MedicalResearch.com Interview with:
Dr. Ziyad Al-Aly, MD
Associate Chief of Staff for Research and Education
Veterans Affairs St. Louis Health Care System
Institute for Public Health
Washington University, St. Louis MO
MedicalResearch.com: What is the background for this study?
Response: A lot has changed in the US over the past 15 years including aging, population growth, and increased exposure to risk factors such as obesity, elevated blood pressure, etc. With all of these changes, we wondered, how did the burden of kidney disease change in the United States over the past 15 years.
MedicalResearch.com: What are the main finding?
Response: The main findings were that burden of kidney disease has increased significantly, by more than 50% and the increase was variable among states where some states had double the increase seen in others. In 2016 there were 2 million of years of healthy life lost and 83 thousand deaths due to CKD.
The increase in burden of kidney disease was attributable to increased risk exposure (40.3%), aging (32.3%), and population growth (27.4%). The increase in age-standardized burden of kidney disease was driven by increased metabolic (93.8%) and dietary (5.3%) risk exposure which manifested in increased probability of death due to diabetic CKD especially among young adults.
Most alarmingly, we found that the probability of death due to kidney disease increased by 26.8% even among the population aged 20-54 years old and this was primarily driven by CKD due to diabetes.
The probability of death due to CKD also increased by 25.6% among the population older than 55 years and was driven by CKD due to diabetes and decreased probability of death from causes other than CKD.
The second alarming finding was the peculiar behavior of CKD epidemiology; whereas age-standardized burden of cardiovascular disease and non-communicable diseases have decreased, burden of CKD has actually increased. And the pace of change, the speed of change was fastest than other non-communicable diseases in the United States.
MedicalResearch.com: What should readers take away from your report?
Response: I think there need to be more attention paid to the increased rates of CKD among those in the 20-54 age group. Our findings suggest not only increased burden of CKD among this segment of the population, but that it was driven by increased exposure to metabolic and dietary risk factors and most alarmingly this has resulted increased probability of death due to CKD among this young age group. Metabolic and dietary risks among this age group should be targeted aggressively to reduce burden of CKD.
One other take away is that burden of CKD has increased at a much faster rate than other non-communicable diseases. This is in large part a testament to the significant improvement in burden of cardiovascular disease, and cancer where significant breakthrough in early identification of disease, and successful therapies led to a remarkable reduction in burden. Progress in treatment of CKD has been relatively stagnant and as a result the rate of change in burden now outpaces all other non-communicable diseases.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Effort need to be devoted to stimulate progress in identifying therapies for CKD. Public health priorities, policy initiatives, funding allocation, advocacy effort need to catch up to this reality that burden of CKD is rising, and the speed of change now outpaces other non communicable diseases. A concerted effort should be made to put the brakes on this.
Bowe B, Xie Y, Li T, et al. Changes in the US Burden of Chronic Kidney Disease From 2002 to 2016An Analysis of the Global Burden of Disease Study. JAMA Netw Open. 2018;1(7):e184412. doi:10.1001/jamanetworkopen.2018.4412
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