Здоровье почек для всех: заботясь о людях, защищая планету

Существующая модель помощи при заболеваниях почек, сфокусированная на поздних стадиях болезни и амбулаторном гемодиализе, экологически небезопасна из-за затрат, воздействия на окружающую среду, неудовлетворительных исходов и снижения качества жизни. Признание болезней почек серьезной угрозой здоровью на 78-й сессии Всемирной ассамблеи здравоохранения представляет собой важнейшую возможность для преобразования почечной помощи. В соответствии с этим тема Всемирного дня почки 2026 года «Здоровье почек для всех: заботясь о людях, защищая планету» призывает к системным изменениям. Экологически безопасная модель должна отдавать приоритет раннему выявлению и профилактике, сокращая потребность в заместительной почечной терапии (ЗПТ). Трансплантация и домашний диализ демонстрируют явные преимущества для людей с почечной недостаточностью, окружающей среды и общества. Сам диализ должен стать более эко-рациональным без ущерба для качества лечения, поскольку глобальные нарушения состояния окружающей среды, в свою очередь, ухудшают здоровье почек. Следует также рассматривать вариант консервативного ведения, если выигрыш в качестве жизни перевешивает перспективы, предлагаемые диализом, особенно у пожилых и ослабленных пациентов. Для осуществления этого перехода необходимы скоординированные действия всех заинтересованных сторон, просвещение и вовлечение общественности, политиков и медицинских работников для повышения осведомленности об угрозе болезней почек, а также безотлагательное внедрение пациент-ориентированной модели помощи.

1. Francis A, Harhay MN, Ong ACM et al. Chronic kidney disease and the global public health agenda: an international consensus. Nature reviews Nephrology 2024;20(7):473–485

2. Collaborators GBDKFwRT. Global, regional, and national prevalence of kidney failure with replacement therapy and associated aetiologies, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet Glob Health 2025; 13(8): e1378–e1395

3. Vanholder R, Annemans L, Bello AK et al. Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney. Clinical kidney journal 2021;14(7):1719-1730

4. Vanholder R, Annemans L, Braks M et al. Inequities in kidney health and kidney care. Nature reviews Nephrology 2023; 19(11):694–708

5. https://apps.who.int/gb/ebwha/pdf_files/EB156/B156_(20)en.pdf

6. Vanholder R, Coppo R, Bos WJW et al. A Policy Call to Address Rare Kidney Disease in Health Care Plans. Clinical journal of the American Society of Nephrology: CJASN 2023;18(11):1510–1518

7. Gregg EW. Diabetes-related disability as a target for prevention. The lancet Diabetes & endocrinology 2013;1(2):81–82

8. Vanholder R, Annemans L, Brown E et al. Reducing the costs of chronic kidney disease while delivering quality health care: a call to action. Nature reviews Nephrology 2017;13(7):393–409

9. https://www.worldkidneyday.org/facts/8-golden-rules/

10. Norton JM, Moxey-Mims MM, Eggers PW et al. Social Determinants of Racial Disparities in CKD. Journal of the American Society of Nephrology: JASN 2016;27(9):2576–2595

11. Ferro CJ, Wanner C, Luyckx V et al. ABCDE to identify and prevent chronic kidney disease: a call to action. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association European Renal Association 2025

12. Heerspink HJ, Desai M, Jardine M, Balis D, Meininger G, Perkovic V. Canagliflozin Slows Progression of Renal Function Decline Independently of Glycemic Effects. Journal of the American Society of Nephrology: JASN 2017;28(1):368–375

13. Cordero L, Ortiz A. Albuminuria-based universal screening for CKD should be implemented now in high-income countries. Kidney international 2025;108(5):754–759

14. Stehle T, Delanaye P. Which is the best glomerular filtration marker: Creatinine, cystatin C or both? European journal of clinical investigation 2024;54(10):e14278

15. van Mil D, Kieneker LM, Evers-Roeten B et al. Participation rate and yield of two home-based screening methods to detect increased albuminuria in the general population in the Netherlands (THOMAS): a prospective, randomised, open-label implementation study. Lancet 2023;402(10407):1052–1064

