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 25 20 15 10 5 0 20-29 30-39 40-49 50-59 60-69 70+ 0.3% 1.0% 5.0% 2.9% Stage 4 Stage 5 20.7% 7.5% 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 30-39 40-49 50-59 60-69 70+ 119 109 103 100 86 77 116 107 99 93 85 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 6000 5070 5000 4000 3000 2000 4363 4409 5597 5997 2001 2002 2003 2004 2005 NEW PATIENTS ON DIALYSIS: 2001-2005 ACCORDING TO DIALYSIS MODALITY Number of Patients 7000 6000 5000 4000 3000 2000 1000 0 PD HD 5597 5070 4363 4409 5997 TOTAL 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 PHIL 2003 PHIL 2004 PHIL 2005 INDONESIA CHINA MALAYSIA AUSTRALIA KOREA INDIA SPAIN CANADA MEXICO US 71 PMP 55 PMP 63 PMP 68 PMP 0 50 100 150 200 250 300 Patients per million population 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 50 100 150 200 250 300 Patients per million population PRIMARY RENAL DISEASE OF ALL NEW DIALYSIS PATIENTS N = 5,997 HD OTHERS APKD GOUT OBSTR UNK CPN HPN GN DM PD 20% 26% 38% 0 500 1000 1500 2000 2500 DISTRIBUTION OF TOP 3 CAUSES OF ESRD 2002 2003 2004 2005 2500 Number of Patients 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 ALL NEW DIALYSIS PTS Stage 3 Stage 4 52 YEARS Stage 5 20.7% 25 20 15 10 5 0 ESRD - DM NEPHRO 58 YEARS ESRD – HTN NEPHRO ESRD – CGN 57 YEARS 38 YEARS 7.5% 5.0% 0.3% 1.0% 2.9% 20-29 30-39 40-49 50-59 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 analysis time 730 1000 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%) 1.00 Private – n=129 (40%) 0.75 Private 0.50 0.25 Service 0.00 365 days 730 1000 Log rank test: chi2 = 29.62, p<.001 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 ESRD survival data National mortality 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