Transcript Kidney Disease, Diabetes and Hypertension and your Heart

WHY
WORLD
KIDNEY
DAY?
WORLD KIDNEY DAY (1)
PURPOSE:
1.World Kidney Day was established to
increase awareness of the need for detection
programs for CKD & to improve
prevention & treatment of CKD.
2.The motto of World Kidney Day:
Kidney Disease is Common,
Harmful and Treatable.
About 20 Million People With
Chronic Kidney Disease (CKD) in
the United States and
~20 Million More at Risk
Estimates Suggest That About 10
Percent of Adult Patients Worldwide
May Have CKD
Dialysis Mortality: 20%
Annual CVD Mortality (%)
General
Population vs ESRD Dialysis Patients
100
10
GP Male
1
GP Female
GP Black
GP White
0.1
Dialysis Male
Dialysis Female
0.01
Dialysis Black
Dialysis White
0.001
25-34
35-44
45-54
55-64
66-74
75-84
>85
Age (years)
RN Foley, PS Parfrey, and MJ Sarnak; Clinical epidemiology of cardiovascular disease in
chronic renal disease AJKD, 1998 32(5):S112-S119
Most People with CKD will Die
Prematurely from their Increased
Risk of Cardiovascular and
Cerebrovascular Disease Before
they Develop End-Stage Kidney
Failure
Interconnections
Between Obesity, Diabetes
Mellitus, High Blood
Pressure, and Chronic
Kidney Disease (CKD)
Number of Patients
(thousands)
Diabetes Is the Most Common Primary
Diagnosis in Patients With Kidney
Failure
350
45%
300
Diabetes
27%
Prevalent Dialysis
(2003: 324,826)
Hypertension
8% Glomerulonephritis
250
20%
200
Other
Prevalent Transplant
(2003: 128,131)
150
100
Incident Dialysis
(2003: 100,499)
50
0
′88
′90
′92
′94
′96
′98
′00
′02
Year
ESRD = end-stage renal disease.
USRDS 2005 Annual Data Report. The data reported here have been supplied by the USRDS. The interpretation
and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official
policy or interpretation of the U.S. government. Available at: www.usrds.org. Accessed December 6, 2005.
Primary Diagnoses for
Patients Who Start Dialysis
Other
10%
Glomerulonephritis
13%
Diabetes
50%
Hypertension
27%
United States Renal Data System
(USRDS) 2005 Annual Data Report •
WWW.USRDS.ORG
DEFINITION OF OBESITY
1.
2.
3.
4.
Overweight: BMI 25.0 -29.0 kg/m2
Obese: BMI ≥30 kg/m2
Morbidly Obese: ≥35kg/m2
Abdominal Obesity: Waist
circumference ≥102 cm in men; ≥88
cm in women
Hill, Endocrine Reviews 2006;27:750-761
HSU et al. Ann Int Med 2006;144:21
OBESITY RISK FOR ADVANCED
BMI ≥ 25 at 20 years old CKD
OR for Incidence of Advanced
CKD
Stratified by Comorbidity
No Diabetes
1.6-3.6)
No Hypertension
7.1)
No Diabetes or Hypertension
6.4)
Stratified by Type of CKD
Diabetic Nephropathy
8.4)
Nephrosclerosis
5.5)
2.4( CI:
3.6 (1.83.0 (1.4-
5.2 (3.23.0 (1.6-
Iseki Contrib Nephrology 2006;42-56
Percentage of population that is overweight
(BMI 25-29kg/m2)
Percentage of population that is obese (BMI≥30kg/m2
Kelley et al, Int J Obesity 2008;32:1431-1437
Challenges of CKD
Management problems, enormous
everywhere, are particularly great, even
overwhelming, in developing countries:
1. Little awareness of CKD or its
consequences
2. Few financial resources for
prevention, detection or treatment
3. Little expertise
4. High prevalence of CKD
Today There are Many
Safe and Effective
Treatments That Prevent
or Slow the Progression
of Chronic Kidney
Disease
Simple Methods for
Detection of CKD
1. Urine Albumin, including
Microalbumin (indicator of
kidney disease especially of
small blood vessels in kidney)
2. Serum Creatinine (indicator of
kidney function)
3. Blood Pressure
What Can WKD Do (1)?
