RRT

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RRT
2,095,000
1,065,000
426,000
1990
2010
2000
Lysaght, J Am Soc Nephrol, 2002
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Adjusted incident rates annual percent
changeFigure 2.2
Incident ESRD patients Medical Evidence form
data rates adjusted for age, gender, race.
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There are 1,065,000 people on dialysis
worldwide 90 of them live in North America,
Japan, and Europe, whose population is less than
20 of world population
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K/DOQI

• CKD Classification
• Stage Description GFR
• 1 Kidney damage/normal GFR gt90ml/min
• 2 Mild renal insufficiency 89-60
• 3 Moderate renal insufficiency 59-30
• 4 Severe renal insufficiency 29-15
• 5 Kidney Failure lt15

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PRE-CKD
X
CKD 1
X
CKD 2
CKD3
CKD4
X
ESRF
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PRE-CKD
CKD 1
CKD 2
CKD3
AT RISK
CKD4
ESRF
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Risk Factors in CKD
S
P
I
Genetic/Relatives of CKD Race Gender Age Diseases
DM, HT, auto-immune, Rheumatic Infections
Malaria, HIV, HCV, Streptococcus
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USA
UK
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Risk Factors in CKD
S
I
P
BP Glycaemia Dyslipidemia Weight Smoking INFECTION
S HCV, HIV, Malaria, schisto
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HIV
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MRFIT Study
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AIRC, Jurkovitz et al, 2003
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Iseki et al, 2003
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PRE-CKD
Established CKF
CKD 1
CKD 2
CKD3
CKD4
ESRF
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Risk Factors in CKD
S
I
P
Modifiable BP Proteinuria Dyslipidemia Smoking
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Locatelli et al 1996
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Locatelli et al 1996
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Attman et al 1999
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Bonnet et al 2001
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DN
Non-DN
Orth 2002
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PRE-CKD
Established CKF
CKD 1
CKD 2
CKD3
CKD4
ESRF
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Proteinuria lt1g/d
Hypertension lt125/75
Alcohol
Lipids lt5
Weight
Smoking STOP
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ACEI/ARB NDCCB
Renoprotection
ACEI/ARB NDCCB b-blocker
STATIN
STOP
Cardioprotection
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PRE-CKD
X
CKD 1
X
CKD 2
CKD3
CKD4
X
ESRF
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ESRD
Lack of resources Lack Nephologists Lack
Dialysis
GUIDELINES
Death
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What to do????????

• Community Health Education and Awareness
  Programmes (CHEAP)
• Screening programmes
• Train a new generation of Nephro-epidemiologists
• Inform General practitioners
• Train Community Health Work Assistants
• Engage communities, NGO and Pharmaceutical
  industry

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PRE-CKD
CKD 1
CKD 2
CKD3
AT RISK
CKD4
ESRF
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K/DOQIAt-risk Population CKD 1

• At-risk Population
• DM, HT
• Obese individuals
• Relatives of CKD
• Ethnic/racial populations at risk
• Infections malaria, Schisto, HCV, HIV

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DM
Prevent
PREVENTION
Screen
Treat
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IGT 2000197m 2025380m
DM 2000155m 2025 300m
DN 200015-30m 202530-60m
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Obesity/Glucose intolerance

• Da Qing IGT and Diabetes Study (Pan et al, 1997)
• Exercise (4h/week)
• Diet
• Diet exercise
• Diabetes Prevention Programe (Molitch et al 2003)
• Metformin v Lifestyle modification
• Finnish Diabetes Prevention Study (Lindstrom et
  al, 2003)
• Lifestyle

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Obesity/Glucose intolerance

• Da Qing IGT and Diabetes Study (Pan et al, 1997)
• Exercise (4h/week) -36
• Diet -31
• Diet exercise -42
• Diabetes Prevention Programe (Molitch et al 2003)
• Metformin -31
• Lifestyle modification -58
• Finnish Diabetes Prevention Study (Lindstrom et
  al, 2003)
• Lifestyle -58

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Diabetes prevention

•  if everybody exercised few hours a week, type 2
  diabetes would be virtually nonexistent 
  
  
• Ken Goodrick M.D. (Baylor College of Medicine)
  
  TIME 5
  February 2001

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HT
Prevent
PREVENTION
Screen
Treat
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Lifestyle Modifications CKD

• Salt Restriction
• Weight Reduction
• Exercise

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DASH-Salt Na 141 mmol/d Na 106 Na 65
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Evolution
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PRE-CKD
CKD 1
CKD 2
CKD3
CKD4
ESRF
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What to do????????

• Community Health Education and Awareness
  Programmes (CHEAP)
• Screening programmes
• Inform General practitioners
• Train a new generation of Nephro-epidemiologists
• Train Community Health Work Assistants
• Engage communities, NGO and Pharmaceutical
  industry

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K/DOQIAt-risk Population CKD 1

• At-risk Population
• DM, HT
• Obese individuals
• Relatives of CKD
• Ethnic/racial populations at risk
• Infections malaria, Schisto, HCV, HIV

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The oedematous woman - Gerard Dou 1662 (Louvre
Museum)
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What to do????????

• Community Health Education and Awareness
  Programmes (CHEAP)
• Screening programmes
• Inform General practitioners
• Train a new generation of Nephro-epidemiologists
• Train Community Health Work Assistants
• Engage communities, NGO and Pharmaceutical
  industry

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FAMUS BP Control Study

• 677 hypertensive type 2 diabetics
• 166 (24.5 ) BP lt 140/90
• 81 (7.53 ) BP lt 130/85
• 22 (3.25 ) BP lt 130/80

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What to do????????

• Community Health Education and Awareness
  Programmes (CHEAP)
• Screening programmes
• Train a new generation of Nephro-epidemiologists
• Inform General practitioners
• Train Community Health Work Assistants
• Engage communities, NGO and Pharmaceutical
  industry

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Sheffield School of Nephrology
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What to do????????

• Community Health Education and Awareness
  Programmes (CHEAP)
• Screening programmes
• Inform General practitioners
• Train a new generation of Nephro-epidemiologists
• Train Community Health Work Assistants
• Engage communities, NGO and Pharmaceutical
  industry

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What to do????????

• Community Health Education and Awareness
  Programmes (CHEAP)
• Screening programmes
• Inform General practitioners
• Train a new generation of Nephro-epidemiologists
• Train Community Health Work Assistants
• Engage communities, NGO and Pharmaceutical
  industry

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Adjusted incident rates annual percent
changeFigure 2.2
Incident ESRD patients Medical Evidence form
data rates adjusted for age, gender, race.
61
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