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A developmental approach to the prevention of hypertension and kidney disease: a report from the Low Birth Weight and Nephron Number Working Group
- Source :
- Lancet (UK), 390(10092), 424-428. Elsevier Ltd.
- Publication Year :
- 2016
-
Abstract
- In 2008, the World Health Assembly endorsed the Global Noncommunicable Disease (NCD) Action Plan based on the realization that NCDs caused more deaths than communicable diseases worldwide. 1 This plan strongly advocates prevention as the most effective strategy to curb NCDs. The “Life Course Approach”, also recently highlighted in the Minsk Declaration, reflects the increasing recognition that early development impacts later-life health and disease. 1,2 Optimization of early development offers the opportunity for true primary prevention of NCDs. Developmental programming in the kidney has been recognized for over 2 decades but its contribution to the global burden of kidney diseases remains underappreciated by policy makers. 3 Given the many factors known to impact fetal kidney development, including maternal health and nutrition, exposure to stress, poverty, pollutants, drugs and infections during gestation, 3 a holistic strategy to prevent such programming effects is consistent with the “Life-Course” approach and aligns with the United Nations Sustainable Development Goals (SDG) to foster health. 2,4 Chronic kidney disease (CKD) is an important contributor to the NCD burden that has been relatively neglected in the Global NCD Action Plan, despite CKD being a major cause of hypertension, and a major risk multiplier of cardiovascular disease 1,5 While the prevalence of CKD in many lower-income countries remains unknown, CKD is more prevalent among disadvantaged populations within industrialized nations, e.g. African Americans and Aboriginal Australians. 6 People receiving dialysis or transplantation are projected to double from 2.6 million in 2010 to 5.4 million in 2030. 7 Between 2.3 and 7.1 million adult people died from lack of access to dialysis and transplantation in lower-income countries in 2010. 7 Given the clinical consequences and often prohibitively high costs of treatment, prevention and early detection are the only sustainable solutions to address this growing global burden. To address the neglected issue of developmental programming of kidney disease and hypertension, a multidisciplinary workgroup, including international expert obstetricians, neonatologists and nephrologists (see Appendix), was convened. We argue that the Global NCD Action Plan does not adequately address the impact of developmental origins of NCDs which is globally but is particularly important in low- and middle-income countries (LMICs) where developmental risk is highest and the burden of NCDs is growing fastest. 8 The working group identified the need to raise awareness of the role of developmental programming in renal disease, and suggests locally adapted preventive strategies that could have long-term benefits on health and heath cost savings worldwide, integrating obstetrical, neonatal and nephrology perspectives.
- Subjects :
- medicine.medical_specialty
Hypertension, Renal
Urology
Gestational Age
Prenatal care
Disease
030204 cardiovascular system & hematology
Kidney
Article
03 medical and health sciences
0302 clinical medicine
Environmental health
medicine
Birth Weight
Humans
030212 general & internal medicine
Poverty
business.industry
Medicine (all)
Infant, Newborn
Prenatal Care
General Medicine
Nephrons
Acute Kidney Injury
Infant, Low Birth Weight
medicine.disease
Transplantation
Settore MED/40
Action plan
Population Surveillance
nephron, CKD, low birth weight
Life course approach
Kidney Diseases
business
Developed country
Infant, Premature
Kidney disease
Subjects
Details
- ISSN :
- 1474547X and 01406736
- Volume :
- 390
- Issue :
- 10092
- Database :
- OpenAIRE
- Journal :
- Lancet (London, England)
- Accession number :
- edsair.doi.dedup.....bb258088d2f820c36ef5c4ce1e7dc297