Decreased life expectancy: a health outcome not corrected by kidney replacement therapy that emphasizes the need for primary prevention of CKD

The European Renal Association ( ERA) Registry Annual Report 2021 was published online in 2023 [1 ]. Its data provide a compelling illustration of the need to prevent chronic kidney disease ( CKD) to effectively improve outcomes, given the shortened life expectancy in patients undergoing kidney replacement therapy ( KRT) as compared with the general population. The ERA Registry Annual Report 2021 [1 ] illustrates the short-comings of the current approach to kidney health. In most patients, the current criteria to diagnose CKD identify late stages of a disease process that, by the time CKD is diagnosed, has already wiped out 50% of the functioning kidney mass or caused injury leading to an increase in urinary albumin excretion of > 10-fold the physiological level [2 ]. Increased albuminuria may allow earlier detection of CKD than low glomerular filtration rate ( GFR) , as it allows a CKD diagnosis and treatment when GFR is still normal. However, albuminuria assessment is underused and guidelines recommending albuminuria assessment in persons with diabetes mellitus, hypertension, the elderly and other high-risk populations are not followed. In fact, albuminuria assessment is not reimbursed outside of diabetes in some European countries such as Belgium, effectively impeding early diagnosis and treatment of CKD. This is clearly not helpful in addressing the high KRT burden. In this regard