Kidney replacement therapy as a key performance indicator for population health. A call to action by REDYT, ALCER, EKPF, S.E.N. and RICORS2040-renal.

The 2023 Spanish Registry of Dialysis and Transplantation (REDYT) real data exceeded previous estimates and forecasts for the prevalence of kidney replacement therapy (KRT). This trend will continue as the baby boom generation reaches the age of peak incidence of chronic kidney disease (CKD) and KRT. REDYT disclosed heterogeneity in clinical practice regarding initiation of KRT in the very elderly across Autonomous Communities, which should lead to benchmarking studies that dissect the drivers and outcomes. REDYT also disclosed an inverse correlation between KRT incidence/prevalence and life expectancy. That is, a lower need for KRT may be considered a key performance indicator of better overall societal health. This is not unexpected, as the main consequence of CKD is accelerated biological aging and kidney health is a key component of cardiovascular-kidney-metabolic (CKM) health. Spanish health authorities should follow the lead of international organizations, such as the 2025 World Health Organization (WHO) kidney health resolution, the associated United Nations political statement, the KDIGO guidance on the prevention of CKD and maintenance of kidney health, and the European Renal Association holistic ABCDE approach to cardiovascular-kidney-metabolic health. These organizations emphasize prevention and early treatment, identifying albuminuria as an actionable diagnostic criterion for CKD. Albuminuria drives interventions that improve cardiovascular-metabolic outcomes and may delay KRT by almost three decades. As deaths from CKD will soon overcome those from colorectal cancer, integrating albuminuria-based CKD screening into colorectal cancer screening programs for baby boomers has the potential to stem the tide of KRT and improve societal health.