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Semin Nephrol. 2019 May;39(3):308-314. doi: 10.1016/j.semnephrol.2019.02.009.

CKD Hotspots: Challenges and Areas of Opportunity.

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Department of Medicine, Universidad Panamericana School of Medicine, Mexico City, Mexico. Electronic address:
Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, Canada.


The global burden of illness from chronic kidney disease (CKD) continues to increase not only because of a higher prevalence of traditional causes of CKD, such as diabetes and hypertension, but also because of a higher than average incidence of CKD resulting from infections and unknown causes in certain geographic locations around the world (the so-called, CKD hotspots). This article summarizes the main gaps and areas of opportunity related to CKD hotspots that were discussed in a recent CKD Global Summit sponsored by the International Society of Nephrology. Gaps include the lack of a universally accepted definition of CKD hotspots and CKD of unknown etiology (CKDu), which clearly compromises our understanding of the burden, severity, and natural history of these conditions. In addition, there is scarce knowledge of the causes of CKDu, limitation regarding CKD prevention and treatment, and insufficient funding and advocacy for research and clinical care. Areas of opportunity include a better epidemiologic characterization of CKD hotspots and CKDu, improved knowledge of the causes of CKDu, prevention and treatment of CKD and end-stage kidney disease, increased advocacy and funding for research and clinical care, and improved education and awareness in CKD hotspots.


Chronic kidney disease (CKD); challenges; hotspots; research

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