1. CARIBBEAN RENAL REGISTRY:
JAMAICA-ARM 2012
ADR
AK. SOYIBO
EN. BARTON
CARIBBEAN INSTITUTE
OF NEPHROLOGY

2. COLLABORATORS/SPECIAL
THANKS
1. MINISTRY OF HEALTH, JAMAICA
1. Dr. T Davidson
2. Caribbean Institute of Nephrology
1. TEAM
3. Spanish Town Hospital
1. Dr. R. Smith
2. Staff
4. Mandeville Regional Hospital
1. Dr.Ukala
2. Staff
5. St. Ann’s Bay Hospital
1. Records department and Renal Clinic Staff
6. Diabetic Associates Renal Unit
1. Dialysis Unit staff

3. COLLABORATORS/SPECIAL
THANKS
1. Hope Dialysis Unit
1. Dr. R. Smith
2. University Hospital of the West Indies
1. Department of Medicine Research Team
3. Winchester Dialysis
1. Staff of Unit
4. Hargreeves Dialysis
1. Staff
5. Lydia Dialysis
1. Staff of unit
6. Belamour Dialysis
1. staff

4. SPECIAL THANKS
National Health Funds
CHASE
e-Health Portfolio

8. Chronic non-communicable disease
and chronic kidney disease
• There is always an ongoing concern for the burden of disease
worldwide.
• There is an incessant search to calculate disease burden and
to project prevalence, if not the incidence, of CNCD globally.
 Diabetes mellitus
 Hypertension
 Obesity
 Cardiovascular diseases (CVD)
 Chronic kidney disease (CKD)
 Dyslipidaemia
• are now the focus of healthcare global talk.
• Jamaica as well other Caribbean countries are also engaged
in this wave.
» AK Soyibo, L Roberts, EN Barton. WIMJ 2012

9. SIGNIFICANCE OF A REGISTRY
• TO MONITOR THE INCIDENCE AND PREVALENCE
OF CHRONIC KIDNEY DISEASE (CKD).
• TO DETERMINE THE CAUSES OF CKD AND
EMERGING TRENDS.
• FOR COMPARISON OF THESE CAUSES WITHIN THE
CARIBBEAN AND WITH NON-CARIBBEAN
COUNTRIES.

10. ….CONTINUED
• TO ASSESS THE QUALITY OF LIFE IN PATIENTS WITH
CKD IN THE CARIBBEAN USING SURROGATE
MARKERS
• TO DETERMINE OTHER CO-MORBID CONDITIIONS
IN CKD.
• TO DETERMINE CAUSES OF MORBIDITY AND
MORTALITY.

11. ….CONTINUED
• TO DETERMINE THE BURDEN OF CKD FOR EACH
COUNTRY
• TO ASSESS WHETHER THE BURDEN OF CKD IS
UNIFORM THROUGHOUT.
• TO DETERMINE THE ECONOMIC AND SOCIAL
COST OF CKD IN CARIBBEAN COUNTRIES.
• TO PLAN AND FORMULATE POLICIES IN THE
HEALTH CARE SECTOR.

12. BURDEN OF CKD
• CKD/ESRD-specific complication
• CKD/ESRD-related complication

13. BURDEN OF CKD
CKD/ESRD-specific complications
• Such as
 Anemia
 mineral bone disease.
• tend to occur later in the course of disease and
may be best treated by a nephrologist.
• The emphasis would be to identify and monitor
these complications before or as they arise

14. BURDEN OF CKD
CKD-related complications
• Which includes
 obesity
 Diabetes
 hypertension
• though treatable by nephrology, may be most
easily treated by primary care physicians and
internists.

16. DATA COLLECTION
Incidence of ESRD
Prevalence
Patients survival
• LIMITED DATA
 Demographics
 Date of start
 Cause of CKD
 Stages of CKD
 Treatment and switches
 Death (date and cause)

17. Structural administrative organization
of the Caribbean Renal Registry

18. Caribbean Renal Registry
data flowchart

19. CARIBBEAN RENAL REGISTRY:
JAMAICA-ARM 2012
JRR ADR

22. Distribution of CKD/ESRD
patientsby stage of CKD 2007 and
2011
STAGE OF KIDNEY DISEASE
45
60 40
35
50 30
25
40 20
15
30 10
5
0
20
1
2
3
10
4
5
0
STAGE 1 STAGE 2 STAGE 3 STAGE 4 STAGE 5

23. Distribution of CKD
patients, by CKD stage (n=1,237)

24. AETIOLOGY OF RENAL DISEASES
AT MRH. (G. Ukala, 2007) DM
HTN
%
SLE

25. Cause of
Renal
Failure in
Patients
dying from Obstruct.
Uropath.
CKD
Metastatic
dx.
83.56%
Proportion of patients
16.4%
who had dialysis
Before death

28. Insurance status in patients with
CKD, by CKD stage (n=1,237)

29. Type of insurance in CKD patients with
insurance, by CKD stage (n=408)

30. Smoking status of patients
with CKD, by CKD stage (n=1,226)

31. Body mass index (kg/m2) in patients
with CKD, by CKD stage (n=1,237)
DaVita visit, November 27, 2012

33. Summary statistics on the prevalence
of CKD inJamaica

34. Biochemical markers in
patients with CKD, by CKD stage
DaVita visit, November 27, 2012

35. ESRD POPULATION
HEMODIALYSIS
DaVita visit, November 27, 2012

37. Distribution of ESRD patients at
initiation, by modality (n=772)
DaVita visit, November 27, 2012

38. Place of death in
hemodialysis patients

39. Primary cause of death in
hemodialysis patients

41. Type of Insurance in
HD Patients with Insurance status in HD patients
insurance (N=101) (N= 598)
Insured Not Insured Unknown
17%
80
70
13%
60
50
40 70%
30
20
10
0
Government Private Unknown
name/conference (to edit: View  Master  Slide master

42. Smoking history in ESRD-HD
(N=598) for Jamaica
Never Smoked
Ex-smoker
Current Smoker
0 10 20 30 40 50 60

43. ?RENAL HISTOLOGY REGISTRY
DaVita visit, November 27, 2012

44. Indication for Kidney Biopsy
diagnosis
atypical
pro/hem
Hemauria
Proteinuria
0 10 20 30 40 50 60 70 80
name/conference (to edit: View  Master  Slide master