Reducing the burden of non-communicable disease through
kidney health promotion and disease prevention
Draft resolution proposed by Guatemala
The Seventy-Eight World Health Assembly,
(PP1) Recalling the WHO Global Action Plan for the Prevention and Control of Non-
Communicable Diseases 2013-2030, which aims to reduce premature mortality from
non-communicable diseases by 30% by 2030;
(PP2) Recalling resolution WHA66.10 (2013) on the endorsement of WHO’s global action
plan for the prevention and control of noncommunicable disease 2013-2020 and
decision WHA72(11) (2019), which extended the global action plan until 2030;
(PP3) Recalling the Political Declaration of the High – Level Meeting of the General
Assembly on the Prevention and Control of Non-Communicable Diseases (United
Nations General Assembly resolution 66/2 (2011), which recognizes the primary role and
responsibility of Governments in responding to the challenge of noncommunicable
diseases by developing adequate national responses for their prevention and control;
(PP4) Reaffirming the right of every human being, without distinction of any kind, to the
enjoyment of the highest attainable standard of physical and mental health;
(PP5) Recognizing that approximatively 850 million people are affected by kidney
disease1, amounting to more than 10% of the world’s population.
(PP6) Alarmed that kidney disease is the third fastest-growing cause of death globally and
the only NCD showing a continued rise in mortality2. Concerned that kidney disease is
projected to become the fifth leading cause of death by 2040 if no action is taken.
(PP7) Recognizing that kidney disease is present in 1 in 5 people with hypertension, and
contributes to 1 in 10 deaths attributed to hypertension3;
(PP8) Acknowledging the close relationship between kidney disease and circulatory
health, with cardiovascular diseases being both a cause and consequence of kidney
disease (CKD), and about 2.1 million cardiovascular deaths occurring each year that are
attributable to kidney disease4;
1
Luyckx VA, et al., Mind the gap in kidney care: Translating what we know into what we do. Clin Nephrol.
2024 May 31. doi: 10.5414/CNWKDEdi24. Epub ahead of print. PMID: 38818714.
2
GBD. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for
249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.
Lancet 388, 1459–1544 (2016).
3
WHO Global report on Hypertension , [Link]
4
Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease 2021: Findings from the GBD
2019 Study. Seattle, WA: IHME, 2019.
1
(PP9) Recognizing that kidney disease occurs in 4 of 10 people affected by diabetes, and
accounts for a large proportion of the morbidity and mortality that is attributed to
diabetes5;
(PP10) Recognizing that kidney disease is a preventable but often fatal consequence of
many infections, including malaria, HIV, tuberculosis, hepatitis, sepsis, COVID-19,
diarrheal illnesses and neglected tropical diseases in adults and children6,7,8;
(PP11) Recognizing that kidney disease is a major risk factor and consequence of
hypertensive disorders of pregnancy (impacting 1 in 10 pregnancies) and small and
vulnerable neonatal births, and is a major contributor to maternal mortality9;
(PP12) Recognizing that kidney health is strongly impacted by the social determinants of
health, environmental factors, and climate change, and that risk for kidney disease
begins in utero and accumulates across the life course10,11;
(PP13) Recognizing that kidney disease significantly impacts economies and societies,
requires complex management, and contributes disproportionately to national
healthcare costs12;.
(P14) Recognizing that over 95% of people living with kidney disease have multiple health
conditions requiring specialized care across sectors to effectively manage various health
issues13.
(PP15) Concerned that in many LMICs, individuals bear heavy financial burdens as they
pay out-of-pocket for kidney care as only a small percentage provide coverage for kidney
5
WHO HEARTS D package: [Link]
6
Luyckx VA, etal., Reducing major risk factors for chronic kidney disease. Kidney Int Suppl (2011). 2017
Oct;7(2):71-87. doi: 10.1016/[Link].2017.07.003. Epub 2017 Sep 20. PMID: 30675422; PMCID:
PMC6341126.
7
Levin A, etal., ISN Global Kidney Health Summit participants. Global kidney health 2017 and beyond: a
roadmap for closing gaps in care, research, and policy. Lancet. 2017 Oct 21;390(10105):1888-1917. doi:
10.1016/S0140-6736(17)30788-2. Epub 2017 Apr 20. PMID: 28434650.
8
Batte A, et al., guidelines fall short in diagnosing acute kidney injury. Lancet Glob Health. 2024
Feb;12(2):e194-e196. doi: 10.1016/S2214-109X(23)00546-6. PMID: 38245108.
9
Bilano VL, et al., Risk factors of pre-eclampsia/eclampsia and its adverse outcomes in low- and middle-
income countries: a WHO secondary analysis. PLoS One. 2014 Mar 21;9(3):e91198. doi:
10.1371/[Link].0091198. PMID: 24657964; PMCID: PMC3962376.
