|Year : 2007 | Volume
| Issue : 4 | Page : 147-149
The third World Kidney Day: Looking back and thinking forward
SV Shah1, J Feehally2
1 Department of Internal Medicine, Division of Nephrology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
2 The John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom
S V Shah
Division of Nephrology, UAMS College of Medicine, 4301 West Markham, Slot 501, Little Rock, AR 72205
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shah S V, Feehally J. The third World Kidney Day: Looking back and thinking forward. Indian J Nephrol 2007;17:147-9
[On behalf of the World Kidney Day Steering Committee: William G. Couser1 (ISN), John Davis2 (IFKF), Joel Kopple2 (IFKF), Thomas Reiser1 (ISN), Miguel Riella1 (ISN), Anne Wilson2 (IFKF)]
1International Society of Nephrology, 2International Federation of Kidney Foundation.
"Never doubt that a small group of thoughtful, committed citizens can change the world: indeed, it's the only thing that ever has." - Margaret Mead.
March 13, 2008, heralds the third annual World Kidney Day-an event that will be celebrated in more than 60 countries. We accept this opportunity to recount how this concept has gained worldwide traction and momentum and reflect on the challenges faced by its creators and supporters.
| The Beginnings of the World Kidney Day|| |
There have probably been many individuals who conceived of marking one calendar day in which to call attention toward the gravity of kidney disease globally; many may even have shared their thoughts with others. However, there is one individual who not only conceived the idea but was persistent in persuading many in the leadership positions to bring this notion-a World Kidney Day (hereafter referred to as WKD) -to fruition. This individual is also the founder of the International Federation of Kidney Foundations (IFKF)-Joel Kopple. He first conceived the idea of WKD in the spring of 2003, recognizing that chronic kidney disease (CKD) is a global threat to public health, but is typically low on government health agendas; despite the availability of simple and inexpensive tests for its detection, the national detection programs are rare; and that, while it can be treated with the existing and effective therapies, few people with CKD are able to receive appropriate health care.
In September 2003, Kopple proposed the organization of an annual WKD program in a letter to Warwick Prime, then the president of the IFKF. In order to make it truly an international collaborative effort, the representatives of the IFKF and International Society of Nephrology (ISN) met in November 2003, where Kopple presented a prιcis entitled, "Proposal for the Establishment of a WKD." A WKD ISN-IFKF liaison committee was established, with the initial membership of Bill Couser, John Dirks, Joel Kopple, Warwick Prime and Jan Weening. In 2004, both the IFKF Executive Committee and the ISN Council endorsed the WKD program, and the ISN agreed in 2005 to commit sufficient resources to enable an inaugural WKD to be held on March 7, 2006. In the same month, an editorial regarding the WKD was published in eight scientific journals. Despite being planned at a short notice and with limited resources available, kidney organizations in 45 countries enthusiastically embraced the first WKD and organized various health screening events, road shows, walkathons, public lectures and press conferences. It was clear that the WKD was responding to an urgent need and tapping the tremendous energy and motivation of kidney health professionals, patients and their friends and relatives across the globe.
This success was recognized by those from the ISN and IFKF who met in April 2006 and agreed on a formal organizational structure for the WKD. A memorandum of understanding between the IFKF and ISN for the planning and implementation of an annual WKD was signed in June 2006 by the two presidents, Bill Couser (ISN) and Sudhir Shah (IFKF). The document stated that, "Based on a proposal and invitation by the IFKF, IFKF and ISN jointly agree to declare an annual WKD to increase awareness, detection, prevention and treatment of the kidney and related diseases." The "World Kidney Day" name and logo were trademarked and are now jointly possessed by the IFKF and ISN.
A WKD Steering Committee was established with eight members, four members nominated by each organization, as well as a scientific advisory committee. The ISN agreed to provide the initial funding required for the central operational management of a WKD project team.
The continued leadership of the ISN/IFKF Steering Committee in 2007 helped secure funding from global sponsors; create a WKD logo, slogan, website and "brand"; widely disseminate designs for posters, banners, t-shirts and other promotional materials, which could be adapted for local use; gain the moral support of celebrities ranging from Tom Hanks to Jacques Rogge; and enlist the participation of 66 countries.
The remarkable initiative and ingenuity of various kidney organizations on March 8, 2007, can be viewed on http://www.worldkidneyday.org. The WKD website will feature planned activities for March 13, 2008, which promises to be an even greater event, with continued emphasis on the message that "kidney disease is common, harmful and curable."
| The Main Challenges and Aims of the WKD: Public Awareness|| |
WKD offers a crucial, visible opportunity to inform and educate health policy makers and those at the highest risk of CKD as well as the general public. One of our greatest challenges is the general ignorance regarding the kidneys. Surveys conducted before the advent of WKD demonstrate that less than 5% of the general population knows the location and functions of the kidneys. Therefore, the WKD 2008 international campaign theme- "Amazing Kidneys!"-stresses on the positive message that kidneys are truly "amazing." A focus for the general public is on simple facts regarding the daily function of the kidneys-for example, "Every day our kidneys filter and clean 200 liters of blood." "Amazing kidney stories" can also be used-stories based on kidney patients, kidney organ donors and health professionals who are "exceptional" in some way. The WKD offers an increasingly visible opportunity to contemplate public awareness messages to the media for a wide impact.
