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Introduction

The Center for Prevention and Research, National Kidney Foundation Singapore, Singapore and Faculty of Medicine, National University of Singapore, Singapore.

Correspondence to Dr. Sylvia Paz B. Ramirez, National Kidney Foundation Singapore, 81 Kim Keat Road, Singapore 328836. Phone: 65-6351-5443; Fax: 65-6354-9410; E-mail: paesr{at}nus.edu.sg

	Introduction

Top Introduction

 
With the recognition of the rising burden of ESRD in all regions of the world, the First International Summit on Kidney Disease Prevention sponsored by the National Kidney Foundation (NKF) Singapore met on July 25 to 27, 2002. This meeting brought together experts in the prevention of kidney and related chronic diseases to discuss issues and identify questions relevant to the detection, prevention, and control of chronic kidney disease (CKD). The specific goals of the sessions were to (1) describe the current state of knowledge of approaches to the prevention of renal and related diseases, particularly diabetes mellitus and hypertension; (2) characterize novel clinical care models to ensure the delivery of known effective interventions for renal disease prevention; (3) identify and prioritize outstanding research questions that deserve urgent study, through either randomized clinical trials or observational studies; and (4) define an action plan backed by sufficient scientific evidence for efficacy.

The scientific program was developed around a public health approach to prevention of chronic kidney disease that targets the primary, secondary, and tertiary levels as opportunities for intervention. Participants presented an overview of their current work in various fields related to the prevention not just of chronic kidney disease, but of chronic diseases that are associated with kidney disease, particularly diabetes mellitus and hypertension. This supplement is dedicated to the proceedings of the Summit, which is unique in its collaborative and multispecialty approach. The participants are experts representing diverse fields such as cardiovascular epidemiology, diabetes disease translation, molecular genetics, general prevention, and public health, in addition to nephrologists engaged in both clinical and basic science research.

The first section of this supplement offers the justification for approaching the burden of chronic kidney disease from a public health perspective. McClellan and Flanders summarize recognized and novel risk factors for CKD. Jones and Owen each provide an analysis of the current limitations in the management of hypertension and chronic kidney disease in the United States, respectively.

The second section defines the importance of a primary prevention approach to chronic kidney disease by focusing on the leading causes of ESRD in developed countries, diabetes mellitus, and hypertension. McClellan and colleagues review whether evidence exists for the systematic population-based screening for chronic kidney disease. This is followed by comprehensive discussions by Engelgau et al. and Flack et al. on the broad approach to addressing the current problem of suboptimal management of diabetes and hypertension, respectively. The effectiveness of primary prevention through lifestyle intervention is then elegantly described by Appel, drawing on the DASH studies for hypertension; and by Molitch et al. and Tuomilehto et al., for diabetes mellitus, based on the Diabetes Prevention Program and the Finnish Diabetes Prevention Study, respectively. Closing this section are illustrations of existing prevention programs worldwide. Based on established programs in the United States, Hostetter and Lising provide an overview of the National Kidney Disease Education Program, followed by a description of the ongoing Longitudinal Study of the NKF Inc.’s Kidney Early Evaluation Program (KEEP) by Flack and colleagues. Asian programs are discussed by Ramirez for the NKF Singapore’s primary and secondary prevention initiatives, and by Iseki for the Okinawa Screening Program. Atkins and colleagues describe preliminary findings from the AusDiab Kidney Study. Closing this section is a description of the Zuni Kidney Project by Zager and others.

The subsequent section addresses secondary prevention programs, as well as planned or ongoing longitudinal cohort studies or clinical trials that are destined to increase our understanding of modifiable risk factors for chronic kidney disease development and progression. Hostetter reviews the evidence for known interventions for the prevention of CKD. Feldman and colleagues then describe the design of the ongoing Chronic Renal Insufficiency Cohort or CRIC study. This is followed by a description of the African American Study of Kidney Disease or AASK study by Gassman et al., as well as a presentation on the design of the AASK cohort study by Appel and colleagues. Rossert and others review the role of anemia management in delaying CKD progression, and introduce the Early Correction of Anemia in Patients with Chronic Kidney Disease or ECAP study. Hoy and colleagues conclude this section by reporting on their secondary prevention program in the Australian Aboriginal community.

Section IV is dedicated to the role of molecular genetics in renal disease and the role of emerging new therapeutic approaches to CKD prevention. Hsu and Couser provide an extensive review of the role of complement activation in renal disease progression, and conclude with preliminary evidence suggesting the future role of complement inhibitors in prevention. Freedman presents an extensive review of the evidence for the genetic basis of hypertension and hypertensive nephrosclerosis. Iyengar and colleagues describe the identification of a candidate locus for diabetic ESRD on chromosome 10. Finally, Zager and colleagues present the design of the ongoing Family Investigation of Nephropathy and Diabetes or FIND study.

Closing these proceedings is the Summit Consensus Document that was developed during extensive discussions among the participants throughout the entire duration of the Summit. This document defines consensus priority points for discussion, including the importance of developing standard nosology for chronic kidney disease, identification of biomarkers for CKD, recognition of the ethnic or race-specific differences in defining risk for kidney disease, the need for immediate implementation of population-based primary prevention strategies and high-risk individualized intervention, and the increasingly important role of molecular genetics in defining strategies for prevention. Clinical action plans—strategies for which evidence for effectiveness clearly exists—are also presented. Concluding this document are research questions that participants believe merit consideration for clinical trials or longitudinal cohort studies. The Summit organizers hope that these proceedings provide a strong and convincing argument for the prevention approach to kidney disease and related chronic diseases. It is also our hope that these manuscripts and the resulting Summit Consensus Document prove useful to our colleagues in defining priority areas for further research, as well as for identifying strategies that deserve immediate implementation.

The organizers of this summit are grateful for the dedication of the participants during the meeting and for the opportunity to publish these proceedings. We are indebted to our panel of reviewers, each of whom participated in the extensive peer-review process used to achieve the highest possible standards for the contents of this supplement.

Organizing Committee
Sylvia Paz B. Ramirez, MD, MPH (Chairperson)

Stephen I-H. Hsu, MD, PhD

William M. McClellan, MD, MPH

Guest Reviewers
John Flack, MD, MPH

Barry I. Freedman, MD

Stephen I-H. Hsu, MD, PhD

Mark Molitch, MD

William M. McClellan, MD, MPH

Sylvia Paz B. Ramirez, MD, MPH

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ramirez, S. P. B. Search for Related Content PubMed Articles by Ramirez, S. P. B.