16. Tangri N, Alvarez CS, Arnold M et al. Suboptimal monitoring and management in patients with unrecorded stage 3 chronic kidney disease in real-world settings: Insights from REVEAL-CKD. European journal of clinical investigation 2024;54(11): e14282

17. Pouwels X, van Mil D, Kieneker LM et al. Cost-effectiveness of home-based screening of the general population for albuminuria to prevent progression of cardiovascular and kidney disease. EClinicalMedicine 2024;68:102414

18. Chavarina KK, Lou-Meda R, Luyckx VA. Strategic rebalancing of kidney-related investments is key to implementing the WHO kidney health resolution. Nature reviews Nephrology 2025; 21(12): 813–814

19. www.kdsap.org

20. Afkarian M, Sachs MC, Kestenbaum B et al. Kidney disease and increased mortality risk in type 2 diabetes. Journal of the American Society of Nephrology: JASN 2013;24(2):302–308

21. Wan EYF, Yu EYT, Chin WY et al. Burden of CKD and Cardiovascular Disease on Life Expectancy and Health Service Utilization: a Cohort Study of Hong Kong Chinese Hypertensive Patients. Journal of the American Society of Nephrology: JASN 2019;30(10):1991–1999

22. Luyckx VA, Ulasi II. Kidney disease must be counted everywhere. Lancet 2025

23. Kidney Disease: Improving Global Outcomes CKDWG. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney international 2024;105(4S):S117–S314

24. Rama Krishna C, Venkateswar S, Bogdan M et al. Pointof-Care Testing and Integrated Digital Health Technology for CKD Screening in High-Risk Populations of India. Kidney international reports 2025;10(7):2128–2139

25. Guedes M, Dias PT, Rea RR et al. Patterns of kidney function and risk assessment in a nationwide laboratory database: the Brazilian CHECK-CKD study. BMC nephrology 2024;25(1):191

26. Hajat S, Casula A, Murage P et al. Ambient heat and acute kidney injury: case-crossover analysis of 1 354 675 automated e-alert episodes linked to high-resolution climate data. Lancet Planet Health 2024;8(3):e156–e62

27. Maline GE, Goldfarb DS. Climate change and kidney stones. Current opinion in nephrology and hypertension 2024; 33(1):89–96

28. Gopalakrishnan N, Sudharshini S, Sakthirajan R et al. CKDuAGRI Study-a population-based cross-sectional study of chronic kidney disease and chronic kidney disease of unknown aetiology among agricultural workers in Tamil Nadu, India. Lancet Reg Health Southeast Asia 2025;42:100683

29. Garcia-Trabanino RA. The Human Burden of Mesoamerican Nephropathy: Diagnosis and Treatment in a Complex Web of Socioeconomics, Context, and Stigma. Seminars in nephrology 2025;45(1–2):151601

30. Chretien JP, Anyamba A, Small J et al. Global climate anomalies and potential infectious disease risks: 2014–2015. PLoS Curr 2015;7

31. Bowe B, Artimovich E, Xie Y, Yan Y, Cai M, Al-Aly Z. The global and national burden of chronic kidney disease attributable to ambient fine particulate matter air pollution: a modelling study. BMJ Glob Health 2020;5(3):e002063

32. https://climahealth.info/alliance-for-transformative-actionon-climate-and-health-atach-meeting-on-accessing-climatefinance-for-health/

33. Talbot B, Fletcher RA, Neal B et al. The potential for reducing greenhouse gas emissions through disease prevention: a secondary analysis of data from the CREDENCE trial. Lancet Planet Health 2024;8(12):e1055-e64

34. Vanholder R, Dominguez-Gil B, Busic M et al. Organ donation and transplantation: a multi-stakeholder call to action. Nature reviews Nephrology 2021;17(8):554–568

35. Tonelli M, Wiebe N, Knoll G et al. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 2011;11(10): 2093–2109

36. Schaapherder A, Wijermars LGM, de Vries DK et al. Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation. EClinicalMedicine 2018;4–5:25–31

37. Azegami T, Kounoue N, Sofue T et al. Efficacy of pre-emptive kidney transplantation for adults with end-stage kidney disease: a systematic review and meta-analysis. Renal failure 2023;45(1):2169618

