Economic and Health Implications of Risk Factors in Chronic Kidney Disease
Abstract
Background: Chronic Kidney Disease (CKD) represents a substantial global health and economic challenge, affecting millions of individuals and placing a heavy burden on healthcare systems. This review delves into the major risk factors contributing to CKD, with a focus on diabetes, hypertension, cardiovascular diseases, age, gender, genetic factors, family history, socioeconomic status, chronic use of certain medications, high protein diet, auto-immune diseases, urinary tract obstruction, recurrent kidney infections, and some additional factors. Methods: This review provides a comprehensive analysis of the impact of these risk factors on both healthcare costs and patient out-of-pocket expenses, highlighting the direct and indirect financial burdens associated with CKD. Results: It critically examines how these factors not only accelerate CKD progression but also compound the financial strain on patients. Diabetes, characterized by persistent hyperglycaemia, leads to kidney damage and necessitates extensive medical management, while hypertension exacerbates kidney deterioration through increased vascular pressure. Socioeconomic status further complicates CKD management, as lower income and limited access to healthcare services hinder effective treatment and exacerbate health disparities. Conclusion: This article offers insights into potential interventions and policy measures designed to mitigate the economic impact on affected individuals, emphasizing the need for integrated strategies to address both the health and financial aspects of CKD.
[1] Plantinga LC. Socio-economic impact in CKD. Néphrologie & thérapeutique. 2013 Feb 1;9(1):1-7.
[2] Hannan M, Ansari S, Meza N, Anderson AH, Srivastava A, Waikar S, Charleston J, Weir MR, Taliercio J, Horwitz E, Saunders MR. Risk factors for CKD progression: overview of findings from the CRIC study. Clinical Journal of the American Society of Nephrology. 2021 Apr 1;16(4):648-59.
[3] Kazancioğlu R. Risk factors for chronic kidney disease: an update. Kidney international supplements. 2013 Dec 1;3(4):368-71.
[4] Kurzhagen JT, Dellepiane S, Cantaluppi V, Rabb H. AKI: an increasingly recognized risk factor for CKD development and progression. Journal of nephrology. 2020 Dec;33(6):1171-87.
[5] Wang F, He K, Wang J, Zhao MH, Li Y, Zhang L, Saran R, Bragg-Gresham JL. Prevalence and risk factors for CKD: a comparison between the adult populations in China and the United States. Kidney international reports. 2018 Sep 1;3(5):1135-43.
[6] Yang W, Xie D, Anderson AH, Joffe MM, Greene T, Teal V, Hsu CY, Fink JC, He J, Lash JP, Ojo A. Association of kidney disease outcomes with risk factors for CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) study. American journal of kidney diseases. 2014 Feb 1;63(2):236-43.
[7] Zhang X, Fang Y, Zou Z, Hong P, Zhuo Y, Xu Y, Wan J. Risk factors for progression of CKD with and without diabetes. Journal of diabetes research. 2022;2022(1):9613062.
[8] Lin CY, Hsieh MC, Kor CT, Hsieh YP. Association and risk factors of chronic kidney disease and incident diabetes: a nationwide population-based cohort study. Diabetologia. 2019 Mar;62:438-47.
[9] Levey AS, Bilous R, Shlipak MG. CKD and diabetes: what can we learn from their similarities and differences?. American Journal of Kidney Diseases. 2016 Mar 1;67(3):360-3.
[10] Lea JP, Nicholas SB. Diabetes mellitus and hypertension: key risk factors for kidney disease. Journal of the National Medical Association. 2002 Aug;94(8 Suppl):7S.
[11] Burnier M, Damianaki A. Hypertension as cardiovascular risk factor in chronic kidney disease. Circulation research. 2023 Apr 14;132(8):1050-63.
[12] Barri YM. Hypertension and kidney disease: a deadly connection. Current hypertension reports. 2008 Feb;10(1):39-45.
[13] Hamrahian SM, Falkner B. Hypertension in chronic kidney disease. Hypertension: from basic research to clinical practice. 2017:307-25.
[14] Yamagata K, Ishida K, Sairenchi T, Takahashi H, Ohba S, Shiigai T, Narita M, Koyama A. Risk factors for chronic kidney disease in a community-based population: a 10-year follow-up study. Kidney international. 2007 Jan 2;71(2):159-66.
[15] Zelnick LR, Weiss NS, Kestenbaum BR, Robinson-Cohen C, Heagerty PJ, Tuttle K, Hall YN, Hirsch IB, De Boer IH. Diabetes and CKD in the United States population, 2009–2014. Clinical Journal of the American Society of Nephrology. 2017 Dec 1;12(12):1984-90.
[16] Anders HJ, Huber TB, Isermann B, Schiffer M. CKD in diabetes: diabetic kidney disease versus nondiabetic kidney disease. Nature Reviews Nephrology. 2018 Jun;14(6):361-77.