1. Advertise/Educate
i. The public-at –large
ii. National, regional and local
governments, insurers and other health
related organizations (eg, the
pharmaceutical industry)
iii. Health care professionals (There is
abundant evidence that medical care is
suboptimal nationally, even when financial
resources are not a limiting factor).
What Can WKD Do (2)?
2. Advocate
i. With National, State and Local
Governments for Better Kidney Disease:
- Education
- Prevention
- Detection
- Treatment
ii. With Other Major Organizations; e.g.,
Insurance Agencies, Large Health Care
Providers, Universities, etc.
What Can Be Done (2)?
2. Conduct Detection and Treatment Programs
i. Particularly for high risk groups.
ii. Employ inexpensive methods of detection and
treatment (Experience of Dr. Manis from
Chennai, consider using non-physicians where
possible).
iii. Collaboration with other like-minded
organizations will increase efficiency and
effectiveness – especially for a nation as
populous and with as many volunteer health
organizations as India.
What Can Be Done (4)?
4. Ultimately, the costs of prevention,
detection and treatment programs
nationally will require resources that can
only be provided by such national or
regional organizations as governments or
other third party insurers – But this is for
the future.
WORLD KIDNEY DAY
A SUCCESS STORY:
There has been an overwhelming
response around the world to
World Kidney Day.
WKD Successes (1)
• Outstanding response from around the
world:
– 45 participating countries - 2006
– 63 participating countries - 2007
– 90 participating countries & territories –
2008
– Over 100 participating countries &
territories -2009
WKD Successes (2)
Participating Countries
– from Albania to Zimbabwe
– In many countries, activities in many different
places
– Participating organizations included:
societies, foundations, universities, colleges,
hospitals associations, trusts and individuals
– Local activities focused on raising awareness
across all key audiences:
– Public-at -large, Government ministers and
Health Officials, Physicians and Allied Health
Professionals
World Kidney Day Los Angeles
2010 (2)
Many Southern California Organizations joined
together for this event (continued)
March, 2010
4. Kidney Disease Lectures at Scheduled
Hospital Conferences, Universities Academic Nephrologists
World Kidney Day Los Angeles
2010 (1)
Many Southern California Organizations joined
together for this event
March 7, 2010
1. Polycystic Kidney Disease / KidneyWise Walk
March 11, 2010
2. Minority community education program and
focus groups – Drew Postgraduate Medical
School, Community Organizations
3. KEEP Dectetion Program– National Kidney
Foundation
World Kidney Day Los Angeles
2010 (3)
Many Southern California Organizations
joined together for this event (continued)
March 13, 2009
5. CKD Management Training for MD’s,
RN’s, General Internists, Family
Practitioners, Nurse Practitioners and
Specialists, Case Managers – Kaiser
Permanente Health Care System and
Foundation, Los Angeles County
Department of Health Services
World Kidney Day Los Angeles
2010 (4)
Many Southern California Organizations
joined together for this event (continued)
March, 2008, 2009 And 2010
6. Innumerable planning meetings and
individual activities – By representatives of
all of the above organizations and entities
7. In Washington and elsewhere, meeting with
government officials, editorials, the media
and many many other activities
World
Kidney
Day
March 11, 2010
Interconnections Between Obesity,
Diabetes Mellitus (DM), High Blood
Pressure, and Chronic Kidney Disease
(CKD)
Relationships between Obesity, Diabetes & CKD:
i. Obesity predisposes to both Diabetes & CKD
ii. Diabetes is the most common cause of endstage CKD that requires chronic dialysis
treatments or renal transplantation
iii. Roughly one-third of people with Diabetes
will develop CKD
Interconnections Between Obesity,
Diabetes Mellitus, High Blood Pressure,
and Chronic Kidney Disease (CKD)
Relationships between Obesity, Diabetes & CKD:
(continued)
iv. Diabetes is easy to detect, can be prevented in
most cases, and can usually be treated
effectively in most cases.
Interconnections Between Obesity,
Diabetes Mellitus, High Blood Pressure
and Chronic Kidney Disease (CKD)
Relationships between Obesity, Diabetes & CKD
:
v. Tight glucose control in DM appears to
reduce the risk for CKD.
vi. Blood pressure control reduces the harmful
complications of DM.
vii. DM is easy to detect, and in most cases, it
can be prevented and usually treated effectively.
