Table 2. Relevance of the targets of sustainable development goal 3 to kidney disease, 2015.
| Target | Description | Relevant kidney condition | Strategies or actions to reduce risk of kidney disease | Policies facilitating improved kidney health |
|---|---|---|---|---|
| 3.1 | By 2030, reduce global maternal mortality to less than 70 deaths per 100 000 live births | Pregnancy-related AKI and pre-eclampsia | Improve access to antenatal care and institutional deliveries and the recognition of pregnancy complications, e.g. eclampsia, pre-eclampsia and peripartum haemorrhage | UHC Promotion of gender equity Public health promotion of healthy lifestyles through education and regulation of unhealthy food and tobacco consumption Promotion of the consumption of healthy food |
| Identify, during antenatal care or at delivery, mothers at risk, for education and follow-up to reduce long-term risk of maternal CKD and cardiovascular disease associated with pre-eclampsia | ||||
| 3.2 | By 2030, end preventable deaths of neonates and children under 5 years of age, with all countries aiming to reduce neonatal mortality to no more than 12 deaths per 1000 live births and mortality among children under 5 years of age to no more than 25 deaths per 1000 live births | Perinatal AKI | Reduce prematurity | UHC Education of health-care workers Enhancement of the capacity and infrastructure for detection and surveillance |
| Avoid or reduce perinatal use of nephrotoxins, e.g. aminoglycoside antibiotics and non-steroidal anti-inflammatory drugs | ||||
| Optimize neonatal nutrition | ||||
| CKD and hypertension in later life | Reduce prematurity and low birth weight, which are both risk factors for low nephron numbers | UHC to improve access to prevention and screening services Public health promotion of healthy lifestyles through education and regulation of unhealthy food and tobacco consumption Adoption and implementation of the FCTC |
||
| Diarrhoea-associated and HUS-associated AKI, post-infectious glomerulonephritis | Improve sanitation and access to vaccinations and medical care | Development of public health policy to improve disease surveillance and response to outbreaks | ||
| 3.3 | By 2030, end the epidemics of AIDS, malaria, neglected tropical diseases and tuberculosis, and combat hepatitis, waterborne diseases and other communicable diseases | HIV nephropathy | Provide equitable access to services for the prevention and treatment of HIV infection | UHC Enactment of protections for women victims of domestic violence and sexual assault Taking action, including legal, policy and regulatory reforms, to ensure full political enfranchisement for women Legislation for the protection of sex workers |
| Malaria-associated AKI, black water fever | Prevent and provide early treatment of malaria and combat both availability of fake medication and emergence of resistance to antimalarials | Development of public health policy to improve disease surveillance and response to outbreaks Reforming of pharmaceutical supply chains and enhancement of regulations to combat fake medicines |
||
| CKD – a risk factor for tuberculosis | Increase awareness of risk | Development of public health policy to improve disease surveillance and the effectiveness of diagnosis and treatment Development of innovative interventions to improve labour conditions and conditions in prisons |
||
| Adapt medication doses according to kidney dysfunction | ||||
| Hepatitis-associated glomerulonephritis and hepatorenal syndrome | Improve access to vaccination and treatment for hepatitis B and C | Provision of public education and UHC Development of care models integrating traditional healers. Legislation on alcohol consumption to reduce high-risk drinking |
||
| Reduce hepatitis-associated inflammation and immune-complex deposition | ||||
| Reduce kidney-disease-associated cirrhosis and liver failure | ||||
| CKD from infections | Prevent and treat Hantavirus, leptospirosis and scrub typhus | Development of public health policy to improve disease surveillance and the effectiveness of diagnosis and treatment | ||
| Urinary obstruction | Reduce schistosomiasis | Development of public health policy to improve disease surveillance and response to outbreaks | ||
| Diagnose and treat kidney tuberculosis adequately, to reduce long-term obstruction of urinary tract | ||||
| 3.4 | By 2030, reduce by one third premature mortality from noncommunicable diseases through prevention and treatment and promote mental health and well-being | CKD | Prevent and screen for CKD, improve access to early diagnosis and effective treatment for CKD, provide equitable access to treatment for kidney failure, i.e. dialysis and transplantation, and strengthen access to options for lifestyle improvement | UHC Enactment of protections for women victims of domestic violence and sexual assault Taking action, including legal, policy and regulatory reforms, to ensure full political enfranchisement for women Promotion of healthy lifestyles through education and regulation of unhealthy food consumption Adoption and implementation of FCTC Enhancement of capacity and infrastructure for detection and surveillance Development of care models integrating traditional healers. Enhancement of occupational safety standards Development of transparent policies governing access to expensive therapies such as dialysis and transplantation |
| Reduction in CKD could reduce morbidity and mortality associated with some other diseases, e.g. cancer, diabetes and liver disease | ||||
| Cardiovascular disease | Reduce CKD, this should reduce the burdens posed by global hypertension and cardiovascular disease and the associated mortality | |||
| AKI | Prevent AKI through improved access to sanitation and vaccination, decrease reliance on toxic traditional remedies, improve access to early diagnosis and effective treatment for AKI and provide equitable access to dialysis | |||
| Reduction in AKI could reduce morbidity and mortality associated with some other conditions, e.g. heart failure, liver disease, sepsis and surgery | ||||
