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Inequities in kidney health and kidney care

Nature Reviews Nephrology volume 19, pages 694–708 (2023)Cite this article

Subjects

Abstract

Health inequity refers to the existence of unnecessary and unfair differences in the ability of an individual or community to achieve optimal health and access appropriate care. Kidney diseases, including acute kidney injury and chronic kidney disease, are the epitome of health inequity. Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of disease. Insufficient investment across the spectrum of kidney health and kidney care is a fundamental source of inequity. In addition, social and structural inequities, including inequities in access to primary health care, education and preventative strategies, are major risk factors for, and contribute to, poorer outcomes for individuals living with kidney diseases. Access to affordable kidney care is also highly inequitable, resulting in financial hardship and catastrophic health expenditure for the most vulnerable. Solutions to these injustices require leadership and political will. The nephrology community has an important role in advocacy and in identifying and implementing solutions to dismantle inequities that affect kidney health.

Key points

  • Insufficient investment across the spectrum of kidney health and kidney care (from raising awareness of kidney disease, to its prevention, diagnosis and treatment) is a fundamental source of inequity, and affects all people at risk of, or living with, kidney diseases.

  • Social and structural inequities are major risk factors for, and contribute to, poor outcomes for individuals living with kidney diseases.

  • Access to essential diagnostics and medications for kidney disease is inequitable and insufficient, as are programmes to track their burden; these insufficiencies disadvantage patients in low- and middle-income countries from early in their disease course.

  • The ability to access kidney care across the spectrum of disease without exposure to financial hardship is very inequitable; this inequity results in vastly different outcomes and life courses for patients who have the same diseases but live under different circumstances.

  • Novel therapies for rare (orphan) diseases are often only available at extremely high prices; their use in children is often not adequately documented and the cost of these medications exacerbates inequities.

  • All nephrology professionals should become skilled at advocating on behalf of their patients to communities, policy makers, administrators and insurers to develop constructive strategies and collectively reach optimal solutions to improve equity in the accessibility of quality kidney care locally and across the globe.

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Fig. 1: Factors that contribute to inequities in kidney health and kidney care.
Fig. 2: Expanding universal health-care coverage for kidney diseases in low resource settings.

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Acknowledgements

This manuscript was coordinated by the European Kidney Health Alliance (EKHA), a non-governmental not-for-profit organization that advocates for kidney health at the level of the European Commission. The EKHA network has five full members (the European Renal Association, the International Society of Nephrology, the European Kidney Patients Federation, the European Dialysis and Transplant Nurses Association-European Renal Care Association and the Dutch Kidney Foundation), and 31 National or Regional Societies as affiliated members. The EKHA receives support from the European Union in the context of the Annual Work Program 2022 of EU4Health, relating to the prevention of non-communicable diseases, topic ID EU4H-2022-PJ02, project # 101101220 PREVENTCKD.

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Authors and Affiliations

  1. European Kidney Health Alliance, Brussels, Belgium

    Raymond Vanholder & Marion Braks

  2. Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium

    Raymond Vanholder & Arjan van der Tol

  3. Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

    Lieven Annemans

  4. Association Renaloo, Paris, France

    Marion Braks

  5. Imperial College Healthcare NHS Trust, Imperial College Renal and Transplant Center, London, UK

    Edwina A. Brown

  6. Department of Paediatric Nephrology, St John’s Medical College, Bengaluru, India

    Priya Pais

  7. Departments of Epidemiology and Surgery, Johns Hopkins University, Baltimore, MD, USA

    Tanjala S. Purnell

  8. Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK

    Simon Sawhney

  9. Rural and Remote Health, Flinders University, Adelaide, South Australia, Australia

    Nicole Scholes-Robertson

  10. Clinical Epidemiology Team, Center for Research in Epidemiology and Population Health (CESP), University Paris-Saclay, UVSQ, Inserm, Villejuif, France

    Bénédicte Stengel

  11. Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Elliot K. Tannor

  12. Renal Unit, Directorate of Medicine, Komfo Anokye, Teaching Hospital, Kumasi, Ghana

    Elliot K. Tannor

  13. Department of Nephrology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic

    Vladimir Tesar

  14. Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Valérie A. Luyckx

  15. Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa

    Valérie A. Luyckx

  16. Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland

    Valérie A. Luyckx

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Contributions

R.V., L.A., E.A.B., P.P., S.S., N.S.-R., B.S., E.K.T. and V.A.L. researched data for the article. All authors contributed substantially to discussion of the content. R.V., E.A.B., P.P., S.S., N.S.-R., and V.A.L. wrote the article, and R.V., S.S. and V.A.L. reviewed and/or edited the manuscript before submission.

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Correspondence to Raymond Vanholder.

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Competing interests

R.V. is an adviser to AstraZeneca, Glaxo Smith Kline, Fresenius Kabi, Novartis, Kibow, Baxter, Nipro, Fresenius Medical Care and Nextkidney. L.A. is an adviser to AstraZeneca and Baxter. E.A.B. is an adviser to Baxter, IiberDi and AWAK, and has received speaker fees from Baxter and Vifor. B.S. has received grant support from Glaxo Smith Kline, Fresenius Medical Care and Boehringer Ingelheim as part of the CKD-REIN study. V.A.L. receives royalties as a co-editor of “The Kidney” textbook. The other authors declare no competing interests.

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Vanholder, R., Annemans, L., Braks, M. et al. Inequities in kidney health and kidney care. Nat Rev Nephrol 19, 694–708 (2023). https://doi.org/10.1038/s41581-023-00745-6

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