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Chronic Kidney Disease (CKD) affects approximately 10-15% of the general population worldwide and is associated with an increased risk of adverse cardiorenal outcomes and increased mortality. In low- and middle-income countries (LMICs), the situation is aggravated due to the scarcity or lack of access to kidney replacement therapies (KRTs). For example, in 2010, an estimated 2.3-7.1 million adults died prematurely from a lack of access to KRTs. The objective of this study was to conduct a review of the literature to inform the future epidemiological and economic burden of CKD in four LMICs located in four different regions of the world.
Pragmatic literature reviews were carried out to obtain the inputs required for the peer reviewed Inside CKD microsimulation to project the epidemiological and economic burden of CKD for Bolivia, Kenya, Sri Lanka, and Uzbekistan. A model input template was created to guide the literature search, aimed at identifying country demographics, epidemiological data including CKD staging, comorbidities and complications, economic data including health costs and quality-of-life measures, as well as identifying any country-specific needs or challenges.
At present, we have results of the literature reviews for Kenya, Sri Lanka and Uzbekistan. In Kenya, the results showed the importance of malnutrition, infections, and hot climate as key parameters when modelling CKD in LMICs. Using a data quality scoring system designed as part of the Inside CKD programme, a 2018 meta-analysis presenting a CKD prevalence of 18% in Kenya was selected to derive the eGFR and UACR required to project the CKD prevalence. In Sri Lanka and Uzbekistan, environmental factors (air and water pollution) and the agricultural activities have shown to contribute to high CKD prevalence in rural areas. For example, in Sri Lanka, CKD has been estimated at around 8.2% in the general population versus 15.0% in rural areas. Using these data, the future burden of CKD and associated costs using the Inside CKD model will be projected between 2024 and 2030. Annual disability adjusted life years and premature death due to lack of treatments will also be estimated in the four countries.
CKD is a major public health problem in LMICs and local capacities and healthcare financing priorities vary between regions (given the local competing demands of acute, infectious and non communicable diseases) warranting foresight of the future burden for policy and planning purposes. Patient-level simulation analysis, using data gathered from the literature reviews, enables us to understand the present and future costs and burden of CKD in LMICs and allows us to quantify the costs of earlier diagnosis and treatment to delay progression.