| 3.5 | Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol | CKD and hypertension in later life | Reduce low birth weight associated with alcohol use, smoking and substance abuse in pregnancy | UHC Enactment of protection for women victims of domestic violence and sexual assault Taking action, including legal, policy and regulatory policy reforms, to ensure full political enfranchisement for women Promotion of urban safety Legislation and regulation of alcohol consumption Adoption and implementation of FCTC Legislation for the protection of sex workers |
| Alcohol use and smoking are risk factors for CKD progression | ||||
| HIV and hepatitis-associated kidney disease, infectious glomerulonephritis | Reduce infections transmitted by intravenous drug use | |||
| Rhabdomyolysis | Prevent rhabdomyolysis by increasing awareness and providing treatment for drug withdrawal and delirium tremens | |||
| 3.6 | By 2020, halve the number of global deaths and injuries from road traffic accidents | AKI | Prevent trauma-related crush injury or blunt kidney trauma | Enforcement of existing traffic laws and reform of traffic laws to reduce road trauma Promotion of occupational safety Development and building of infrastructure and safe roads, with capacity to absorb urban growth |
| CKD | Prevent accident-related losses in employment, increases in poverty and reductions in access to health care | |||
| 3.7 | By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes | Pregnancy-related AKI, CKD | Empower women, increase spacing of pregnancies and reduce teenage pregnancies | Promotion of access to education for all and family planning, gender equity and UHC Strengthen legislation on access to safe abortion and the protection of sex workers |
| Reduce risk of low birth weight and preterm birth, as these can adversely affect kidney health of the child | ||||
| 3.8 | Achieve UHC, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all | AKI, CKD | Provide universal access to basic health care and services for the diagnosis, prevention and treatment of all kidney disease and its risk factors, e.g. diabetes and hypertension | Promotion of innovative financing, regulation of the pricing of medical products and UHC Monitoring of catastrophic health expenditure |
| 3.9 | By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination | CKD of unknown origin, observed in Egypt, India and Sri Lanka, and Balkan nephropathy | Reduce exposure to environmental toxins that may be associated with CKD, e.g. aristolochic acid and cadmium and others | Promotion of environmental protection and safety Promotion of sustainable agriculture and fishing Commitment to combat climate change |
| 3.a | Strengthen the implementation of WHO’s FCTC in all countries, as appropriate | CKD | Reduce tobacco smoking, a risk factor for cardiovascular disease and mortality, haematuria, low birth weight and proteinuria | Adoption and implementation of FCTC |
| 3.b | Support the research and development of vaccines and medicines for the communicable and noncommunicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full, the provisions in the TRIPS Agreement regarding flexibilities to protect public health and, in particular, provide access to medicines for all | AKI | Provide and support the uptake of vaccines that can prevent diarrhoeal illness, sepsis and other infections that can cause AKI and can prevent low birth weight in pregnancy | Promotion of budget allocation for locally relevant research Strengthening and empowerment of local research ethics committees Utilization of TRIPS Agreement exemptions Enhancement of the regulation of generic medication Monitoring of medication supply and use Promotion of health technology assessments Development of transparent policies governing access to expensive therapies, e.g. dialysis and transplantation Development of innovative financing models to reduce costs of dialysis and transplantation Implementation and enforcement of the Istanbul Declaration against organ trafficking Development of legislation regarding brain death and organ donation Opt-out or presumed-consent policies for organ donation |
| Support prompt access to the intravenous fluid and appropriate antibiotics that can prevent AKI and glomerulonephritisd | ||||
| Vaccination in pregnancy can reduce the risk of low birth weight | ||||
| Vaccination during pregnancy can reduce the incidence of low birth weight | ||||
| CKD | Provide affordable and sustainable access to basic medications for CKD, diabetes and hypertension and so reduce burden of end-stage kidney disease | |||
| ESKD | Devise innovative ways to deliver cheaper dialysis worldwide | |||
| Transplantation | Promote safe and altruistic kidney donation by living donors. Improve supply from deceased donors where permissible. Stop organ trafficking | |||
| 3.c | Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing states | Kidney disease awareness and capacity to treat | Improve awareness and capacity to diagnose, prevent and treat kidney disease | Development of innovative financing models to reduce costs of dialysis and transplantation Promotion of the education, licensing and registration of health-care workers and researchers Promotion of the fair remuneration of health-care workers Legislation to define the scope of practice of community health workers and any associated task shifting |
| Train and retain health-care workers with knowledge of kidney disease | ||||
| 3.d | Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks | Crush syndrome |
Improve disaster planning and responses to earthquakes and other major disasters | Promotion of international collaboration to respond to natural disasters Commitment to equality and peace Promotion of democracy Strengthening of intersectoral communication and collaboration |
| CKD | Promote peace | |||
| Prevention of wars should reduce both the burden of kidney disease associated with low birth weight and malnutrition and the conflict-related disruption of care |
AIDS: acquired immunodeficiency syndrome; AKI: acute kidney injury; CKD: chronic kidney disease; ESKD; end-stage kidney disease; FCTC: Framework Convention on Tobacco Control; HIV: human immunodeficiency virus; HUS: haemolytic uraemic syndrome; TRIPS: Trade-related Aspects of Intellectual Property Rights; UHC: universal health coverage; WHO: World Health Organization.