Chronic kidney disease: dangerous and silent but now treated at home

Chronic Kidney Disease (CKD) is a disease that the WHO in May 2025 and the UN a few months later defined as a 'global public health priority'. There are three reasons behind this important recognition.

The first is that 10-15% of the world's population lives with this disease; the total number of patients in the world is just over 850 million, 95% of whom have a disease that is not in the dialysis phase (in Italy, around 5 million), and these numbers are constantly growing. This is because diabetes, hypertension, obesity and cardiovascular disease, which are the main risk factors, are now epidemic diseases. But in a percentage exceeding 30-40%, we also find renal inflammatory diseases - the so-called glomerulonephritis - and certain hereditary diseases, polycystic kidney disease in primis, causing it.

The second reason is that MRC is burdened by high costs for patients and the state. It is a major cause of fatal and non-fatal cardiovascular events: mortality from MRC has increased by 41% in the last 30 years and it is estimated that MRC will become the third leading cause of death in Europe by 2050. For the 'survivors', the natural history of the disease leads to dialysis (which exponentially increases cardiovascular risk) or, in the lucky few, renal transplantation. Dialysis is a treatment that disproportionately reduces life expectancy and quality of life and is also burdened by high - and increasingly unsustainable - costs for the state. In the last three decades, dialysis cases have increased (+37% in Italia). Today in our country we have around 40,000 patients undergoing haemodialysis treatment in accredited hospital or private centres, for which our SSN spends around 2.5 billion euros per year. The use of renal transplantation is lower than in other European countries (28,000 patients in Italia). Peritoneal dialysis is also underdeveloped (only 4,500 patients in Italia, 10% of dialysed patients), a more physiological therapy performed by patients at home.

The final factor indicated by the WHO and UNO is that, despite the fact that the burden of MRC is far greater than that of other chronic degenerative diseases in terms of frequency, prognosis and costs, paradoxically awareness of this disease is still low in the general population and among non-nephrologists: only 10-20% of affected patients are aware that they are 'kidney patients'. The low awareness is caused by the scarcity of symptoms until the advanced stages of the disease. Moreover, the low level of therapeutic innovation in the past century has contributed to a fatalistic attitude towards MRC, lowering the level of attention of clinicians and the general public on this disease.

Today, however, attitudes can and must change radically. WHO and UNO recommend raising the level of attention on this disease by favouring early diagnosis and timely treatment. This paradigm shift is not only determined by the negative characteristics mentioned above, but also and above all by the new therapeutic armamentarium, primarily glyflozines, non-steroidal antialdosteronic drugs, and GLP1-RA, which if included early in therapy can 'cure' MRC and postpone dialysis by more than 20 years. Moreover, technological improvements in peritoneal dialysis have elevated this dialysis method from 'niche' therapy to first-choice therapy.