[17] Perkovic V, Agarwal R, Fioretto P, Hemmelgarn BR, Levin A, Thomas MC, Wanner C, Kasiske BL, Wheeler DC, Groop PH, Bakris GL. Management of patients with diabetes and CKD: áconclusions from a “Kidney Disease: Improving Global Outcomes”(KDIGO) Controversies Conference. Kidney international. 2016 Dec 1;90(6):1175-83.
[18] McQueen RB, Farahbakhshian S, Bell KF, Nair KV, Saseen JJ. Economic burden of comorbid chronic kidney disease and diabetes. Journal of medical economics. 2017 Jun 3;20(6):585-91.
[19] Vupputuri S, Kimes TM, Calloway MO, Christian JB, Bruhn D, Martin AA, Nichols GA. The economic burden of progressive chronic kidney disease among patients with type 2 diabetes. Journal of Diabetes and its Complications. 2014 Jan 1;28(1):10-6.
[20] Horowitz B, Miskulin D, Zager P. Epidemiology of hypertension in CKD. Advances in chronic kidney disease. 2015 Mar 1;22(2):88-95.
[21] Hamrahian SM, Falkner B. Hypertension in chronic kidney disease. Hypertension: from basic research to clinical practice. 2017:307-25.
[22] Muntner P, Judd SE, Gao L, Gutiérrez OM, Rizk DV, McClellan W, Cushman M, Warnock DG. Cardiovascular risk factors in CKD associate with both ESRD and mortality. Journal of the American Society of Nephrology. 2013 Jul 1;24(7):1159-65.
[23] Doan QV, Gleeson M, Kim J, Borker R, Griffiths R, Dubois RW. Economic burden of cardiovascular events and fractures among patients with end-stage renal disease. Current medical research and opinion. 2007 Jul 1;23(7):1561-9.
[24] Goldberg I, Krause I. The role of gender in chronic kidney disease. Emj. 2016 Apr 5;1(2):58-64.
[25] Eriksen BO, Ingebretsen OC. The progression of chronic kidney disease: a 10-year population-based study of the effects of gender and age. Kidney international. 2006 Jan 2;69(2):375-82.
[26] Roderick PJ, Atkins RJ, Smeeth L, Nitsch DM, Hubbard RB, Flectcher AE, Bulpitt CJ. Detecting chronic kidney disease in older people; what are the implications?. Age and ageing. 2008 Mar 1;37(2):179-86.
[27] Obrador GT, Schultheiss UT, Kretzler M, Langham RG, Nangaku M, Pecoits-Filho R, Pollock C, Rossert J, Correa-Rotter R, Stenvinkel P, Walker R. Genetic and environmental risk factors for chronic kidney disease. Kidney international supplements. 2017 Oct 1;7(2):88-106.
[28] Vehaskari VM. Genetics and CKD. Advances in Chronic Kidney Disease. 2011 Sep 1;18(5):317-23.
[29] Baker M, Perazella MA. NSAIDs in CKD: are they safe?. American Journal of Kidney Diseases. 2020 Oct 1;76(4):546-57.
[30] Gooch K, Culleton BF, Manns BJ, Zhang J, Alfonso H, Tonelli M, Frank C, Klarenbach S, Hemmelgarn BR. NSAID use and progression of chronic kidney disease. The American journal of medicine. 2007 Mar 1;120(3):280-e1.
[31] Arora P, Gupta A, Golzy M, Patel N, Carter RL, Jalal K, Lohr JW. Proton pump inhibitors are associated with increased risk of development of chronic kidney disease. BMC nephrology. 2016 Dec;17:1-8.
[32] Klatte DC, Gasparini A, Xu H, de Deco P, Trevisan M, Johansson AL, Wettermark B, Ärnlöv J, Janmaat CJ, Lindholm B, Dekker FW. Association between proton pump inhibitor use and risk of progression of chronic kidney disease. Gastroenterology. 2017 Sep 1;153(3):702-10.
[33] Ko GJ, Rhee CM, Kalantar-Zadeh K, Joshi S. The effects of high-protein diets on kidney health and longevity. Journal of the American Society of Nephrology. 2020 Aug 1;31(8):1667-79.
[34] Friedman AN. High-protein diets: potential effects on the kidney in renal health and disease. American Journal of kidney diseases. 2004 Dec 1;44(6):950-62.
[35] Boesen EI, Kakalij RM. Autoimmune-mediated renal disease and hypertension. Clinical Science. 2021 Sep;135(17):2165-96.
[36] Chevalier RL. Congenital urinary tract obstruction: the long view. Advances in chronic kidney disease. 2015 Jul 1;22(4):312-9.
