Why Europe’s health policies must prioritize chronic kidney disease

Approximately, one in every 10 adults in Europe is affected by chronic kidney disease , yet most are unaware they have it. Many might find out too late.⁽¹⁾

If caught early, CKD can be manageable. Left untreated, it progresses toward kidney failure — a complex, life-threatening condition that cannot be reversed.⁽²⁾ Despite the severity of the disease, it is underdiagnosed and often overlooked in European public health policies.⁽²⁾

If caught early, CKD can be manageable. Left untreated, it progresses toward kidney failure.

Even so, there is hope that Europe can change the course of the growing CKD epidemic. The solution is simple and cost-effective: Implement policies prioritizing early screening for high-risk patients and treatments according to guidelines.^(3,4)

CKD’s extensive impact

CKD involves the gradual loss of kidney function, which disrupts the body’s critical systems. It often progresses without symptoms until the later stages — at which point it may be that only a third or less of kidney function remains.^(2,5,6)

In Europe, an estimated 100 million adults live with CKD, with another 300 million at risk.

Reduced kidney function can be detected early with simple urine and blood tests.⁽⁷⁾ But these tests are underutilized, even for high-risk CKD patients — such as those with diabetes. This may be partly because kidney health is not prioritized in public health policies.⁽⁸⁾ For instance, despite kidney disease affecting an estimated 850 million people globally⁽⁹⁾ and CKD being projected as the fifth leading cause of death by 2040,⁽³⁾ CKD is still not recognized by the World Health Organization as a priority non-communicable disease, neither is it highlighted in the 2022-2027 EU Non-Communicable Diseases Initiative ”Healthier Together”.^(10,11)

In Europe, an estimated 100 million adults live with CKD, with another 300 million at risk.⁽¹²⁾ Alarmingly, global stats estimate fewer than 10 percent of the affected know they have the disease.⁽¹³⁾

The impact of CKD extends beyond physical health. Nearly a third of CKD patients in stage 3 to 5 experience anxiety or depression, and treatments such as dialysis and kidney transplants are invasive and life-altering.^(14,15) Later stages of the disease can also take a heavy toll on families, who often face financial strain and disruptions to daily life while caring for loved ones.⁽²⁾

For health care systems, the costs are staggering. Europe allocates approximately €140 billion annually to CKD and kidney failure.⁽⁴⁾ In many high-income countries, end-stage CKD accounts for 2 to 3 percent of health care budgets, despite affecting just 0.03 percent of the population.⁽¹⁶⁾

But there is also an environmental price we pay for the treatment of late stage CKD, with dialysis being one of the most resource-intensive medical fields.⁽¹⁷⁾ If current trends persist, projections indicate that by 2032, CKD-related environmental burden in Germany alone could generate approximately 1.24 billion kilograms of carbon emissions — equivalent to the annual carbon footprint of 737,000 cars.⁽¹⁸⁾

As Europe’s population ages, the prevalence of CKD is expected to rise dramatically, placing even greater pressure on health care systems.⁽¹⁹⁾ Dr Navdeep Tangri, chair of the Medical Advisory Council for the Global Patient Alliance for Kidney Health, a professor of medicine at the University of Manitoba and senior scientist at the Chronic Disease Innovation Centre, warns of the dire consequences of inaction.

“We know, even counting in today’s standards, that globally there has been a 33 percent rise in the prevalence of CKD from 1990 to now⁽²⁰⁾, and there is a projected 116 percent rise in mortality from chronic kidney disease between 2019 and 2040,” he says. ^(21,22) “Those numbers tell the story of a billion-person, trillion-dollar disease.”

The case for early detection

Despite CKD’s widespread impact, it can be a solvable problem — if caught early.

The health benefits of optimized treatment according to guidelines are clear.⁽²³⁾ Preliminary results from a recent study found that CKD patients (the majority of whom were in mid-to-late stages of the disease) who were prescribed and adhered to guideline-recommended therapies (kidney-protective medication) lowered their risk of death by 67 percent and hospitalization by 20 percent.⁽²³⁾

And, economically, early detection and treatment are particularly cost-effective because treatments and procedures become more expensive as the disease advances.⁽³⁾ Around 250,000 Europeans rely on dialysis to survive — a number rising by 5 to 8 percent annually.⁽²⁴⁾ The cost of haemodialysis to health care systems can reach an eye-watering €80,000 per patient per year.⁽²⁵⁾ By contrast, early diagnosis and treatment allow for lower-cost interventions that can slow progression, reduce complications, preserve quality of life and significantly ease the burden on health systems.⁽²⁾

