Screening for chronic kidney disease in emerging countries: feasibility and hurdles

Chronic kidney disease (CKD) is a worldwide threat to public health, but the dimension of the problem is probably not fully appreciated. There are ∼1.8 million people in the world who are alive simply because they have access to one form or another of renal replacement therapy [1]. Ninety percent of those live in high-income countries, where the average gross income is in excess of US $10000 per capita. However, the prevalence rate of renal replacement therapy varies among countries particularly in the emerging world, and this is related to the capacity of the health system to provide such a costly treatment rather than a true difference in epidemiology of renal disease [2]. Although data on the prevalence of predialysis CKD in lowand middle-income countries are sparse, we would expect that there are at least comparable numbers of patients with CKD in poor countries as in developed nations. Some examples indicate that the overall prevalence of CKD is 21%, 10.6% and 11% in urban areas, respectively, of Moldova [3], Nepal [4] and China [5]. Data from India also suggest that in a developing country the prevalence rate of CKD could vary almost 5-fold between rural and city populations [6,7]. These observations imply that CKD would affect not only very many people in the developing world, but preferentially the poor within these countries who usually have no information about disease and risk factors and cannot have access to health care. It is also increasingly recognized that the burden of CKD is not limited to its implications on demands for renal