1. March 12, 2009 World Kidney Day

2. WHY WORLD KIDNEY DAY?

3. 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.

4. 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

5. Most People with CKD will Die Prematurely from their Increased Risk of Cardiovascular and Cerebrovascular Disease Before they Develop End-Stage Kidney Failure

7. Dialysis Mortality: 20% General Population vs ESRD Dialysis Patients RN Foley, PS Parfrey, and MJ Sarnak; Clinical epidemiology of cardiovascular disease in chronic renal disease AJKD, 1998 32(5):S112-S119

8. Diabetes 50% Hypertension 27% Glomerulonephritis 13% Other 10% Primary Diagnoses for Patients Who Start Dialysis United States Renal Data System (USRDS) 2005 Annual Data Report WWW.USRDS.ORG

9. WHY WORLD KIDNEY DAY? Chronic, non-communicable diseases (i.e. CVD, HTN, DM and CKD) have now replaced communicable diseases as the LEADING THREAT to public health & health budgets worldwide Deaths… –Attributed to infectious diseases will decline by 3% over the next decade –Attributed to chronic diseases will increase by 17% over the same time frame

10. Interconnections Between Obesity, Diabetes Mellitus, High Blood Pressure, and Chronic Kidney Disease (CKD)

11. 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 end- stage CKD that requires chronic dialysis treatments or renal transplantation iii. Roughly one-third of people with Diabetes will develop CKD

12. 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.

13. Interconnections Between Obesity, Diabetes Mellitus, High Blood Pressure and Chronic Kidney Disease (CKD) Relationships between Obesity, Diabetes & CKD : v. Tight glucose control in Diabetes appears to reduce the risk for CKD. vi. Blood pressure control reduces the harmful complications of Diabetes. vii. Diabetes is easy to detect, and in most cases, it can be prevented and usually treated effectively.

14. Diabetes: Tight Glucose & Blood Pressure Control and CV Outcomes Stroke Any Diabetic Endpoint DM Deaths Microvascular Complications -50 -40 -30 -20 -10 0 % Reduction In Relative Risk Tight Glucose Control (Goal <6.0 mmol/l or 108 mg/dL) Tight BP Control (Average 144/82 mmHg) 32% 37% 10% 32% 12% 24% 5% 44% * * * * *P <0.05 compared to tight glucose control Bakris GL, et al. Am J Kidney Dis. 2000;36(3):646-661.

15. 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.

16. 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.

17. 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?

18. 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 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

19. What Can Be Done (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).

20. WORLD KIDNEY DAY (2) A SUCCESS STORY: There has been an overwhelming response around the world to World Kidney Day.

21. 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 (estimated)

22. 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

23. 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.

24. Today There are Many Safe and Effective Treatments That Prevent or Slow the Progression of Chronic Kidney Disease

25. 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

26. 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).

27. 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.

28. 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.).

29. 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.

30. 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. 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. 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.

31. World Kidney Day Los Angeles 2009 (1) Many Southern California Organizations joined together for this event March 12, 2009 1.Minority community education program and focus groups – Drew Postgraduate Medical School, Community Organizations 2.KEEP it Hollywood - NKFSC 3.Dinner Lecture – NKFSC, Teaching Programs

32. World Kidney Day Los Angeles 2009 (2) Many Southern California Organizations joined together for this event (continued) March, 2009 4. Kidney Disease Lectures at Scheduled Hospital Conferences, Universities - Academic Nephrologists

33. World Kidney Day Los Angeles 2009 (3) Many Southern California Organizations joined together for this event (continued) March 14, 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

34. World Kidney Day Los Angeles 2009 (4) Many Southern California Organizations joined together for this event (continued) March, 2008 – March, 2009 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

35. March 12, 2009 World Kidney Day

37. Who should be screened for CKD?

38. 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, Non- Dihydropyridine-CCBs HbA 1c 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)

39. 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.