38. Achkar KA, Abdelnour LM, Abu Jawdeh BG, Tantisattamoa E, Al Ammary F. Evaluation and Long-Term Follow-Up of Living Kidney Donors. Adv Kidney Dis Health 2024;31(5):400–407

39. Barraclough KA, Agar JWM. Green nephrology. Nature reviews Nephrology 2020;16(5):257–268

40. Lenzen M, Malik A, Li M et al. The environmental footprint of health care: a global assessment. Lancet Planet Health 2020; 4(7):e271–e279

41. Vanholder R, Agar J, Braks M et al. The European Green Deal and nephrology: a call for action by the European Kidney Health Alliance. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association European Renal Association 2023;38(5):1080–1088

42. Connor A, Lillywhite R, Cooke MW. The carbon footprint of a renal service in the United Kingdom. QJM: monthly journal of the Association of Physicians 2010;103(12):965–975

43. Piccoli GB, Nazha M, Ferraresi M, Vigotti FN, Pereno A, Barbero S. Eco-dialysis: the financial and ecological costs of dialysis waste products: is a 'cradle-to-cradle' model feasible for planet-friendly haemodialysis waste management? Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association European Renal Association 2015;30(6):1018-1027

44. Tarrass F, Benjelloun M, Benjelloun O. Recycling wastewater after hemodialysis: an environmental analysis for alternative water sources in arid regions. American journal of kidney diseases: the official journal of the National Kidney Foundation 2008; 52(1): 154–158

45. McAlister S, Talbot B, Knight J et al. The Carbon Footprint of Peritoneal Dialysis in Australia. Journal of the American Society of Nephrology: JASN 2024;35(8):1095–1103

46. Barraclough KA, Talbot B, Knight J et al. Carbon Emissions From Different Dialysis Modalities: A Life Cycle Assessment. American journal of kidney diseases : the official journal of the National Kidney Foundation 2025;86(4):465–474 e1.

47. Solomon D, Arumugam V, Sakthirajan R et al. A Pilot Study on the Safety and Adequacy of a Novel Ecofriendly Hemodialysis Prescription-Green Nephrology. Kidney international reports 2024; 9(5):1496–1503

48. Ramada DL, de Vries J, Vollenbroek J et al. Portable, wearable and implantable artificial kidney systems: needs, opportunities and challenges. Nature reviews Nephrology 2023;19(8):481–490

49. Lunney M, Bello AK, Levin A et al. Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide. Clinical journal of the American Society of Nephrology: CJASN 2020;16(1):79–87

50. Kurella Tamura M, Covinsky KE, Chertow GM, Yaffe K, Landefeld CS, McCulloch CE. Functional status of elderly adults before and after initiation of dialysis. The New England journal of medicine 2009; 361(16):1539–1547

51. Morton RL, Snelling P, Webster AC et al. Factors influencing patient choice of dialysis versus conservative care to treat end-stage kidney disease. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 2012; 184(5):E277–283

52. Stel VS, de Jong RW, Kramer A et al. Supplemented ERAEDTA Registry data evaluated the frequency of dialysis, kidney transplantation, and comprehensive conservative management for patients with kidney failure in Europe. Kidney international 2021;100(1):182–195

53. de Jong RW, Stel VS, Rahmel A et al. Patient-reported factors influencing the choice of their kidney replacement treatment modality. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association European Renal Association 2022;37(3):477–488

54. Joosten EA, DeFuentes-Merillas L, de Weert GH, Sensky T, van der Staak CP, de Jong CA. Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother Psychosom 2008;77(4): 219–226

55. EUPATI. https://eupati.eu/

56. Sever MS, Luyckx V, Tonelli M et al. Disasters and kidney care: pitfalls and solutions. Nature reviews Nephrology 2023; 19(10):672–686

57. Pawlowicz-Szlarska E, Vanholder R, Sever MS et al. Distribution, preparedness and management of Ukrainian adult refugees on dialysis-an international survey by the Renal Disaster Relief Task Force of the European Renal Association. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association European Renal Association 2023;38(10):2407–2415