A simple and inexpensive public health intervention helped prevent many cases of chronic kidney disease (CKD) in Pakistan. The intervention, described in a study in the Clinical Journal of the American Society of Nephrology, will be especially helpful for protecting the kidney health of people living in developing countries.
Up to 500 million people—an estimated 10 to 15 percent of adults—in the world have CKD, which has become one of the most rapidly escalating causes of death globally. Patients with advanced CKD require dialysis or transplantation to sustain life, but these therapies are unaffordable for the vast majority of people with CKD in developing nations. Unfortunately, there is dearth of information on public health interventions to preserve kidney health and prevent CKD, even though certain lifestyle factors and conditions (such as hypertension and diabetes) are known to increase the risk of developing the disease.
To address this problem, Tazeen Jafar, professor of global health at the Duke Global Health Institute and the Duke-NUS Medical School in Singapore, and her colleagues from Pakistan, Singapore and the United Kingdom assessed the effects of a combined public health intervention on the kidney health of hypertensive adults in Pakistan’s general population.
Based at the Aga Khan University in Karachi, the study included 1,271 participants, and the intervention was delivered over two years. It included training community health workers on aspects of a healthy lifestyle (such as improving diet, stopping smoking, increasing physical activity and taking prescribed blood pressure–lowering medications) and training community general practitioners on the latest standards related to managing hypertension.
After seven years of follow up—five years after cessation of the intervention—kidney function remained unchanged among adults in the communities assigned to the combined intervention, whereas kidney function significantly declined among those who received the usual care. Individuals in the communities with the combined intervention were half as likely as other individuals to experience a 20 percent or greater decline in kidney function.
“We show that such a practical model based on primary care doctor training coupled with lifestyle advice from non-physician health workers is likely to have a long-term benefit on preserving kidney function at a population level,” said Jafar. “These simple strategies can be implementable in other low- and middle-income countries with similar risk factor burden and health systems infrastructure.”
In an accompanying editorial, Min Jun and Brenda Hemmelgarn of the University of Calgary noted that adequate blood pressure control among high-risk patient groups such as those with CKD is as low as 13.2 percent, and awareness of CKD is lower in developing countries than in developed countries.
“It follows that simple interventions based on education and communication of the importance of established prevention strategies including blood pressure management may have a significant impact at the population level,” they wrote. “This therefore warrants further consideration including the assessment of the cost-effectiveness and sustainability of prevention strategies specific to CKD management in developing countries.”