10
Bosi, A. et al. Use of nephrotoxic medications in adults with chronic kidney disease in Swedish and US
routine care. Clin. Kidney J. 15, 442–451 (2022).
11
Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2021 (US
Department of Health and Human Services, 2021).
12
Vanholder R, et al., European Kidney Health Alliance. Reducing the costs of chronic kidney disease while
delivering quality health care: a call to action. Nat Rev Nephrol. 2017 Jul;13(7):393-409. doi:
10.1038/nrneph.2017.63. Epub 2017 May 30. PMID: 28555652.
13
Hawthorne G, et al., Multimorbidity prevalence and patterns in chronic kidney disease: findings from an
observational multicentre UK cohort study. Int Urol Nephrol. 2023 Aug;55(8):2047-2057. doi:
10.1007/s11255-023-03516-1. Epub 2023 Feb 21. PMID: 36806100; PMCID: PMC10329585.
2
replacement therapy, and kidney disease is the leading cause of catastrophic health
expenditure14,15;
(PP16) Recognizing that people living with kidney disease are highly vulnerable in
humanitarian settings, especially those living on dialysis or with kidney transplants;
Acknowledging efforts have been made to strengthen services for treating
noncommunicable diseases (NCDs) in emergencies, as highlighted in the 75th World
Health Assembly16,17.
(PP17) Concerned that kidney disease often goes undetected and untreated, particularly
in resource-poor settings with weak primary care infrastructure, and that this misses
critical opportunities to prevent and treat kidney disease early, reduce the need for costly
kidney replacement therapy and prevent many deaths.18,19. Stressing that the number of
people receiving costly kidney replacement therapies is projected to more than double
from 2.6 million in 2010 to 5.4 million by 203020, while at least as many may remain
without access to these therapies and die.
(PP18) Recognizing the importance of public awareness, patient education, community
engagement and policy action in controlling risk factors and improving outcomes for
individuals at risk or affected by kidney disease;
(PP19) Hopeful, that highly effective medications for kidney disease are now available
and can dramatically reduce morbidity and mortality from kidney disease as well as other
NCDs that often coexist with kidney disease, such as hypertension, diabetes and
cardiovascular disease21; Concerned that these highly effective medicines are
unaffordable or unavailable in many low- and middle-income settings 22;
(PP20) Reaffirming our commitment in the United Nations General Assembly resolution
74/2 (2019) to progressively cover 1 billion additional people by 2023 with quality
essential health services and quality, safe, effective, affordable and essential medicines,
14
Beverley M. Essue, etal., Economic Burden of Chronic Ill Health and Injuries for Households in Low- and
Middle-Income Countries, World Bank group, 2017, [Link]
15
Luyckx VA, et al., Ethical Challenges in the Provision of Dialysis in Resource-Constrained Environments.
Semin Nephrol. 2017 May;37(3):273-286. doi: 10.1016/[Link].2017.02.007. PMID: 28532556.
16
WHA/A75/10/ Annex 4 Add.21
17
Global high-level technical meeting on noncommunicable diseases in humanitarian settings: building
resilient health systems, leaving no-one behind, [Link]
room/events/detail/2024/02/27/default-calendar/global-high-level-technical-meeting-on-
noncommunicable-diseases-in-humanitarian-settings
18
Liyanage T, et al., Worldwide access to treatment for end-stage kidney disease: a systematic review.
Lancet. 2015 May 16;385(9981):1975-82. doi: 10.1016/S0140-6736(14)61601-9. Epub 2015 Mar 13. PMID:
25777665.
19
Gummidi, B. et al. A systematic study of the prevalence and risk factors of CKD in Udana, India. Kidney
Int. Rep. 5, 2246–2255 (2020).
20
Liyanage, T. et al. Worldwide access to treatment for end-stage kidney disease: a systematic review.
