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Global inequality in kidney care

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From screening to renal replacement therapy, gross inequity exists between affluent and disadvantaged populations

Global inequity in the distribution of both the burden and management of kidney disease is behind the theme of World Kidney Day, 12 March 2015, “Kidney Health for All”.1 It will be observed in Australia later in March.2 Disadvantaged populations experience greater risk, prevalence and progression of chronic kidney disease (CKD); less access to, and worse outcomes from, both dialysis and transplantation; and higher incidence and decreased recovery after acute kidney injury.

Worldwide prevalence of adult CKD is about 10%, reaching up to 50% in high-risk populations, including the Australian Aboriginal and Torres Strait Islander community, for whom CKD prevalence is twice the national average. The prevalence of advanced (stage 4 and 5) CKD is four times higher among Indigenous peoples than among non-Indigenous Australians, and up to 20 times as high among remote and very remote populations. This excess is driven partially by higher prevalences of diabetes mellitus, infectious diseases and poor nutrition;2 and disadvantaged populations have more unrecognised and more untreated CKD.3

One fifth of the world’s population lives in extreme poverty and is subject to…