Globally, How Serious Is The Burden Of CKD?

Chronic kidney disease is a major disease threatening human health. Currently, on average, one in every ten adults worldwide suffers from chronic kidney disease, and the number of patients with chronic kidney disease in China has exceeded 100 million. March 14, 2024, is the 19th "World Kidney Day". This year's theme is "Kidney Health for All: Advancing Equitable Access to Care and Optimal Drug Treatment Practices." Medication Practice).

Click to Cistanche for kidney disease

The latest article "Update on Global Disparities in Kidney Disease Burden and Management in Countries and Regions of the World" just published in "The Lancet Global Health" updates the International Society of Nephrology's Global Kidney Health Atlas, as well as the publication of "Chronic Kidney Disease" "Major Global Burden of the World" review article. On World Kidney Day, Dr. Xiao compiled this review article for everyone, aiming to improve everyone's understanding of chronic kidney disease and promote the improvement of management quality.

Chronic kidney disease is a global public health problem, accounting for approximately 10% of the global population. Awareness of this major burden is relatively new and incomplete. Unfortunately, the multifaceted burden (prevalence, morbidity, mortality, cost) of chronic kidney disease continues to increase, especially in low-income countries (LIC).

In The Lancet Global Health, Aminu K Bello and colleagues update the International Society of Nephrology Global Kidney Health Atlas, which assesses differences in kidney disease burden and management in approximately 200 countries.

The report relies on a detailed review of the literature, available databases, and registries to estimate the burden of chronic kidney disease, and the incidence and prevalence of treated kidney failure. Findings were triangulated with data from a multi-country survey of opinion leaders based on WHO health system components (i.e. health financing, service delivery, access to essential medicines and technologies, health information systems, workforce, and governance). The authors are to be congratulated for this monumental effort. The global median prevalence of chronic kidney disease is 9.5% (IQR 5.9–11.7). Of the 165 countries surveyed, hemodialysis (defined as more than 50% of patients with renal failure, the minimal definition) is available in 162 (98%), while peritoneal dialysis and kidney transplantation are available in about three-quarters of the countries. The prevalence of renal replacement therapy (KRT, dialysis, or kidney transplantation) varies 200-fold from high-income regions (highest in Taiwan) to LIC (such as sub-Saharan African countries). Within LICs, KRT availability varies greatly depending on the political or public health agenda of each country. Renal care capabilities have increased recently, but the number of nephrologists in LIC remains low. In almost 50% of the countries surveyed, funding for KRT costs relies entirely on private and cash payments.

The global picture reflected in this report is important. Unsurprisingly, some results raise questions or point to limitations for an effort of this magnitude. In Africa, the authors reported a prevalence of CKD of 4.2%, which is much lower than other recent reports (12.2–15.8%). This low prevalence in a population of recent sub-Saharan African ancestry was unexpected due to the high prevalence of apolipoprotein L1 mutations, a major risk factor for chronic kidney disease. The authors did not discuss KRT quality (frequency and duration of hemodialysis, availability of modern immunosuppressants, etc.). Furthermore, they mentioned only half of the countries provided some public funding for chronic kidney disease management before KRT. Finally, only a small part of this paper is about the impact of KRT on patients' quality of life.

In addition to reducing the above limitations, the next iteration should enhance chronic kidney disease management before KRT. KRT for the treatment of renal failure is just the tip of the chronic kidney disease iceberg. Most of its morbidity and mortality occur before KRT and are mainly caused by cardiovascular diseases. However, until recently, tools to slow the progression of CKD were limited to antihypertensive drugs and renin-angiotensin system blockers, and treatment of CKD is now shifting toward multidrug therapy. Multiple trials have shown that SGLT2 inhibitors can reduce renal outcomes and cardiovascular hard endpoints in patients with albuminuric chronic kidney disease regardless of whether they have diabetes or not. Fenelidone, a nonsteroidal mineralocorticoid receptor antagonist, has been approved for the treatment of chronic kidney disease in patients with type 2 diabetes. Therefore, the Kidney Disease: Improving Global Outcomes (KDIGO) global guidelines recommend the concurrent use of SGLT2 inhibitors and fenelidone in appropriate patients. This wave of new chronic kidney disease drugs is likely to continue: in fact, a Phase 3 study of fenelidone in non-diabetic proteinuric chronic kidney disease is ongoing. Endothelin receptor antagonists and aldosterone synthase inhibitors will soon be tested in phase 3 trials following positive phase 2 studies. Additionally, a large, yet unpublished trial using semaglutide, a GLP1 agonist, was terminated early as an interim analysis by the independent data monitoring committee concluded that the trial met prespecified efficacy criteria for primary renal outcomes. Specify standards.

But drug registration is just the beginning of the battle. Many healthcare physicians, not just nephrologists but also primary care physicians, cardiologists, endocrinologists, and others who care for patients with undiagnosed chronic kidney disease, will have a critical role. Of note, the American Heart Association recently issued a position statement on cardiorenal metabolic syndrome (early diagnosis by urinalysis when eGFR remains normal). Collaboration between the medical profession, patients, and public health organizations is critical to increasing prescriptions of medications that are effective in slowing the progression of chronic kidney disease. True, a prescription is not enough. In low- and middle-income countries, access to new medicines is needed and poverty remains. Therefore, more efforts from WHO and policymakers are needed to make such medicines available globally.

Overall, the report by Bello and colleagues highlights the urgent need for more advocacy efforts to place chronic kidney disease management on the global health agenda. KRT is underfunded and most countries lack management policies. Future action plans should increase awareness of the burden of chronic kidney disease, promote early detection and management of high-risk groups, train more medical practitioners, and provide essential medicines to patients with chronic kidney disease.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, is a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.