Lancet 385, 1975–1982 (2015)
21
Luyckx, V.A. et al. (2024) ‘Mind the gap in kidney care: Translating what we know into what we do’,
Kidney International, 105(3), pp. 406–417. doi: 10.1016/[Link].2023.12.003
22
Luyckx VA, et al., Mind the gap in kidney care: Translating what we know into what we do. Ibid
3
vaccines, diagnostics and health technologies, with a view to achieving universal health
coverage by 2030;
(PP21) Stressing that universal health coverage implies that all people have access,
without discrimination, to nationally determined sets of the needed promotive,
preventive, curative, rehabilitative, and palliative essential, timely measures and health
services, promotion of lifestyle changes, healthy and balanced diets and regular physical
activity and essential, safe, affordable, effective and quality medicines and vaccines,
while ensuring that the use of these services does not expose the users to financial
hardship, with a special emphasis on the poor, vulnerable and marginalized segments of
the population23;
(PP22) Emphasizing the importance of integrating kidney health into broader strategies
for preventing and controlling non-communicable diseases and recognizing the need for
multi-sectoral approaches;
(PP23) Noting that prevention and promotion of kidney health play a crucial role in
achieving the Sustainable Development Goals, especially SDG 3.4, which aims to ensure
healthy lives and promote well-being for all ages;
ENDORSES the establishment of the World Kidney Day, to be marked annually on 13
March to increase public awareness and engagement, enhance global understanding,
and work towards global solidarity and action by Member States to promote kidney
health.
URGES Member States:
1) Recognize kidney care within the Universal Health Coverage (UHC) by integrating
prevention, early detection, and timely management into national public health
policies, leading to achieving the Sustainable Development Goals target 3.8;
2) Integrate testing for kidney disease and management of kidney disease into
primary healthcare, ensuring that individuals at risk or affected by kidney disease
have equitable and affordable access to timely and appropriate care;
3) Strengthen public health initiatives to address key risk factors for kidney disease,
including obesity, diabetes, hypertension and cardiovascular diseases, physical
inactivity, dietary habits, and tobacco use, through education, awareness
campaigns, and community-based interventions;
4) Enhance collaboration across sectors, including health, education, finance, and
social services, to address the social determinants of health that contribute to
kidney disease;
5) Foster partnerships with civil society, advocacy groups, and the private sector to
strengthen health promotion and improve health literacy by providing accessible,
high-quality patient-friendly information and education;
6) Encourage and support research on kidney disease, including the development of
new treatments and technologies, to advance the understanding and
management of this condition;
23
In accordance with paragraph 9 of United Nations General Assembly resolution 74/2 (2019)
4
7) Strengthen health systems and high quality, integrated and people-centred
primary health services for all, health management information systems, and an
adequate and well - trained and equipped health workforce, considering national
contexts;
8) Strengthen the monitoring and evaluation of kidney disease incidence through
country-level surveillance and monitoring systems, including surveys, that are
integrated into existing national health information systems and identify priority
areas for kidney disease research;
9) Support and strengthen kidney transplantation services, especially for Indigenous
populations;
10) Strengthen efforts to curb climate change and address all social and structural
determinants of health as major risk factors for kidney disease
REQUESTS the Director-General:
1) Support Member States in recognizing and incorporating kidney care into
Universal Health Coverage (UHC) frameworks to contribute to the achievement of
Sustainable Development Goal target 3.8;
2) Develop and implement a global strategy for prevention, early detection, and
timely management of kidney disease throughout the life course. This includes
primary, secondary, and tertiary prevention and care, as well as palliative care for
those with advanced kidney disease by integrating kidney health into existing non-
communicable disease frameworks;
3) Support Member States to achieve the targets for preventing and controlling
kidney disease throughout life by integrating interventions into national responses
to non-communicable diseases, contributing to Sustainable Development Goal
target 3.4. This should include strengthening monitoring and surveillance systems
for kidney disease;
4) Provide guidance to Member States, especially in LMICs, on improving the design
and implementation of policies for preventing and managing kidney disease
across all relevant sectors;
5) Provide guidance to Member States for uninterrupted treatment of people living
with kidney disease in humanitarian emergencies;
6) Facilitate the sharing of best practices, guidelines, and evidence-based
interventions for managing kidney disease and its major risk factors, including
diabetes and hypertension;
7) Develop recommendations for sustainable financing of kidney disease prevention
and treatment in low- and middle-income countries, prioritizing equitable access
for disadvantaged populations and financial risk protection for those with kidney
failure. Emphasize quality and cost-effectiveness of early intervention and the
economic impact of untreated kidney disease;
8) Promote research and data collection on the epidemiology, risk factors, and
outcomes of kidney disease, including developing and maintaining kidney
registries, particularly in LMICs, to inform policy and program development;
9) Recognize kidney disease as a priority noncommunicable disease, along with
cancer, cardiovascular diseases (heart disease and stroke), diabetes, and
respiratory diseases, and mental health, in the national health agendas of
Member States;
5
10) Report periodically to the Health Assembly on progress in implementing the
present resolution, including achievements, challenges, and recommendations
for further action, as part of the consolidated reporting on the progress achieved
in the prevention and control of non-communicable diseases, with an annual
report to be submitted to the Health Assembly through the Executive Board, from
2026 to 203124;
24
In accordance with paragraph 3(e) of decision WHA72(11) (2019)