Transcript Chronic Kidney Disease (The Philippine Situation)

CHRONIC KIDNEY DISEASE
The Philippine Situation

National Nutrition and Health Survey

Philippine Renal Disease Registry

Mortality statistics

Survival data from a cohort study
NATIONAL NUTRITION SURVEY

Resulted from the mandate of the Food and
Research Institute (FNRI) of the Dept. of
Science and Technology (DOST)

Objective: To assess the Philippine food
situation and nutritional status of the
population

Conducted every 5 years since 1978
NNHeS 2003-2004
Objectives

To assess the prevalence of lifestyle and
nutrition-related risk factors and diseases
among Filipinos 2 years and above

To aid in the development of health policies an
programs for the prevention and control of
lifestyle and nutrition-related diseases
NNHeS 2003-2004 Renal Report
Chronic Kidney Disease Stages
Stage GFR
1
2
3
4
5
>=90
60-89
30-59
15-29
<15
Normal or increased GFR
Mildly decreased GFR
Moderately decreased GFR
Severely decreased GFR
Kidney failure
Based on guidelines of the Dialysis Outcomes Quality Initiative – US
NNHeS 2003-2004 Renal Report
Renal function
• Abbreviated MDRD formula
– Predicted GFR = 186.3 * (serum creatinine)−
1.154 * age− 0.203 * (0.742 for women) * (1.21 if
African American)
• Cockcroft & Gault formula
– Ccr (mL/min) = (140 − age)/sCr * weight/72 *
1.73/BSA, where age is in years, sCr is in
mg/dL, weight is in kilograms, and BSA is body
surface area using the formula:
– BSA = 0.20247 × [height (m)]0.725 × [weight
(kg)]0.425
NNHeS 2003-2004 Renal Report
Prevalence of CKD in adults
using predicted GFR from MDRD equation
Stages of GFR
1
2
3
4
5
>=90
60-89
30-59
15-29
<15
72.8%
24.6%
2.2%
0.2%
0.2%
The prevalence of CKD Stage 3-5 is 2.6%
NNHeS 2003-2004 Renal Report
Prevalence of CKD in adults
The population of Filipinos aged 20 years
and above in 2005 was 46,627,172
A prevalence of 2.6% means that
1,212,306 adult Filipinos
have CKD.
NNHeS 2003-2004 Renal Report
Macroalbuminuria
 at least +1 proteinuria using the
Multiple Reagent Strip for Urinalysis®
(Bayer Corporation)
The prevalence of
macroalbuminuria was
4.2%
NNHeS 2003-2004 Renal Report
Microalbuminuria
The prevalence of
microalbuminuria was
18.5%
This is equivalent to
8,626,027
Adult Filipinos
NNHeS 2003-2004 Renal Report
Prevalence of CKD Stage 3-5
according to AGE
Stage 3
Stage 4
Stage 5
25
20.7%
20
15
10
5
0.3%
1.0%
20-29
30-39
5.0%
2.9%
40-49
50-59
7.5%
0
60-69
70+
Mean level of GFR by age group:
Philippine vs. US data
Age Group
in Years
NNHeS 2003
Philippines
NHANES III
U.S.A.
20-29
119
116
30-39
109
107
40-49
103
99
50-59
100
93
60-69
86
85
70+
77
75
PHILIPPINE RENAL DISEASE REGISTRY

Originated by the PSN in 1996 and later
became a joint project with REDCOP

Collects data on ESRD patients who start
hemodialysis, peritoneal dialysis and
undergo kidney transplantation
NEW PATIENTS ON DIALYSIS
2001-2005
Number of Patients
7000
5597
6000
5997
5070
5000
4363
4409
2001
2002
4000
3000
2000
2003
2004
2005
NEW PATIENTS ON DIALYSIS: 2001-2005
ACCORDING TO DIALYSIS MODALITY
Number of Patients
7000
5597
6000
5000
5997
5070
4363
TOTAL
4409
4000
HD
3000
2000
1000
PD
0
2001
2002
2003
2004
2005
ACCEPTANCE RATE TO RRT PROGRAMS
(PMP)
Data from International Federation of Renal Registries
website and the Philippine Renal Disease Registry
71 PMP
55 PMP
63 PMP
68 PMP
PHIL 2003
PHIL 2004
PHIL 2005
INDONESIA
CHINA
MALAYSIA
AUSTRALIA
KOREA
INDIA
SPAIN
CANADA
MEXICO
US
0
50
100
150
Patients per million population
200
250
300
ACCEPTANCE RATE TO RRT PROGRAMS
(PMP)
Data from International Federation of Renal Registries
website and the Philippine Renal Disease Registry
71 PMP
55 PMP
63 PMP
68 PMP
PHIL 2003
PHIL 2004
PHIL 2005
INDONESIA
CHINA
MALAYSIA
AUSTRALIA
KOREA
INDIA
SPAIN
CANADA
MEXICO
US
0
50
100
150
200
Patients per million population
250
300
PRIMARY RENAL DISEASE OF ALL
NEW DIALYSIS PATIENTS
N = 5,997
HD
PD
OTHERS
APKD
GOUT
OBSTR
UNK
CPN
20%
HPN
26%
GN
38%
DM
0
500
1000
1500
2000
2500
DISTRIBUTION OF
TOP 3 CAUSES OF ESRD
2002
2003
2004
2005
Number of Patients
2500
2000
1500
1000
500
0
DM
GN
HPN
NNHeS 2003-2004 Renal Report
Prevalence of CKD Stage 3-5
according to AGE
MEAN AGE – 2004 PRDR DATA
Stage 3
25
20
Stage 4
Stage 5
ALL NEW DIALYSIS PTS
52 YEARS
ESRD - DM NEPHRO
58 YEARS
ESRD – HTN NEPHRO
57 YEARS
ESRD – CGN
38 YEARS
20.7%
15
7.5%
10
5
0.3%
1.0%
20-29
30-39
5.0%
2.9%
40-49
50-59
0
60-69
70+
END STAGE RENAL IS A BAD
DISEASE TO HAVE
Limited survival
Expensive
Retrospective cohort study of 327 patients from NKTI and
SLMC diagnosed to have ESRD 2000-2001
OVERALL SURVIVAL
Kaplan-Meier survival estimate
1.00
0.75
0.50
0.25
0.00
365
730
1000
analysis time
12 month estimated survival rate - 53% (95%CI: 47-58)
24 month estimated survival rate - 36% (95%CI: 30-42
Results
PATIENT GROUP
Service – n=198 (60%)
Private – n=129 (40%)
1.00
0.75
Private
0.50
0.25
Service
0.00
365
days
Log rank test: chi2 = 29.62, p<.001
730
1000
National Statistics Office
Kidney disease is now no. 10 cause
of mortality in the Philippines
Renal
Disease
Registry
NNHes
Population
Survey
GROWING PROBLEM
OF CHRONIC KIDNEY
DISEASE
National
mortality
data
ESRD
survival
data
Treatment is too expensive
Prevention is the key
Kung hindi tayo ang kikilos
Sino ang kikilos?
Kung hindi ngayon, kailan pa?
The Philippine College of Physicians wishes to
acknowledge the following for their invaluable
contribution in the preparation of this module
Philippine Society of
Nephrology