[37] Liu KD, Yang J, Tan TC, Glidden DV, Zheng S, Pravoverov L, Hsu CY, Go AS. Risk factors for recurrent acute kidney injury in a large population-based cohort. American Journal of Kidney Diseases. 2019 Feb 1;73(2):163-73.
[38] Luyckx VA, Tuttle KR, Garcia-Garcia G, Gharbi MB, Heerspink HJ, Johnson DW, Liu ZH, Massy ZA, Moe O, Nelson RG, Sola L. Reducing major risk factors for chronic kidney disease. Kidney international supplements. 2017 Oct 1;7(2):71-87.
[2] Hannan M, Ansari S, Meza N, Anderson AH, Srivastava A, Waikar S, Charleston J, Weir MR, Taliercio J, Horwitz E, Saunders MR. Risk factors for CKD progression: overview of findings from the CRIC study. Clinical Journal of the American Society of Nephrology. 2021 Apr 1;16(4):648-59.
[3] Kazancioğlu R. Risk factors for chronic kidney disease: an update. Kidney international supplements. 2013 Dec 1;3(4):368-71.
[4] Kurzhagen JT, Dellepiane S, Cantaluppi V, Rabb H. AKI: an increasingly recognized risk factor for CKD development and progression. Journal of nephrology. 2020 Dec;33(6):1171-87.
[5] Wang F, He K, Wang J, Zhao MH, Li Y, Zhang L, Saran R, Bragg-Gresham JL. Prevalence and risk factors for CKD: a comparison between the adult populations in China and the United States. Kidney international reports. 2018 Sep 1;3(5):1135-43.
[6] Yang W, Xie D, Anderson AH, Joffe MM, Greene T, Teal V, Hsu CY, Fink JC, He J, Lash JP, Ojo A. Association of kidney disease outcomes with risk factors for CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) study. American journal of kidney diseases. 2014 Feb 1;63(2):236-43.
[7] Zhang X, Fang Y, Zou Z, Hong P, Zhuo Y, Xu Y, Wan J. Risk factors for progression of CKD with and without diabetes. Journal of diabetes research. 2022;2022(1):9613062.
[8] Lin CY, Hsieh MC, Kor CT, Hsieh YP. Association and risk factors of chronic kidney disease and incident diabetes: a nationwide population-based cohort study. Diabetologia. 2019 Mar;62:438-47.
[9] Levey AS, Bilous R, Shlipak MG. CKD and diabetes: what can we learn from their similarities and differences?. American Journal of Kidney Diseases. 2016 Mar 1;67(3):360-3.
[10] Lea JP, Nicholas SB. Diabetes mellitus and hypertension: key risk factors for kidney disease. Journal of the National Medical Association. 2002 Aug;94(8 Suppl):7S.
[11] Burnier M, Damianaki A. Hypertension as cardiovascular risk factor in chronic kidney disease. Circulation research. 2023 Apr 14;132(8):1050-63.
[12] Barri YM. Hypertension and kidney disease: a deadly connection. Current hypertension reports. 2008 Feb;10(1):39-45.
[13] Hamrahian SM, Falkner B. Hypertension in chronic kidney disease. Hypertension: from basic research to clinical practice. 2017:307-25.
[14] Yamagata K, Ishida K, Sairenchi T, Takahashi H, Ohba S, Shiigai T, Narita M, Koyama A. Risk factors for chronic kidney disease in a community-based population: a 10-year follow-up study. Kidney international. 2007 Jan 2;71(2):159-66.
[15] Zelnick LR, Weiss NS, Kestenbaum BR, Robinson-Cohen C, Heagerty PJ, Tuttle K, Hall YN, Hirsch IB, De Boer IH. Diabetes and CKD in the United States population, 2009–2014. Clinical Journal of the American Society of Nephrology. 2017 Dec 1;12(12):1984-90.
[16] Anders HJ, Huber TB, Isermann B, Schiffer M. CKD in diabetes: diabetic kidney disease versus nondiabetic kidney disease. Nature Reviews Nephrology. 2018 Jun;14(6):361-77.
[17] Perkovic V, Agarwal R, Fioretto P, Hemmelgarn BR, Levin A, Thomas MC, Wanner C, Kasiske BL, Wheeler DC, Groop PH, Bakris GL. Management of patients with diabetes and CKD: áconclusions from a “Kidney Disease: Improving Global Outcomes”(KDIGO) Controversies Conference. Kidney international. 2016 Dec 1;90(6):1175-83.
[18] McQueen RB, Farahbakhshian S, Bell KF, Nair KV, Saseen JJ. Economic burden of comorbid chronic kidney disease and diabetes. Journal of medical economics. 2017 Jun 3;20(6):585-91.
[19] Vupputuri S, Kimes TM, Calloway MO, Christian JB, Bruhn D, Martin AA, Nichols GA. The economic burden of progressive chronic kidney disease among patients with type 2 diabetes. Journal of Diabetes and its Complications. 2014 Jan 1;28(1):10-6.
