Sheffield Kidney Institute. Lysaght, J Am Soc Nephrol, 2002 RRT 1990 2000 2010 426,000 1,065,000 2,095,000.

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Presentation transcript:

Sheffield Kidney Institute

Lysaght, J Am Soc Nephrol, 2002 RRT ,000 1,065,000 2,095,000

Sheffield Kidney Institute Adjusted incident rates & annual percent change Figure 2.2 Incident ESRD patients; Medical Evidence form data; rates adjusted for age, gender, & race.

Sheffield Kidney Institute 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

Sheffield Kidney Institute K/DOQI CKD Classification StageDescriptionGFR 1Kidney damage/normal GFR>90ml/min 2Mild renal insufficiency Moderate renal insufficiency Severe renal insufficiency Kidney Failure<15

Sheffield Kidney Institute PRE-CKD CKD 1 CKD 2 CKD3 ESRF CKD4 X X X

Sheffield Kidney Institute PRE-CKD CKD 1 CKD 2 CKD3 ESRF CKD4 AT RISK

Sheffield Kidney Institute S I P Risk Factors in CKD Genetic/Relatives of CKD Race Gender Age Diseases: DM, HT, auto-immune, Rheumatic Infections: Malaria, HIV, HCV, Streptococcus

Sheffield Kidney Institute USAUK

Sheffield Kidney Institute S I P Risk Factors in CKD BP Glycaemia Dyslipidemia Weight Smoking INFECTIONS: HCV, HIV, Malaria, schisto

Sheffield Kidney Institute HIV

Sheffield Kidney Institute MRFIT Study

Sheffield Kidney Institute

AIRC, Jurkovitz et al, 2003

Sheffield Kidney Institute Iseki et al, 2003

Sheffield Kidney Institute PRE-CKD CKD 1 CKD 2 CKD3 ESRF CKD4 Established CKF

Sheffield Kidney Institute S I P Risk Factors in CKD Modifiable BP Proteinuria Dyslipidemia Smoking

Sheffield Kidney Institute Locatelli et al 1996

Sheffield Kidney Institute Locatelli et al 1996

Sheffield Kidney Institute Attman et al 1999

Sheffield Kidney Institute Bonnet et al 2001

Sheffield Kidney Institute Non-DN DN Orth 2002

Sheffield Kidney Institute PRE-CKD CKD 1 CKD 2 CKD3 ESRF CKD4 Established CKF

Sheffield Kidney Institute Hypertension <125/75 Proteinuria <1g/d Lipids <5 Smoking STOP Alcohol Weight

Sheffield Kidney Institute ACEI/ARB NDCCB  -blocker ACEI/ARB NDCCB STATIN STOP Renoprotection Cardioprotection

Sheffield Kidney Institute PRE-CKD CKD 1 CKD 2 CKD3 ESRF CKD4 X X X

Sheffield Kidney Institute GUIDELINES ESRD Lack of resources Lack Nephologists Lack Dialysis Death

Sheffield Kidney Institute 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

Sheffield Kidney Institute PRE-CKD CKD 1 CKD 2 CKD3 ESRF CKD4 AT RISK

Sheffield Kidney Institute K/DOQI At-risk Population + CKD 1 At-risk Population –DM, HT –Obese individuals –Relatives of CKD –Ethnic/racial populations at risk –Infections: malaria, Schisto, HCV, HIV

Sheffield Kidney Institute DM Treat Prevent Screen PREVENTION

Sheffield Kidney Institute

IGT 2000:197m 2025:380m DM 2000:155m 2025: 300m DN 2000:15-30m 2025:30-60m

Sheffield Kidney Institute 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

Sheffield Kidney Institute

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%

Sheffield Kidney Institute 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

Sheffield Kidney Institute HT Treat Prevent Screen PREVENTION

Sheffield Kidney Institute Lifestyle Modifications & CKD Salt Restriction Weight Reduction Exercise

Sheffield Kidney Institute DASH-Salt Na: 141 mmol/d Na: 106 Na: 65

Sheffield Kidney Institute

Evolution

Sheffield Kidney Institute PRE-CKD CKD 1 CKD 2 CKD3 ESRF CKD4

Sheffield Kidney Institute 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

Sheffield Kidney Institute K/DOQI At-risk Population + CKD 1 At-risk Population –DM, HT –Obese individuals –Relatives of CKD –Ethnic/racial populations at risk –Infections: malaria, Schisto, HCV, HIV

Sheffield Kidney Institute The oedematous woman - Gerard Dou 1662 (Louvre Museum)

Sheffield Kidney Institute 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

Sheffield Kidney Institute

677 hypertensive type 2 diabetics –166 (24.5 %) : BP < 140/90 – 81 (7.53 %): BP < 130/85 – 22 (3.25 %): BP < 130/80 FAMUS BP Control Study

Sheffield Kidney Institute 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

Sheffield Kidney Institute Sheffield School of Nephrology

Sheffield Kidney Institute 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

Sheffield Kidney Institute

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

Sheffield Kidney Institute

Adjusted incident rates & annual percent change Figure 2.2 Incident ESRD patients; Medical Evidence form data; rates adjusted for age, gender, & race.

Sheffield Kidney Institute