Lysaght, J Am Soc Nephrol, 2002 Number of patients worldwide treated with chronic dialysis from 1990 to 2010 1990 2000 2010 426,000 1,490,000 2,500,000.

Slides:



Advertisements
Similar presentations
Risk Stratification in Renal Care Mary Jane McKendry Vice President, Operations Fresenius Disease Management Optimal Renal Care.
Advertisements

The National Kidney Foundations Kidney Early Evaluation Program TM The National Kidney Foundations Kidney Early Evaluation Program TM Essex-Passaic Wellness.
Dinkar Kaw, M.D., Division of Nephrology
Chronic kidney disease: [insert title here] Insert name, title, date here Insert acknowledgements here.
The PREVEND Study: Screening for micro-albuminuria
CKD in individuals with CKD
SLOW- COOKING THE BEANS “OR, HOW TO STOP WORRYING AND APPLY SOME LOVE TO THE KIDNEYS” AN APPROACH TO CKD SARA KATE LEVIN, MD JANUARY 2014.
General Practice Workshop This workshop was conceived and developed by Kidney Health Australia’s Kidney Check Australia Taskforce with particular thanks.
Treatment-Resistant Hypertension: Magnitude of the Problem Power Over Pressure
FFBI Change Concepts FFBI Change Concept #12 Presented by: Ellen DePrat, MSN, RN, NE, CPHQ Project Coordinator - HealthInsight (QIO for Nevada/Utah) October.
CKD In Primary Care Dr Mohammed Javid.
Canadian Diabetes Association Clinical Practice Guidelines Chronic Kidney Disease in Diabetes Chapter 29 Phil McFarlane, Richard E. Gilbert, Lori MacCallum,
1 Prediabetes Comorbidities and Complications. 2 Common Comorbidities of Prediabetes Obesity CVD Dyslipidemia Hypertension Renal failure Cancer Sleep.
Dick de Zeeuw Department of Clinical Pharmacology University Medical Center Groningen The Netherlands Early detection, prediction and potential treatment.
The case of microalbuminuria prevention: the ROADMAP study Department for Clinical Pharmacology and Hypertension Charité – University Medicine Berlin,
 Currently 150 Million people worldwide suffering from diabetes and that number may double by the year  The prevalence of type 2 diabetes is dramatically.
Lesley Stevens MD Tufts-New England Medical Center
Reference Cooper BA, and the IDEAL study group. A randomized controlled trial of early versus late initiation of dialysis. N Engl J Med [Accessed.
Prevalance of Chronic Kidney Disease 26 million people have diagnosed chronic kidney 26 million people have diagnosed chronic kidney disease (CKD) ( National.
Section 1: CKD Epidemiology. The Problem Chronic Kidney Disease is an epidemic worldwide –Growth 6-8% per annum of dialysis patients Accumulating data.
Management of Chronic Kidney Disease Stages 1 – 3 Prepared for: Agency for Healthcare Research and Quality (AHRQ)
Early Detection and Prevention of Renal Failure Linda Fried, MD, MPH.
A significant proportion of diabetic patients develop diabetic nephropathy which can eventually progress to end-stage renal disease despite established.
Section 4: Managing progression of CKD. Glomerulosclerosis Reduction in number of functioning glomeruli Increased blood flow to remaining nephrons Intraglomerular.
RENAL DISEASE IN DIABETES
Diabetic Nephropathy Yiming Lit, M.D. May 5, 2009.
Dr Rajendra Prasad Mathur MD, DM, FICP, ISN Scholar Seniour consultant & HOD, Batra hospital Heart and Kidney: Protect Your Kidneys to Save Your Heart.
6 / 5 / RENAL DISEASE OUTCOMES IN HYPERTENSIVE PATIENTS STRATIFIED INTO 3 GROUPS BY BASELINE GLOMERULAR FILTRATION RATE (GFR) ALLHAT.
Randomized, double-blind, multicenter, controlled trial.
SM Gatmiri, MD, Nephrologist Imam Khomeini Hospital,
0902CZR01NL537SS0901 RENAAL Altering the Course of Renal Disease in Hypertensive Patients with Type 2 Diabetes and Nephropathy with the A II Antagonist.
Microalbuminuria – pathogenesis and clinical implications.
EVALUATION AND MANAGEMENT OF CHRONIC KIDNEY DISEASE Dr. D.Adu Ghana College CPD August 2011.
Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL study) Lambers Heerspink,
Irbesartan Diabetic Nephropathy Trial (IDNT) Collaborative Study Group N Eng J Med 345: , 2001 Edmund J. Lewis, M.D. Muehrcke Family Professor of.
Section 5: Configuration of healthcare to manage CKD.
Section 3: CKD, CVD and mortality. Cardiovascular diseases in CKD patients Damage to the heart (Uraemic cardiomyopathy ) Damage to the arteries (Uraemic.
La gestione del paziente diabetico: bisogni, percorsi e strumenti Metodi per lo studio della nefropatia Giuseppe Penno Dipartimento di Medicina Clinica.
Dick de Zeeuw Department of Clinical Pharmacology University Medical Center Groningen The Netherlands Albuminuria; a tool for measuring non-blood pressure.
Dr M Sivalingam Renal Unit, Lister Hospital, Stevenage.
Case Report and Lit Review: Reduction of Proteinuria in Diabetic Nephropathy with Spironolactone Harry W. Floyd, M.D. Family Medicine Kingstree, South.
Heart failure: The national burden AHA. Heart disease and stroke statistics–2005 update. Koelling TM et al. Am Heart J. 2004;147:74-8. VBWG Affects 1 million.
Epidemiology of Anaemia in CKD
Background There are 12 different types of medications to lower blood sugar levels in patients with type 2 diabetes. It is widely agreed upon that metformin.
ALLHAT 6/5/ CARDIOVASCULAR DISEASE OUTCOMES IN HYPERTENSIVE PATIENTS STRATIFIED BY BASELINE GLOMERULAR FILTRATION RATE (3 GROUPS by GFR)
6/5/ CARDIOVASCULAR DISEASE OUTCOMES IN HYPERTENSIVE PATIENTS STRATIFIED BY BASELINE GLOMERULAR FILTRATION RATE (4 GROUPS by GFR) ALLHAT.
1 به نام خدا. Epidemiology of chronic kidney disease 2.
Diabetes and the Kidney Richard Kingston Department of Renal Medicine Kent and Canterbury Hospital.
Professor Tazeen H Jafar Duke-National University of Singapore & Aga Khan University, Karachi, Pakistan Chronic Kidney Disease- Integration into the NCD.
PREVALENCE, PATTERN AND OUTCOMES OF PATIENTS PRESENTING WITH RENAL DISEASES Alfred J. Meremo, MD College of Health Sciences, UDOM. 18 th March 2016.
Sheffield Kidney Institute Global Kidney Academy CKD Micro-Lecture Epidemiology, Screening and Guidelines Professor Meguid El Nahas, PhD, FRCP Sheffield.
Updates in Diabetic Nephropathy Rodica Pop-Busui, M.D., Ph.D Division of Metabolism, Endocrinology and Diabetes Michigan Comprehensive Diabetes Center.
Anemia in CKD The TREAT Trial Reference Pfeiffer MA. A trial of Darbepoetin alpha in type II diabetes and chronic kidney disease. N Engl J Med. 2009;361:2019–2032.
Olmesartan for the Delay or Prevention of Microalbuminuria in Type 2 Diabetes Hermann Haller, M.D., Sadayoshi Ito, M.D., Ph.D., Joseph L. Izzo.Jr., M.D.,
The FAVORIT Study (Folic Acid for Vascular Outcome Reduction in Transplantation) Source Bostom AG, Carpenter MA, Kusek JW, et al. Homocysteine-lowering.
Chronic Kidney Disease (CKD) Dr. Sham Sunder. Now we know why the titanic sank !! < 0.5 % 5- 10%
Cardiovascular Disease and Antihypertensives The RENAAL Trial Reference Brunner BM, and the RENAAL study group. Effects of losartan on renal and cardiovascular.
Section 1: CKD Epidemiology
What should the Systolic BP treatment goal be in patients with CKD?
Section 4: Managing progression of CKD
Section 3: CKD, CVD and mortality
The IDEAL Study Reference
SAVE: Risk of total mortality associated with reduced kidney function
Nat. Rev. Nephrol. doi: /nrneph
Management of hypertension in patients with chronic kidney disease
Insights from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)
Section 5: Configuration of healthcare to manage CKD
Hypertension management in high risk type II diabetes with CKD: Insights from recent trials with a focus on albuminuria. A case based discussion  Matthew.
Adjusted relative risk for developing end-stage renal disease (ESRD) associated with blood-pressure level BP level (mm Hg) Adjusted relative risk 95%
Baseline Characteristics by hs-CRP
Presentation transcript:

Lysaght, J Am Soc Nephrol, 2002 Number of patients worldwide treated with chronic dialysis from 1990 to ,000 1,490,000 2,500,000

Lysaght et al., J Am Soc Nephrol, Medical costs for dialysis per decade in $ billions USD $ $ $ Predicted costs for chronic dialysis worldwide per decade from 1980 until $ $ $

Globally 1,800,000 patients with endstage renal failure 300,000,000 people with kidney malfunction (e.g. albuminuria), which gives them a markedly increased chance to develop heart failure and diabetes

World m 20.2 m 4.1 m 5.6 m High inc. countries Mid/low inc. countries 6.5 m 14.5 m The Global Burden of Cardiovascular Disease Mortality ( ) * In million subjects 37% 144% 130% 119% 96% 139% %

World m 370 m 55 m 84 m High inc. countriesMid/low inc. countries 99 m 286 m * In million subjects 102% 81% 71% 211% 255% 127% 78% Increase of diabetes worldwide in the period 2000 to 2030 WHO, March 2003

Total Medicare Diabetes Heartfailure Dialysis/Tx CKD Numbers 5.8% 1.1% 20.7%25.1% 41.3%48.1% 19% 7.8% Kidney Failure, Heart Failure, and Diabetes; Number of patients and costs; USA 2002 Costs

Mild renal dysfunction is (Albuminuria and slight decrease in GFR) is highly prevalent StageDescription GFR (ml/min/1/73 m 2 ) Est. Prevalence USA Est. Prevalence NETHERLANDS 1 Albuminuria, normal or  GFR > %1.3% 2 Albuminuria, mild  GFR %3.8% 3 Moderate  GFR %5.3% 4 Severe  GFR %0.1% 5 Kidney Failure < 15 or RRT0.2%0.0% Total11.0%10.5% Coresh et al; Am J Kidney Dis 2004 De Zeeuw et al; Kidney Int; in press K/DOQI Clinical Practical Guidelines Am J Kidney Dis 2003

PREVEND; Albuminuria predicts moderate CKD (stage 3) (4 yr) > – Stage 3 CKD (%) Albuminuria (mg/day) Verhave et al. Kidney Int 2004

PREVEND; Albuminuria predicts CV death in the general population (+3 yr) > – CV death (% per 1000 pj) Albuminuria (mg/day) Hillege et al; Circulation 2002;106(14):

PREVEND; Albuminuria predicts new onset diabetes (4,2 yr) > – New onset Diabetes (%) Albuminuria (mg/day) Brantsma et al; Diabetes Care

IRMA 2; Treatment associated with lowering of albuminuria reduces progression to diabetic nephropathy Parving H-H et al. N Engl J Med 2001;345:870–8. Follow-up (months) RiskReduction70% Diabetic Nephropathy (%) Control + Conv tx AIIA (Irbesartan 150 mg) AIIA (Irbesartan 300 mg)

BENEDICT; Treatment associated with lowering of albuminuria reduces progression to microalbuminuria Months Placebo + Conv tx ACEi (trandolapril) Transition to Microalbuminuria (%) Ruggenenti et al; N Engl J Med 2004 RiskReduction50%

Asselbergs et al; Circulation Placebo ACEi (fosinopril) CV mortality (%) Months PREVEND-IT; Treatment associated with lowering of albuminuria reduces CV mortality in the general populationRiskReduction44%

Meta-analysis; Treatment associated with albuminuria reduction reduces incidence of new onset diabetes Conventional BP lowering ACEi AII-A New onset Diabetes (% per 4.1 yr) Lindholm LH; J Hypertens 2003 RiskReduction 39 %

PRIME; Early and Late intervention with AIIA are cost saving in type 2 diabetes Placebo + Conventional Tx Late AIIA (Irbesartan) Early AIIA (Irbesartan) Years since baseline age of 58 Cumulative costs per patient (€) ,000 15,000 25,000 35,000 45,000 Palmer et al; Diabetes Care 2004

Conclusions  Early kidney failure is a common problem, affecting about 10% of the adult population  Early kidney failure is to detect with simple urine tests  Early kidney failure carries an increased risk for cardiovascular disease  Early kidney failure will ultimately result in need for dialysis and transplantation  When treatment (with generally available drugs) is started early, prevention of progressive renal and cardiac disease seems feasible  These approaches seem cost effective