A developmental approach to the prevention of hypertension and kidney disease: a report from the Low Birth Weight and Nephron Number Working Group

VA Luyckx, N Perico, M Somaschini, D Manfellotto… - The Lancet, 2017 - thelancet.com
VA Luyckx, N Perico, M Somaschini, D Manfellotto, H Valensise, I Cetin, U Simeoni
The Lancet, 2017thelancet.com
In 2008, the World Health Assembly endorsed WHO's Global Action Plan for the Prevention
and Control of Non-Communicable Diseases (NCDs) 2013–2020, 1 based on the
realisation that NCDs cause more deaths worldwide than do communicable diseases. This
plan strongly advocates prevention as the most effective strategy to curb NCDs.
Furthermore, the life-course approach, which was highlighted in the Minsk Declaration, 2
reflects increasing recognition that early development affects later-life health and disease. 1 …
In 2008, the World Health Assembly endorsed WHO’s Global Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs) 2013–2020, 1 based on the realisation that NCDs cause more deaths worldwide than do communicable diseases. This plan strongly advocates prevention as the most effective strategy to curb NCDs. Furthermore, the life-course approach, which was highlighted in the Minsk Declaration, 2 reflects increasing recognition that early development affects later-life health and disease. 1 Optimisation of early development offers the opportunity for true primary prevention of NCDs. Developmental programming in the kidney has been recognised for more than two decades, but its contribution to the global burden of kidney diseases remains underappreciated by policy makers. 3 In view of the many factors known to affect 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 lifecourse approach and aligns with the United Nations (UN) Sustainable Development Goals to foster health. 2 Chronic kidney disease is an important contributor to the NCD burden that has been relatively neglected in WHO’s Global Action Plan for the Prevention and Control of NCDs, despite chronic kidney disease being a major cause of hypertension and a major risk multiplier of cardiovascular disease. 1, 4 Although the prevalence of chronic kidney disease in many low-income countries remains unknown, the disease is most prevalent among disadvantaged populations within industrialised nations—eg, African-Americans and Aboriginal Australians. 5 The number of people receiving dialysis or transplantation is projected to double, from 2· 6 million in 2010 to 5· 4 million in 2030. 6 In 2010, 2· 3–7· 1 million adults died from lack of access to dialysis and transplantation in low-income countries. 6 In view of the clinical outcomes and often prohibitively high costs of treatment, prevention and early detection are the only sustainable solutions to address this growing global burden.
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