World Kidney Forum
CKD and Poverty: A Growing Global Challenge

https://doi.org/10.1053/j.ajkd.2007.10.047Get rights and content

Approximately 1.2 billion individuals worldwide live in extreme poverty (<$1/d), and 2.7 billion live in moderate poverty (<$2/d). Poverty is most prevalent in developing countries, but does not spare richer economies, where huge income discrepancies have been reported. Poverty is a major health care marker affecting a number of chronic, communicable, and noncommunicable diseases. Poverty and social deprivation are known to affect the predisposition, diagnosis, and management of chronic diseases; they directly impact on the prevalence of such conditions as obesity, diabetes, and hypertension. Also, growing evidence links poverty to chronic kidney disease (CKD). This may be caused by a direct impact of poverty on CKD or indirectly through the increased health care burden linked to poverty-associated diabetes and hypertension. Furthermore, data have shown that the poor and socially deprived have a greater prevalence of end-stage renal disease. Access to renal care, dialysis, and transplantation may also be affected by social deprivation. Overall, poverty and social deprivation are emerging as major risk markers for CKD in both developing and developed countries. Their impact on CKD warrants careful analysis because it may confound the interpretation of CKD risk factors within communities. This review therefore aims to look at the evidence linking poverty to CKD and its major risk factors, namely, diabetes and hypertension.

Section snippets

Poverty and its Impact on CKD/ESRD

Poverty can be defined in numerous ways. Many countries have individual poverty lines related to average income and identify the numbers of those living below these thresholds. Absolute poverty is classified by the World Bank as less than $1/d or $2/d.6 In developed countries, a measure of relative poverty is more usual, eg, the European Union defines this as an income less than 60% of the median income of the society.6, 7 Approximately 1.2 billion people in the world live in extreme poverty

Poverty and its Impact on CKD Modifiable Risk Factors

CKD is a complex and often progressive condition that leads to both CVD and ESRD. In addition to the underlying susceptibility to CKD, some risk factors have a role in the initiation of kidney damage, whereas others are implicated in the progression of established CKD to ESRD.

A number of modifiable and nonmodifiable risk factors have been associated with the development and progression of CKD. Race, ethnicity, and genetics have major impacts on susceptibility to CKD. Of the modifiable factors

Conclusions

The global increase in and awareness of CKD has prompted considerable interest in its early detection, prevention, and management. It also has focused minds on risk markers and factors involved in the initiation and progression of CKD and its cardiovascular complications. A number of factors have been identified, primarily hypertension and diabetes. However, little attention has been given to date to the fact that these 2 major predisposing factors may be linked to social deprivation and

Acknowledgements

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