The burden of kidney failure requiring kidney replacement therapy explained by estimating biological age from remaining life expectancy

To the Editor,

Chronic kidney disease (CKD) is among the fastest growing causes of death [1]. However, lay audiences, including healthcare authorities, are often unaware of its mortality burden. For lay audiences, CKD is associated with kidney failure, treatable with kidney replacement therapy (KRT). Because KRT replaces some kidney functions, it is often perceived as ‘solving’ advanced CKD. No need may be felt to change the current paradigm of initiating CKD treatment after kidney injury has progressed to a low glomerular filtration rate or to proactively prevent CKD. In this context, albuminuria is an actionable diagnostic criterion enabling earlier diagnosis and guideline-directed treatment than glomerular filtration rate (GFR) [2]. However, albuminuria is often not reimbursed or implemented outside the diabetes mellitus context [3]. We propose a new approach to communicate the burden and limitations of KRT to lay audiences, including the general population and non-physician decision makers, in order to promote awareness of proactive prevention, early CKD detection and treatment, and kidney transplantation over dialysis [4].