Elevating Kidney Disease in Global Health Policy, With Marcello Tonelli, MD

Chronic kidney disease has long been underrecognized on the global health stage, despite affecting hundreds of millions of people worldwide. A new resolution from the World Health Organization at the 78th World Health Assembly aims to change that, elevating kidney disease alongside other major noncommunicable diseases and signaling a shift toward more coordinated, large-scale action.

According to Marcello Tonelli, MD, MSc, a nephrologist and professor of medicine at the University of Calgary, founding director of the World Health Organization Collaborating Centre on Prevention and Control of Chronic Kidney Disease, and president of the International Society of Nephrology, the significance of this resolution lies in its acknowledgment that kidney disease is common, preventable, treatable, and deadly. For the first time, it is being positioned alongside conditions such as hypertension, diabetes, and cardiovascular disease on the global policy agenda.

“We know from experience that if you can mobilize efforts behind resolution, drive implementation, you can get action that benefits millions of people,” he said.

From a clinical perspective, the resolution places strong emphasis on early detection and the integration of kidney care into primary care settings. Tonelli underscores that the current nephrology workforce alone cannot meet the needs of the estimated 800 million people living with kidney disease worldwide. Instead, broader collaboration with primary care providers and other specialties will be essential to expanding access to timely diagnosis and treatment.

Beyond the clinical implications, he highlights the importance of health system infrastructure, areas that may receive less attention but are vital for long-term success. Strategic national planning, effective procurement systems, and workforce development are all key components of implementation. While these efforts may take years or even decades to fully realize, they form the foundation for sustainable progress.

Importantly, Tonelli notes that adoption of the resolution will vary across countries, depending on local resources, priorities, and healthcare systems. Core goals, however, remain consistent: improving early detection, expanding access to treatment, and scaling up kidney replacement therapies such as dialysis and transplantation in a way that is appropriate for each setting. Equally critical will be the development of monitoring and evaluation systems to track progress and ensure accountability.

Clinicians, he adds, have a unique role to play in both delivering care and advocating for change. As trusted voices within their communities, they can help raise awareness and influence policy decisions.

Ultimately, the resolution represents an opportunity to reshape kidney care globally, but realizing its full potential will require sustained collaboration across clinical, policy, and public health domains.

“Clinically speaking, the biggest opportunities are going to be with, in my opinion, early detection and timely treatment. We have so many great new drugs, but there are so many people that don't have access to them, finding the people, getting them on the right therapies, and keeping them on therapies for years. We can make a big impact that way,” Tonelli said. “We're going to have to put the systems in place that make that possible, which is going to take a lot of time and a lot of effort.”

Editors’ note: Tonelli reports no relevant disclosures.

References

1. ISN. Historic win for kidney health as WHO adopts global resolution. May 23, 2025. Accessed April 2, 2026. https://www.theisn.org/blog/2025/05/23/historic-win-for-kidney-health-as-who-adopts-global-resolution/

2. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl.. 2022;12(1):7-11. doi:10.1016/j.kisu.2021.11.003