The public health priority identified by the international community of nephrologists to mark World Kidney Day 2011 is vital for advancing the campaign against cardiovascular disease. The key message is that protecting the kidneys also saves the heart. There is a lot of evidence on the link between hypertension and damage to renal function; in turn, chronic kidney disease (CKD) can produce high blood pressure; diabetes also leads to kidney damage. That is well known, but more recent data indicate that even lesser degrees of renal impairment, manifested as protein in the urine, result in elevated risk of cardiovascular disease (CVD). This is true, in some cases, even where other factors such as diabetes, hypertension, and a history of heart attack do not co-exist. The findings may be disturbing, but affordable solutions are available to mitigate the risk. Where the problem is picked up early and a treatment regimen to reduce proteinuria initiated, there is a significant lowering of CVD risk. The promise of this approach, reported in the American Journal of Nephrology in February, is immense.
The number of deaths due to communicable diseases, and maternal, perinatal, and nutritional causes is projected to decrease in India between 2004 and 2030. By contrast, cardiovascular disease is expected to kill four million people in 2030, a sharp rise from 2.7 million for the base year. This forecast underscores the need for policy initiatives to achieve a substantial reduction in the incidence of cardiovascular disease. The reported CVD link to kidney disease makes it imperative to detect and treat early. As a goal, this is eminently achievable. Large-scale screening to detect proteinuria and early identification of CKD is the first step; involvement of the general practitioner and village nurse under rural health schemes will aid this. For those who are diagnosed with renal disease, other low-cost interventions, such as control of salt in diet, and treatment using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, can lead to a dramatic reduction in its progression. The processed food industry, which uses a large amount of salt, must be encouraged actively to participate in such a programme. The medical community has collected enough evidence to show that early detection and treatment stop individuals from slipping into irreversible renal failure. Now, it is pointing out that doing so can save them from CVD too. The agenda for prevention must get all possible support.