Editorial
The global burden of chronic kidney diseases waits for better renoprotection

Chronic kidney disease (CKD) is a worldwide threat to public health, but the scale of the problem is probably not fully appreciated [1]. In recent decades, we have seen a shift in the major cause of death and disability from nutritional deficiency and infections diseases toward non-communicable diseases, with the highest mortality caused by cardiovascular diseases (CVD). The growing prevalence of CKD is one aspect of this shift. CKD has, indeed, a complex interrelationship with cardiovascular disease, hypertension and diabetes [2]. Of note, diabetes affected 2.8% of the global population in 2000, and this will triple to 6.8% by 2030 [3]. By this time, 81% of those with diabetes will live in the developing world, almost three times the rate of increase compared with developed countries. About 40% of patients with type 2 diabetes will develop CKD. The estimated global dialysis population for end-stage chronic kidney disease will exceed 2 millions by the year 2010, expanding at a rate of 7% per year, with an aggregate cost of more then US$ 1 trillion [4]. Much less is known about the prevalence of earlier stages of CKD, when symptoms may be mild or neglected by patients or their caring physicians. According to the third National Health and Nutritional Examination Survey (NHANES), the estimated prevalence of CKD is 11% of the adult population in the United States [5]. If these data were to be extrapolated to the world population, the number of people with CKD could be estimated as hundred of millions [6]. A sizeable proportion of these patients will eventually progress toward end-stage renal disease and will require renal replacement therapy. With the rising number of patients involved, costs for renal replacement therapy, will become extremely high and prohibitive not only for developing countries. Thus, efforts have to be made to stop progression or even induce remission/regression of renal disease to avoid end-stage renal failure.
At present, there is no specific cure for most of the acquired CKD. This implies that our effort should focus on getting more insights about mechanisms and mediators involved in renal disease progression to ultimately develop targeted renoprotective strategies. Certain renal diseases, although rare, have a rapid course that quickly leads to irreversible ESRD. More common nephropathies progress less rapidly, but still evolve to ESRD within one to four decades after diagnosis. During the past 20 years, research in...


View full text...