A new study by researchers at University of Limerick has revealed an extraordinarily high burden of kidney disease in older individuals in Ireland that suffer from common chronic conditions.
The researchers also found that economic and societal factors had an influence - with medical card holders and unemployed individuals far more likely to have kidney disease.
Women were also 50% more likely to have chronic kidney disease than men, according to the results of the new study by researchers at University of Limerick School of Medicine, which has just been published in the Clinical Kidney Journal of the European Renal Association.
The publication of the research coincides with World Kidney Day this Thursday, 13 March, the primary focus of which is early detection of kidney disease in order the protect long term kidney health.
The findings offer new hope to thousands of patients living with kidney disease in Ireland and support the introduction of a national screening programme that targets high-risk groups in order to reduce the lifetime risk of kidney failure and dialysis.
The study also comes at a time when several new treatments have been shown to slow the progression of kidney disease, with potential for a major impact if prescribed earlier in the course of the disease.
Ireland has an estimated 500,000 individuals living with chronic kidney disease. Many are at significant risk of progressing to kidney failure and premature death. Just over 5,400 of these individuals have already developed kidney failure and are receiving treatment with either dialysis or a kidney transplant.
The goal of the study was to estimate the prevalence of chronic kidney disease in a representative sample of the Irish population aged 50 and over, and determine what groups had the highest burden of disease so that this information might be used to target these groups as part of a national population health screening programme.
The largest study of its kind in Ireland, the research explored in detail factors associated with kidney disease using data from the Irish Longitudinal Study on Aging (TILDA).
It found that one in seven individuals suffered from chronic kidney disease in Ireland (14.7%), age 50 and over, and this increased to one in two individuals over the age of 75 years. Women were more affected than men (17.8% versus 11.5%), a finding that persisted across all age groups.
A detailed analysis revealed that the burden of chronic kidney disease was far more common in individuals with common chronic conditions including pre-existing heart disease (33.9%), diabetes (28%), cancer (25.5%), and bladder problems (23.7%).
Similarly, chronic kidney disease was far more common in individuals with arthritis, hypertension, obesity and chronic lung conditions with one in five affected. These are common clinical conditions that are routinely identified and managed in primary care.
For the first time, the study also found that several socioeconomic indicators have important links with chronic kidney disease and should be considered in any overarching population health strategy. One in four holders of a medical card had evidence of kidney disease (25.5%) as did individuals who were frequently hospitalised.
Among the key findings were:
- Prevalence of chronic kidney disease was far more common in individuals with heart disease, diabetes, hypertension, and chronic lung conditions than the national average
- Women were 50% more likely to have chronic kidney disease than men
- Cancer, obesity, and social deprivation contributed to the burden of kidney disease independent of the traditional risk factors
- Obese individuals were twice as likely to have kidney disease than normal weight individuals
- Individuals with hypertension, diabetes, cardiovascular disease, and cancer were one and a half times more likely to have kidney disease
- The percentage of patients with kidney disease in the population was dependent on the mathematical formula used
The study was led by Dr Meera Tandan, a postdoctoral researcher at the National Kidney Disease Surveillance System (NKDSS) in the UL School of Medicine.
She explained: “Chronic kidney disease poses a huge problem for the Irish population and exerts a significant impact on patient survival and quality of life.
“Our research has generated precise estimates of the burden of kidney disease in Ireland and identified those individuals with the greatest risk in our community. We have shown that chronic kidney disease is very common among individuals with certain chronic conditions, the majority of which are generally managed in primary care.
“We have also for the first time highlighted the importance of new conditions like cancer and obesity as these conditions contributed greatly to the high burden of kidney disease in the population,” added Dr Tandan.
Dr Leonard Browne, senior research fellow at the NKDSS in UL, highlighted the importance of gender and social circumstances in assessing the risk of chronic kidney disease.
“Women were 50% more likely to have chronic kidney disease than men and this finding persisted despite taking into consideration know risk factors like age, diabetes and hypertension. It signifies that women have a greater risk of kidney disease than men, and this should be considered in the development of any national screening strategy.
“We also found that key components of social deprivation—including unemployment, lower educational attainment, and reliance on means-tested healthcare—were strongly linked to chronic kidney disease.
“Unemployed individuals had a five-fold higher prevalence of kidney disease than their employed counterparts, and those receiving free or subsidised healthcare were 30% more likely to have kidney disease taking everything else into consideration. These findings underscore the impact of social disadvantage on chronic kidney disease. Early detection and management strategies must prioritise at-risk communities to ensure better access to care and support.”
Professor Austin Stack, senior author on the study and Director of the NKDSS at UL’s School of Medicine and Consultant Nephrologist, University Hospital Limerick, explained: “These new findings provide an enormous opportunity to the Irish health service to identify and screen these high-risk groups for early signs of kidney damage. Earlier detection of kidney disease will facilitate more timely investigation and treatment, leading to better outcomes.
“There is a real chance that we can stem the tide of kidney failure and improve patient survival. Detecting disease early through an active or passive surveillance system is an effective way of preventing chronic disease, especially if the disease is common, treatable and can be detected with simple screening tests. Chronic kidney disease ticks all these boxes.
“The addition of chronic kidney disease to the Chronic Disease Management Programme of the HSE to begin in July 2025 is a major step forward in improving kidney health in Ireland,” Professor Stack added.
Welcoming the research findings, Carol Moore, CEO of the Irish Kidney Association, said: “The report is timely in that the need for early detection and management is also now being recognised at an international level. We are calling upon the government to endorse the World Health Organisation resolution, ‘Reducing the burden of noncommunicable diseases through promotion of kidney health and strengthening prevention and control of kidney disease’ which is being brought to the World Health Assembly in May in Geneva.”
Professor George Mellotte, Director of the National Renal Office and Consultant Nephrologist said: “This research reinforces the need for inclusion of chronic kidney disease into the Health Services Executive chronic disease management programme so that these patients at risk of kidney disease can benefit from early screening and early intervention.”
