Retardation Of Renal Disease Progression

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  • Overview the rationale of prevention, screening methods, evidences on how to delay renal diseases of diabetic as well as nondiabetic in origin.
  • Renal disease usually progresses slowly about 3 mls/min/year. Even small improvements in slowing renal disease progression can provide large benefits. Multiple risk factors intervention leads to multiple small beneficial effects
  • Retardation Of Renal Disease Progression

    1. 1. Retardation Of Renal Disease Progression Introduction
    2. 2. WHY DO WE BOTHER PREVENTING RENAL FAILURE ?
    3. 3. <ul><li>The Burden of ESRD : </li></ul><ul><li>Economic </li></ul><ul><li>dialysis is a costly treatment </li></ul><ul><li>incidence of ESRD is still increasing especially in the older age groups </li></ul><ul><li>Medical </li></ul><ul><li>Social </li></ul><ul><li>quality of life, work rehabilitation </li></ul>End Stage Renal Disease
    4. 4. Global maintenance dialysis population from 1990 to 2010
    5. 5. <ul><li>Access and Equity </li></ul><ul><li>More Than 80% Of Dialysis Patients Are From USA, Europe And Japan </li></ul><ul><li>The Developing World With 80% Of The World’s Population Has Less Than 20% Of Its Dialysis Patients </li></ul><ul><li>The Capability To Provide Dialysis Treatment Is Directly Related To The Wealth Of The Country. </li></ul>End Stage Renal Disease
    6. 6. <ul><li>Developing countries cannot provide RRT for all patients </li></ul><ul><li>Prevention of ESRD may reduce the burden to the healthcare system. </li></ul>Prevention Of ESRD
    7. 7. Renal Replacement Therapy in Malaysia Prevalence Rate 1980 - 2003
    8. 8. The Economic Burden Of Chronic Renal Failure
    9. 9. <ul><li>Prevention of ESRD may prevent other co-morbid conditions from developing </li></ul><ul><li>In particular, there is a high prevalence of Cardiovascular diseases in patients with Chronic kidney disease </li></ul>The Medical Burden Of Chronic Renal Failure
    10. 10. Cardiovascular mortality in dialysis patients is 10 – 20 times higher than in the general population (GP)
    11. 11. INCREASED BURDEN OF DIABETES
    12. 13. <ul><li>NATIONAL HEALTH AND MORBIDITY SURVEY </li></ul><ul><li>MALAYSIA 1996 </li></ul><ul><li>Prevalence of Diabetes Mellitus – 7% </li></ul><ul><li>Prevalence of impaired GTT - 5% </li></ul><ul><li>Indians had the highest prevalence of DM followed by Chinese, Malays and other indigenous groups </li></ul>( Lim TO et al, Med J Malaysia 2000) Epidemic of Diabetes Mellitus
    13. 14. RENAL REPLACEMENT PROGRAM-MALAYSIA Primary Renal Disease 2000 – 2003 8 1 4 2 2 7 46 31 2036 2001 8 7 9 % miscellaneous 0 0 0 % toxic nephropathy 3 3 3 % obstuctive nephropathy 1 1 1 % polycystic kidney disease 1 1 2 % SLE 5 6 9 % glomerulonephritis 51 50 45 % diabetic nephropathy 30 31 30 % unknown cause 1992 2223 1811 New Dialysis Patient 2003 2002 2000 Year
    14. 15. <ul><li>ESRD due to diabetes is frequently accompanied by other organ complications of diabetes </li></ul>The Medical Burden Of Chronic Renal Failure
    15. 16. Increasing age in patients accepted for dialysis Increased Co-morbidity The Medical Burden Of Chronic Renal Failure
    16. 17. Dialysis Treatment Rate by Age Group 1980 - 2003
    17. 18. WHY DO WE BOTHER PREVENTING RENAL FAILURE ?
    18. 19. Retarding The Progression Of Renal Failure
    19. 20. 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
    20. 21. <ul><li>Who should take the lead? </li></ul><ul><li>The primary care physician and the </li></ul><ul><li>nephrologists </li></ul>PRIMARY CARE PHYSICIAN Screening Diagnosis Treatment NEPHROLOGISTS Diagnosis Management Pre Dialysis care Prevention Of Renal Failure
    21. 22. RENAL DISEASE CHRONIC RENAL FAILURE DIALYSIS OR Tx COMPLICATIONS OF RRT, MORBIDITY/MORTALITY RENOPROTECTION
    22. 23. 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. Prevention Of Renal Failure
    23. 24. REIN (n=352) CAPTOPRIL (n=409) RENAAL (n=1513) IDNT (n=1715) Less Need Of Dialysis For Non Diabetic And Diabetic Renal Disease With Renin – Angitensin Blockade
    24. 25. <ul><li>Management of ESRD poses an immense challenge to healthcare systems all over the world </li></ul><ul><li>Incidence continue to increase and nearly half of the patients are diabetic </li></ul><ul><li>Patients with ESRD have many other medical complications especially CVD </li></ul><ul><li>Retarding the progression renal failure in patients with CKD may reduce the burden of ESRD </li></ul>Conclusion
    25. 26. <ul><li>Good doctor relieve disease </li></ul><ul><li>Better doctor cure disease </li></ul><ul><li>Superior doctor prevent disease </li></ul>Old Chinese saying…….

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