2024 AMR – Kidney Health Population
The landscape of kidney disease is ever-changing. Globally, changes in lifestyle have led to a steady increase in obesity and diabetes, major drivers of chronic kidney disease (CKD). On the other hand, the last couple of decades have seen tremendous progress in the form of improved treatments for CKD such as new drugs to slow the progression and/or treat the underlying etiology of kidney disease such as SGLT2 inhibitors (SGLT2i)1,2,3 and GLP-1 receptor agonists (GLP1ra).4 In addition, innovative dialytic therapies, such as high-volume hemodiafiltration (HVHDF), have documented beneficial impact on clinical outcomes in people with end-stage kidney disease (ESKD) on dialysis.5 Advanced epidemiological-type models are an invaluable tool to assess the integrated impact that novel therapies and demographic changes in the population may have on the size and characteristics of future populations with kidney disease.
The size and demographic composition of the CKD population depend on the complex interplay of various factors. Every year, hundreds of thousands of people develop ESKD around the world, many of them receiving kidney replacement therapy, mostly hemodialysis. At the same time, both the prevention and treatment of kidney disease are steadily improving, facilitated by new drugs and technologies. Novel therapies such as HVHDF have proven survival benefits for people with ESKD on maintenance hemodialysis.5 GLP1ra—originally developed as a treatment for type 2 diabetes—gained much attention for their potential to reduce weight and delay kidney disease progression.4 These are but a few examples. While life expectancy shows a general trend towards longer life expectancy, sudden global events like the COVID-19 pandemic can have a significant impact on the population.6,7
In this complex situation, several questions arise:
- How will new therapeutic drugs like GLP1ra and SGLT2i affect the progression of kidney disease at the population level?
- Will the mortality benefits of HVHDF change the age structure of people on dialysis?
- When will the effects of the COVID-19 pandemic on the ESKD population diminish?
Estimating the impact of these developments on populations with kidney disease is a challenging task, not least because different demographic groups, especially younger and older individuals, may be affected differently.
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