Iranian Red Crescent Medical Journal Iran Red Crescent Med J 2011; 13(3):164-166 ©Iranian Red Crescent Medical Journal EDITORIAL In Memorandum of World Kidney Day: Chronic Kidney Disease: A Common But Often Unnoticed Major Health Problem MK Fallahzadeh 1 , MM Sagheb 2 , MH Fallahzadeh 2, 3 * 1 Shiraz Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 2 Department of Nephrology, Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 3 Department of Pediatric Nephrology, Shiraz University of Medical Sciences, Shiraz, Iran In the past two decades, the international health ef- forts have been focused on the control of infectious diseases in developing countries with non- communicable diseases (NCDs) given a lower priori- ty. 1 However, the incidence of NCDs including chronic kidney disease (CKD) is increasing in devel- oping countries where primary care intervention for CKD is often inadequate. 2 The main international fo- cus is now on NCDs including diabetes mellitus (DM), hypertension, obesity and chronic airway ob- struction. Most of the NCDs share common risk fac- tors which are potentially amenable to behavioral modifications including smoking, unhealthy diet, physical inactivity and stress. These diseases can usu- ally be detected by simple tests which are available in primary care settings even in low and middle income countries. CKD which is often caused by underlying diseases such as DM and hypertension can be effec- tively prevented by detection and treatment of these diseases. 2 According to Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, CKD is de- fined as i) Persistent glomerular filtration rate (GFR) < 60 mL/min/1.73 m 2 for ≥ 3 months with or without kidney damage or ii) Kidney damage for ≥ 3 months based on structural and functional anomalies of the kidney with or without decreased GFR. 3 CKD is now a common health problem globally; up to 10% of world’s population is estimated to suffer from CKD. 4 Number of the patients with end stage renal disease (ESRD) keeps increasing and is now projected to affect more than 2 million people world- wide. Increasing incidence of CKD not only adds burden to global health care resources but also has significant impact on patients and their families. Therefore, it is of great importance to detect and pre- vent CKD at its early stages. 5 In 2004, over 700,000 patients were estimated to have CKD in Iran with incidence rate of 173.5/100,000. CKD was responsible for 1,145,654 disability adjusted life years (DALYs). Among the underlying causes for stages of 1 to 4 of CKD in Ira- nian population, DM and hypertension were the most common ones. In 2008, more than 24,000 patients were estimated to suffer from ESRD (stage 5 of CKD) in Iran. Patients with ESRD constitute the tip of iceberg of patients with varying degrees of CKD. 6 In Iran, the annual number of patients with ESRD beginning maintenance therapy increased by 130% between 2000 and 2006. The incidence of ESRD sec- ondary to DM increased 2 folds from 1997 to 2006 (from 16% to 31%). 7 Patients with CKD are 5 to 11 times more likely to die prematurely than to progress to ESRD. 8 The high disease burden of CKD, the high cost of treatment and the fact that preventive measures are not yet fully in place in many countries, quantify CKD as a public health problem. 9 The main risk factors for CKD are DM, hyperten- sion, obesity, aging of the population, dyslipidemia, family history of kidney disease and smoking. 10 Among these risk factors, DM is the leading cause of CKD globally; presently, diabetic nephropathy is es- timated to affect 285 million adults worldwide. It is expected to rise by 54% to 839 million by 2030 ac- cording to the International Diabetes Federation. 11 Increased prevalence of hypertension from 972 mil- lion to 1.5 billion by 2015 is also expected. 12 The screening and preventive strategies must be well suited to the particular population by considering