| The Significance of CKD|| |
While each country and region may adopt different priorities for the WKD every year-selecting, for example, to promote living donor kidney transplantation or make an effort for improvements in dialysis facilities-in many countries it is the detection and management of CKD that will be the dominant kidney health issue. On the WKD, we should attempt to increase awareness regarding the burden of CKD on human lives and healthcare budgets and place CKD on the agenda of governments and other institutions around the world that shape and reform health policies. It is an opportunity to launch new, high-profile initiatives that will impact CKD and seek the endorsement of agencies that can help in ensuring that such initiatives become embedded into routine healthcare.
Since the term CKD has come into usage and its staging defined,  there have been numerous investigative activities and publications on its importance. ,,,, Recently published studies have confirmed that CKD is a common global disorder, with approximately 90% of those who have CKD remaining unidentified. , The fact that CKD is a major public health issue is now beyond dispute,  and it is obvious that an issue of this magnitude cannot be addressed by volunteer organizations alone.
Two simple and inexpensive tests are available to detect CKD: urine for protein and blood for serum creatinine and hence estimation of glomerular filtration rate (GFR). Despite this, the task of developing widespread detection and management programs for CKD with improved outcomes at a reasonable expense is formidable. It is unlikely that even developed countries have adequate financial and human resources for whole-population screening programs for CKD, and thus far, no evidence is available to ascertain these techniques as cost-effective.
| CKD detection programs|| |
Based on the current available information, we recommend that all countries have targeted screening programs. Steps to establishing an effective program include:
- Reporting of estimated GFR by all laboratories involved in measuring serum creatinine.
- Routinely measuring the estimated GFR and proteinuria in patients at highest risk of CKD, including all those with diabetes, hypertension, coronary heart disease and cerebrovascular disease, who constitute the majority of patients with CKD and end-stage renal disease (ESRD).
- Measuring blood pressure, eGFR and proteinuria in those identified with CKD.
- Establishing targets for blood pressure control in people with CKD and appropriate use of drugs in order to block the renin-angiotensin system.
- Agreeing on guidelines for identifying the minority of people with CKD who benefit from the specialist advice of a nephrologist as well as the routine care of a family physician.
In the UK, for example, over the last few years, there has been encouraging progress toward the establishment of such a program. The reporting of eGFR is now mandatory in all UK clinical laboratories and the guidelines for the detection and management of CKD have been widely accepted.  Government-directed and the UK government-funded healthcare system has been aided in a more straightforward progress; this allows several aspects of the program to be linked to the reimbursement for family physicians, who are already obliged to maintain computerized listings of all patients with diabetes, hypertension and coronary heart disease. Considerably greater challenges exist in countries where healthcare is provided by multiple independent agencies or in the developing world where the resources available for healthcare are inadequate.
In advocating for these programs, which are now proving successful and cost-effective, we advocate small but sure-footed steps. , we should be careful in that screening tests identify people with true disease, and for whom intervention will make a critical difference by delaying or avoiding ESRD or by modifying risk factors for cardiovascular disease that is linked closely with CKD. This may be particularly true in the elderly-in whom is the highest prevalence of CKD and the preventive therapy is less likely to improve the survival or quality of life. ,
Parallelly, we should press for research programs to address the many unanswered questions regarding CKD, and not the least to understand better the factors predicting those with stage 3 CKD who progress to ESRD and to test the efficacy of our new health-care strategies with regard to CKD.
| WKD is Here to Stay|| |
The momentum of the WKD is assured and we anticipate many more than the previous 66 countries that will be reporting to us their initiatives and successes on March 13, 2008. The WKD Steering Committee and Project Team will continue to provide a toolkit of resources (available for downloading at http://www.worldkidneyday.org under the heading WKD Materials) for each WKD, including messages, logos, posters and designs for other materials. The power of WKD is generated by local action, led by those who understand the specific kidney health issues in their countries and who can use this day to showcase successful initiatives already taken and launch positive changes in healthcare systems and practices. For meaningful progress, activities related to kidney disease are required throughout the year. Our vision is that WKD serves as an annual energizing and unifying event through which the health care providers, general public and government bodies that prepare health care policies all unite to improve the early detection programs and optimize medical care for the millions of patients worldwide who can benefit from an improved awareness of CKD as a global health issue.
| Appendix|| |
World Kidney Day 2007 Scientific Advisory Board
Vittorio E. Andreucci, Italy
Rashad S. Barsoum, Egypt
Allan J. Collins, USA
David C. H. Harris, Australia
Bernardo Rodriguez Iturbe, Venezuela
Paul E. De Jong, The Netherlands
Robert W. Schrier, USA
Philip Kam Tao Li, China
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