.

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