A need for more efficient programs and policies

Although international guidelines recommend regular CKD screening for at-risk individuals (those with diabetes and hypertension),⁽²⁶⁾ few European countries have adopted targeted screening programs. Among those that do have them, their implementation remains inconsistent, and many patients do not receive immediate access to guideline-recommended therapy even when diagnosed.⁽²⁾ A lack of CKD-specific training for primary care providers and inadequate referral pathways further hinder Europe’s patient outcomes.⁽²⁾

Take Germany: while it can be applauded for incorporating international CKD guidelines into its national health care system, the reality is that adherence to recommended testing and care pathways remains low.⁽²⁷⁾ And in France, where the care of patients with end-stage-kidney disease is estimated to cost €5 billion by 2025,⁽²⁸⁾ significant gaps persist between clinical guidelines and actual practice.⁽²⁹⁾

“France recommended screening for people over 60 since 2012.⁽³⁰⁾ That was adjusted in 2021 to include individuals of any age at risk,”⁽³¹⁾ explains Yvanie Caillé, Founder of the French patient advocacy group Renaloo. “But uptake is still low.”⁽³²⁾

Political momentum is building

These shortcomings in testing and care pathways leave significant room for policy to make improvements.

Caillé remains hopeful, pointing to recent policies that might encourage more testing. “The French Health Insurance has made CKD one of its strategic priorities. Consequently, it will inform general practitioners about CKD screening and offer them financial incentives for meeting annual screening targets among their at-risk patients.”^(33,34)

Integrating CKD screening into routine health checks is one solution that can make a significant difference.

Encouragingly, recent developments at the EU level suggest policymakers are catching on to the benefits of early detection. The Council’s conclusions on improving cardiovascular health in the EU, published in December under the Hungarian Presidency, acknowledge CKD’s strong link to cardiovascular disease. It also urges member countries to introduce joint health checks for cardiovascular disease and diabetes that include kidney function assessment.⁽³⁵⁾

The path forward

International guidelines for CKD detection are well-researched and ready for implementation. Policymakers have the tools and knowledge to act — now they need to prioritize early detection and equitable access to care.

Integrating CKD screening into routine health checks is one solution that can make a significant difference, particularly for at-risk patients such as those with diabetes, hypertension and cardiovascular conditions. Simple, scalable tests such as blood and urine analysis make early CKD detection accessible, enabling interventions when the disease is easier and less costly to manage.⁽³⁾

“Nobody should face the need to receive dialysis or transplantation in the last part of the 21st century. If all European countries would include CKD as part of joint health checks at the primary care level it would have massive positive impacts on health care systems and give hope for patients. We urge all countries to follow suit,” says Daniel Gallego, president of the European Kidney Patients´ Federation.

Given CKD’s strong ties to other major conditions such as diabetes, heart disease and hypertension, incorporating CKD into existing NCD policies is essential for a robust and effective approach to managing Europe’s growing health challenges.⁽⁸⁾ For too long, CKD has been an afterthought — it’s time for policymakers to correct this life-threatening oversight.

To achieve this, key actions for policymakers include:

• Integrate CKD screening into routine health checks, using simple, cost-effective tools such as blood and urine tests.
• Embed CKD into national NCD strategies and frameworks, ensuring kidney health is part of a comprehensive public health response.
• Ensure diagnosed patients receive guideline-directed treatment, following international standards such as the KDIGO guidelines, to help slow disease progression.
• Prioritize equitable access to CKD care, ensuring early intervention for at-risk populations, particularly those with comorbid conditions.

Finally, these efforts must extend beyond Europe. The WHO should formally recognize CKD as a priority NCD and include it in global health frameworks, such as the WHO Global Monitoring Framework for NCD Prevention and WHO NCD “best buys.” This would provide policymakers worldwide with a roadmap to reduce the burden of CKD and drive coordinated international action.

Now is the time

Europe stands at a critical juncture. With the tools, guidelines and policy frameworks already within reach, there is a clear opportunity to address CKD through early detection, integrated health checks and access to treatment. However, failing to act now will likely escalate costs, strain health care systems, increase the environmental impact and worsen patient outcomes across Europe and beyond. 

The steps we take today will determine the future trajectory of this silent yet devastating disease. It’s time for Europe — and the world — to make CKD a priority and potentially spare millions from the burden of kidney failure.

Veeva ID: Z4-70462

Date of Prep: December 2024

References:

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