Interconnections Between Obesity, Diabetes
Mellitus, High Blood Pressure, and Chronic
Kidney Disease (CKD)
Relationships between CKD & high blood pressure:
i. High blood pressure, like chronic kidney disease
(CKD), is often silent and dangerous.
ii. High blood pressure causes CKD.
iii. CKD causes High blood pressure.
iv. Both CKD and Hogh blood pressure are
common and treatable.
Interconnections Between Obesity,
Diabetes Mellitus, High Blood Pressure,
and Chronic Kidney Disease (CKD)
Relationships between Obesity, Diabetes, CKD,
High blood pressure versus Vascular Disease:
1. Each of the above four conditions increase
the risk for Cardiovascular and Cerebrovascular
Disease.
2. This risk is often markedly increased.
3. Together these 4 diseases (Obesity,
Diabetes, CKD and high blood pressure) cause a
large percentage of the illnesses and deaths in
the Developed and the Developing World.
Interconnections Between Obesity,
Diabetes Mellitus, High Blood Pressure,
and Chronic Kidney Disease (CKD)
What can We do to Prevent and Treat
these Related Diseases and Their
Harmful Effects?
Diabetes: Tight Glucose & Blood
Pressure Control and CV Outcomes
% Reduction In Relative Risk
0
Stroke
Any Diabetic
Endpoint
DM
Deaths
Microvascular
Complications
5%
-10
10%
12%
-20
24%
*
-30
32%
*
-40
-50
32%
*P <0.05 compared to tight glucose control
44%
*
37%
*
Tight Glucose Control
Tight BP Control
(Goal <6.0 mmol/l or 108 mg/dL)
(Average 144/82 mmHg)
Bakris GL, et al. Am J Kidney Dis.
2000;36(3):646-661.
Suggested Goals for CKD Patients esp.
with Diabetes and High Blood Pressure
• Lifestyle modifications (no obesity, regular exercise)
• BP 130/80 mmHg or lower, esp in diabetes or proteinuria)
• Maximal reduction of proteinuria (<1 g/d)
• Multiple BP lowering meds(3-4 meds or more, if needed)
• ACEIs, ARBs, Diuretics, Beta-Blockers, NonDihydropyridine-CCBs
• HbA1c at <7% (in diabetics)
• Dietary protein restriction (0.6 - 0.8 kg/d)
• Dietary sodium restriction (<2-3 g/d sodium)
• Lipid-lowering therapy (diet, statins)
What Can Be Done (3)?
3. New Direction:
We are beginning to join with other
disease focused groups and world health
days that relate to kidney disease (for
example, World Hypertension Day,
possibly in the future, World Diabetes
Day).
World Kidney Day-Plans For 2009(2)
2. Collaboration with World Hypertension Day.
i. Share messages on websites, in printed
messages?
ii. Place links on respective websites?
iii. Inaugurate combined programs in selected
circumstances(2009 WKD will add a HTN focus).
3. Basic Principal: A message has the greatest
impact when it is repeated many times and in
different ways or by different groups.
World Kidney Day-Plans For 2009(3)
i. It follows that we might all come closer
to achieving our respective goals if Heart,
Diabetes and Stroke join in this linkage
effort with WHD and WKD.
4. Role for the Vascular Alliance?
i. Coordinate such linkage efforts?
ii. Facilitate the liaison between Vascular
Alliance and target audiences (eg, Nurses,
family practitioners, general internists,
pharmacists, government ministries, etc.).
World Kidney Day – Future Plans
1. Increase Public Health Message
2. Bring all Kidney Disease Organizations
together for a Unified Effort and Message
(kidney foundations, societies of nephrology,
patient organizations, community activists,
medical schools, teaching hospitals, insurers)
3. Each community to use WKD as time to
announce goals and timelines for targeted
improvements in prevention and health care for
people with or at risk for kidney disease. WKD
is also used to announce the status and
successes of these efforts.
Potential Evolution in Goals for
World Kidney Day
The goal is to use World Kidney Day as a
mechanism to stimulate people to work together
to improve the health care system as it affects
public health, preventative medicine and acute
and chronic medical care in their locality with
regard to acute and chronic kidney disease .
We want to have volunteers from kidney
foundations, kidney patient organizations,
societies of nephrology, other interested
organizations and the public-at-large join
together to attain these goals in their locality.