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RETARDATION OF PROGRESSION OF RENAL FAILURE

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					               Retardation Of Renal
               Disease Progression

                      Introduction




Malaysian Society of Nephrology
  Ministry of Health Malaysia
     WHY
  DO WE BOTHER
PREVENTING RENAL
    FAILURE ?
          End Stage Renal Disease

The Burden of ESRD:

Economic
 dialysis is a costly treatment
 incidence of ESRD is still increasing especially in the
  older age groups

Medical

Social
quality of life, work rehabilitation
Global maintenance dialysis
population from 1990 to 2010
        End Stage Renal Disease

Access and Equity
 More Than 80% Of Dialysis Patients Are
  From USA, Europe And Japan

 The Developing World With 80% Of The
  World’s Population Has Less Than 20% Of
  Its Dialysis Patients

 The Capability To Provide Dialysis Treatment
  Is Directly Related To The Wealth Of The
  Country.
         Prevention Of ESRD



 Developing countries cannot provide RRT
  for all patients

 Prevention of ESRD may reduce the
  burden to the healthcare system.
Renal Replacement Therapy in Malaysia
     Prevalence Rate 1980 - 2003
The Economic Burden Of
 Chronic Renal Failure
          The Medical Burden Of
          Chronic Renal Failure

 Prevention of ESRD may prevent other co-
  morbid conditions from developing

 In particular, there is a high prevalence of
  Cardiovascular diseases in patients with Chronic
  kidney disease
     Cardiovascular mortality in dialysis patients is
10 – 20 times higher than in the general population (GP)
 INCREASED
   BURDEN
OF DIABETES
      Epidemic of Diabetes Mellitus

NATIONAL HEALTH AND MORBIDITY SURVEY
MALAYSIA 1996

 Prevalence of Diabetes Mellitus – 7%

 Prevalence of impaired GTT          - 5%

 Indians had the highest prevalence of DM
  followed by Chinese, Malays and other
  indigenous groups
                       ( Lim TO et al, Med J Malaysia 2000)
RENAL REPLACEMENT PROGRAM-MALAYSIA
    Primary Renal Disease 2000 – 2003

Year                          2000   2001   2002   2003
New Dialysis Patient          1811   2036   2223   1992
% unknown cause               30     31     31     30
% diabetic nephropathy        45     46     50     51
% glomerulonephritis           9      7      6      5
% SLE                          2      2      1      1
% polycystic kidney disease    1      2      1      1
% obstuctive nephropathy       3      4      3      3
% toxic nephropathy            0      1      0      0

% miscellaneous                9      8      7      8
The Medical Burden Of
Chronic Renal Failure



    ESRD due to
    diabetes is
    frequently
    accompanied by
    other organ
    complications of
    diabetes
          The Medical Burden Of
          Chronic Renal Failure


Increasing age in
patients accepted
    for dialysis




   Increased
  Co-morbidity
Dialysis Treatment Rate by Age Group
              1980 - 2003
       WHY
  DO WE BOTHER
PREVENTING RENAL
    FAILURE ?
Retarding The Progression Of
        Renal Failure
      Prevention Of Renal Failure



The need to retard the progression of renal
failure is obvious.



Who should take the lead and be the driving
force?
          Prevention Of Renal Failure


Who should take the lead?

The primary care physician and the
nephrologists


 PRIMARY CARE
   PHYSICIAN                         NEPHROLOGISTS

   Screening                         Diagnosis
   Diagnosis                         Management
   Treatment                         Pre Dialysis care
                        RENAL DISEASE




RENOPROTECTION
                   CHRONIC RENAL FAILURE




                        DIALYSIS OR Tx




   COMPLICATIONS OF RRT, MORBIDITY/MORTALITY
        Prevention Of Renal Failure


Will it work?
Recent studies have shown that certain
strategies in the management of diabetic
nephropathy and the non diabetic proteinuric
renal disease can lead to decreased rate of
progression of renal failure.
Less Need Of Dialysis For Non Diabetic And Diabetic
  Renal Disease With Renin – Angitensin Blockade


                               REIN     CAPTOPRIL   RENAAL       IDNT
                              (n=352)     (n=409)   (n=1513)   (n=1715)
                        0%


                       -10%
   relative risk (%)




                       -20%


                       -30%


                       -40%


                       -50%


                       -60%
                  Conclusion

 Management of ESRD poses an immense
  challenge to healthcare systems all over the
  world

 Incidence continue to increase and nearly half of
  the patients are diabetic

 Patients with ESRD have many other medical
  complications especially CVD

 Retarding the progression renal failure in patients
  with CKD may reduce the burden of ESRD
             Old Chinese saying…….


Good doctor relieve disease

Better doctor cure disease

Superior doctor prevent disease