[20] Horowitz B, Miskulin D, Zager P. Epidemiology of hypertension in CKD. Advances in chronic kidney disease. 2015 Mar 1;22(2):88-95.
[21] Hamrahian SM, Falkner B. Hypertension in chronic kidney disease. Hypertension: from basic research to clinical practice. 2017:307-25.
[22] Muntner P, Judd SE, Gao L, Gutiérrez OM, Rizk DV, McClellan W, Cushman M, Warnock DG. Cardiovascular risk factors in CKD associate with both ESRD and mortality. Journal of the American Society of Nephrology. 2013 Jul 1;24(7):1159-65.
[23] Doan QV, Gleeson M, Kim J, Borker R, Griffiths R, Dubois RW. Economic burden of cardiovascular events and fractures among patients with end-stage renal disease. Current medical research and opinion. 2007 Jul 1;23(7):1561-9.
[24] Goldberg I, Krause I. The role of gender in chronic kidney disease. Emj. 2016 Apr 5;1(2):58-64.
[25] Eriksen BO, Ingebretsen OC. The progression of chronic kidney disease: a 10-year population-based study of the effects of gender and age. Kidney international. 2006 Jan 2;69(2):375-82.
[26] Roderick PJ, Atkins RJ, Smeeth L, Nitsch DM, Hubbard RB, Flectcher AE, Bulpitt CJ. Detecting chronic kidney disease in older people; what are the implications?. Age and ageing. 2008 Mar 1;37(2):179-86.
[27] Obrador GT, Schultheiss UT, Kretzler M, Langham RG, Nangaku M, Pecoits-Filho R, Pollock C, Rossert J, Correa-Rotter R, Stenvinkel P, Walker R. Genetic and environmental risk factors for chronic kidney disease. Kidney international supplements. 2017 Oct 1;7(2):88-106.
[28] Vehaskari VM. Genetics and CKD. Advances in Chronic Kidney Disease. 2011 Sep 1;18(5):317-23.
[29] Baker M, Perazella MA. NSAIDs in CKD: are they safe?. American Journal of Kidney Diseases. 2020 Oct 1;76(4):546-57.
[30] Gooch K, Culleton BF, Manns BJ, Zhang J, Alfonso H, Tonelli M, Frank C, Klarenbach S, Hemmelgarn BR. NSAID use and progression of chronic kidney disease. The American journal of medicine. 2007 Mar 1;120(3):280-e1.
[31] Arora P, Gupta A, Golzy M, Patel N, Carter RL, Jalal K, Lohr JW. Proton pump inhibitors are associated with increased risk of development of chronic kidney disease. BMC nephrology. 2016 Dec;17:1-8.
[32] Klatte DC, Gasparini A, Xu H, de Deco P, Trevisan M, Johansson AL, Wettermark B, Ärnlöv J, Janmaat CJ, Lindholm B, Dekker FW. Association between proton pump inhibitor use and risk of progression of chronic kidney disease. Gastroenterology. 2017 Sep 1;153(3):702-10.
[33] Ko GJ, Rhee CM, Kalantar-Zadeh K, Joshi S. The effects of high-protein diets on kidney health and longevity. Journal of the American Society of Nephrology. 2020 Aug 1;31(8):1667-79.
[34] Friedman AN. High-protein diets: potential effects on the kidney in renal health and disease. American Journal of kidney diseases. 2004 Dec 1;44(6):950-62.
[35] Boesen EI, Kakalij RM. Autoimmune-mediated renal disease and hypertension. Clinical Science. 2021 Sep;135(17):2165-96.
[36] Chevalier RL. Congenital urinary tract obstruction: the long view. Advances in chronic kidney disease. 2015 Jul 1;22(4):312-9.
[37] Liu KD, Yang J, Tan TC, Glidden DV, Zheng S, Pravoverov L, Hsu CY, Go AS. Risk factors for recurrent acute kidney injury in a large population-based cohort. American Journal of Kidney Diseases. 2019 Feb 1;73(2):163-73.
[38] Luyckx VA, Tuttle KR, Garcia-Garcia G, Gharbi MB, Heerspink HJ, Johnson DW, Liu ZH, Massy ZA, Moe O, Nelson RG, Sola L. Reducing major risk factors for chronic kidney disease. Kidney international supplements. 2017 Oct 1;7(2):71-87.
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Issue | Vol 10 No 3 (2024) | |
Section | Review Article(s) | |
Keywords | ||
Chronic Kidney Disease Risk Factors Financial Burden Healthcare Costs Economic Implications. |
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How to Cite
1.
Gireesh G. Economic and Health Implications of Risk Factors in Chronic Kidney Disease. JPPM. 2025;10(3).