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Report

Teaser, summary, work performed and final results

Periodic Reporting for period 1 - CKD AKI (Chronic kidney disease and acute kidney injury â€“ evaluation of EU and global epidemiology)

Teaser

Summary

Kidney diseases are widespread and increasing non-communicable diseases with high burden, but their epidemiology is still insufficiently evaluated. Kidney diseases are defined as chronic kidney disease (CKD) or acute kidney injury (AKI) depending on their duration. CKD is a set of chronic conditions of different etiology that affects about 10-15% of general adult population as shown in the high-quality screening programs performed in different world regions. CKD has a profound impact on public health due to premature mortality, renal and cardiovascular complications. Renal complications with development of end-stage kidney disease (ESKD) require costly therapy with dialysis or transplantation and pose substantial economic burden, with the worldwide number of such patients is estimated at more than 3 million (of them about 400,000 in EU-25), and annual growth rate of 8%. The rates of cardiovascular complications are elevated independently of other risk factors even from the early CKD stages.
AKI is characterized by the rapid loss of kidney function, and occurs in different settings, with higher rates among hospitalized or critically ill patients. AKI incidence varies from 295 to more than 5,000 cases per million population per year depending to its severity defined whether dialysis treatment is required or not. According England guidelines, prevention and delivery of optimal care for AKI could save about 12,000 lives and Â£150 million each year, and similar projections could be expected for all countries in EU.
Both CKD and AKI more frequently affect elderly people and patients with diabetes mellitus that make both conditions even more important in the face of general population aging and worldwide growth of diabetes prevalence. The healthcare services are unequally provided for men and women, and studying sex and gender disparities in kidney disease burden should be one of the integrative measures of equal access to health care.
The overall objectives of the project were to develop bibliographic system for collection of published data on CKD and AKI, to model kidney disease epidemiologic estimates on the global, regional, and country levels (including detailed estimates for European region) involving an international collaboration with leading institutes in the filed of non-communicable disease epidemiology, and to present the results of the project to public health stakeholders. The project has achieved these objectives, and provided substantial impact on the knowledge about kidney disease.

Work performed

For collection of the information about CKD and AKI epidemiology the experienced researcher (ER) developed a custom bibliographic system. Several rounds of systematic review of the literature have been performed to collect available data on epidemiology of kidney disease, and several versions of the search queries to most used bibliographic databases were constructed. The latter allows to compare search strategies for CKD and AKI, and to reveal the best ones for each of these conditions. This methodology could be useful for future systematic reviews both on epidemiology of kidney disease, and as a general research approach for any disease.
The collected data were shared with the Institute of Health Metrics and Evaluations (IHME, University of Washington, USA) to be used in the innovative epidemiological modelling of kidney disease morbidity and mortality in the framework of the Global Burden of Disease Study. For the collaboration with a wide range of leading experts in the field, data modelling, and preparation of manuscripts, the ER performed a short-term professorship visit to IHME, and interacted with IHMEÂ’s key persons during the project. The applied inter-disciplinary approach allows to consider kidney disease burden in a complex global environment, and to estimate CKD burden on the country, regional, and global levels.
The estimates of kidney disease morbidity and mortality, which were produced as a part of the fellowship activities, provide crucial information for scientific community, health care authorities, and a wide range of key stakeholders in the field of public health. Results presented in the scientific publications with co-authorship by both ER and Supervisor demonstrated that the global CKD prevalence is as high as 700 million individuals, of them almost 53 million live in European Union. The analysis performed in the collaboration with IHME has shown that globally in 2017 there were 1.23 million deaths directly related to CKD. Moreover, the developed models were able to quantitatively estimate that kidney impairment was attributed to 1.36 million deaths from myocardial infarction, stroke, and peripheral arterial disease (of which 140 thousand deaths were occurred in European Union). It means that 7.6% of all cardiovascular deaths could be attributed to kidney dysfunction, and the prevention and treatment of kidney disease should be a priority in combating cardiovascular morbidity and mortality Â— a strong message currently under-recognized by health authorities.
The results of the project become the basis of several papers published in high-impact scientific journals. Special attention was dedicated to the analysis of gender and sex differences of the CKD prevalence, and explanation of reasons for observed disparities. The published papers obtained a great interest from scientific community, mass media, social media, and general public. Some of these articles are entered in the top-1% or top-5% of papers ever published, according to Web of Science and Altmetrics.
Several activities have been performed for the communication and dissemination, including participation in congresses on epidemiology and kidney disease, giving lectures, publications in social networks, web-site and newsletter of the hosting institute. The support with the fellowship also provide a plenty of opportunities of the career development.

Final results

The collected data and collaboration with leading world institutions allow to produce estimates for kidney disease burden on both national and global levels. These estimates reflect morbidity and mortality also in the countries of European Union, and could be currently used to plan healthcare policy, allocate resources more efficiently according to the burden of disease, and estimate the long-term consequences of public health interventions. As a particular goal, the obtained results could be used for estimation of gender and sex disparities in the burden of kidney disease, as it was done in one of the published manuscripts.

The systematic review performed during the project established the general methodology, developed search strategies, and proposed new metrics to estimate the effectiveness of a given search strategy (such as number of data rows extracted from full-text articles and mean number of rows per article). These metrics, together with already widely used bibliometric indicators, could be reported universally in all systematic reviews, which would facilitate comparison of different search strategies and the selection of the best strategy for future use. Due to this, the results of the performed analysis could be generalized for systematic literature reviews on epidemiology in all fields of medicine. Eventually, this approach will help to ameliorate decision making process in public health.