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CKD Epidemiology 2014
- 1. Sheffield Kidney Institute Global Kidney Academy 5th GKA-Haidylena Nephrology Master Class Alexandria, 2014
- 2. Sheffield Kidney Institute CKD Epidemiology Professor Meguid El Nahas, PhD, FRCP Chairman, Global Kidney Academy Sheffield, UK
- 3. Sheffield Kidney Institute cCKD v rCKD Age Hypertension Diabetes Nephrotoxicity AKI Primary GN Vasculitis GN Pyelonephritis CAKUT PKD
- 4. Sheffield Kidney Institute CKD in the West Community CKD cCKD
- 6. Sheffield Kidney Institute McCullough et al, 2012
- 7. Sheffield Kidney Institute Global CKD Detection Programmes • CKD: 10-16% • Microalbuminuria: ~7% • eGFR<60: ~2.5-5% • eGFR<30: ~0.3-4% • ESRD: ~0.1-0.3%
- 8. Sheffield Kidney Institute Flaws in CKD Screening Programs • Equating Isolated Microalbuminuria to CKD! • Equating Isolated Microscopic Hematuria to CKD! • Testing undertaken only x 1: NOT CHRONIC! • MDRD Formula: Not applicable to General Population • Mostly Elderly people diagnosed as CKD!!!! Overestimation of “CKD”?!
- 9. Sheffield Kidney Institute McCullough et al, 2012
- 10. Sheffield Kidney Institute McCullough et al, 2012
- 11. Sheffield Kidney Institute cCKD in the West Prevalence Unknown!!!!
- 12. Sheffield Kidney Institute The Human Burden of Disease: Historical Perspective 1. The Stage of Pestilence and Famine Life expectancy 20-40 yrs; malnutrition, infections 2. The Stage of Receding Pandemics Life expectancy 30-50 yrs; improved nutrition, public health increasing hypertension, hemorrhagic strokes 3. The Stage of Degenerative and Man-made Diseases Life expectancy > 50 yrs increased fat and caloric intake, tobacco use increasing deaths due to chronic (CV) diseases 4. The stage of delayed degenerative diseases Life expectancy > 70 yrs Prevention and treatment delays onset Age adjusted CVD death rates reduced Gersh B J et al. Eur Heart J 2010;31:642-648
- 13. Sheffield Kidney Institute Prevalence of CKD NHANESIII 0% 5% 10% 15% 20% 25% 30% 35% 40% Prevalenc e (%) 20-39 40-59 60-69 70+ Age Group (years) <2% >30%
- 14. Sheffield Kidney Institute the registries, underdiagnosis and scant resources to detect and treat patients with CKD (figure 1.3-A and 1.3-B). Table 1.3: Prevalence (%) of CKD in the NHANES population within age, gender, race/ethnicity, & risk-factor categories All CKD eGFR <60 ml/min/1.73m2 ACR >=30 mg/g 1988- 1994 2005- 2010 1988- 1994 2005- 2010 1988- 1994 2005- 2010 20-39 5.1 5.7 0.1 0.2 5.0 5.7 40-59 8.4 9.1 1.3 2.2 7.7 7.6 60+ 32.2 35.0 19.5 24.1 18.3 18.4 Male 10.2 12.1 4.1 5.6 7.4 8.6 Female 14.2 15.8 5.6 7.7 10.2 10.2 Non-Hispanic white 12.3 14.3 5.5 7.9 8.2 8.6 Non-Hispanic Blk Af Am 14.5 16.0 4.1 6.2 12.7 12.6 Other 10.5 11.9 2.2 2.6 9.2 10.6 Diabetes 43.1 40.1 15.6 19.3 36.3 29.9 Self-reported diabetes 42.7 41.6 16.4 20.4 35.9 30.8 Hypertension 22.2 23.2 10.4 12.9 15.4 14.8 Self-reported hypertension 25.3 26.8 12.9 15.6 17.1 16.7 Cardiovascular disease 25.4 40.8 14.5 27.9 16.6 24.3 Obesity (BMI >=30) 16.6 16.8 6.2 7.4 12.3 11.7 All 12.3 14.0 4.9 6.7 8.8 9.4 US NHANES
- 15. Sheffield Kidney Institute McCullough et al, 2012
- 16. Sheffield Kidney Institute cCKD in the West A “Disease” of Old People
- 17. Sheffield Kidney Institute El Nahas, KI 2010
- 18. Sheffield Kidney Institute CKD in the East (Emerging Countries) Community CKD cCKD
- 19. Sheffield Kidney Institute cCKD in Emerging Economies Poverty + Infections + Westernisation
- 20. Sheffield Kidney Institute The Human Burden of Disease: Historical Perspective 1. The Stage of Pestilence and Famine Life expectancy 20-40 yrs; malnutrition, infections 2. The Stage of Receding Pandemics Life expectancy 30-50 yrs; improved nutrition, public health increasing hypertension, hemorrhagic strokes 3. The Stage of Degenerative and Man-made Diseases Life expectancy > 50 yrs increased fat and caloric intake, tobacco use increasing deaths due to chronic (CV) diseases 4. The stage of delayed degenerative diseases Life expectancy > 70 yrs Prevention and treatment delays onset Age adjusted CVD death rates reduced Gersh B J et al. Eur Heart J 2010;31:642-648
- 21. Sheffield Kidney Institute HIV 40 million 170 million 300 million 200 million Malaria Hepatitis Schistosomiasis INFECTIONS
- 23. Sheffield Kidney Institute Kearney et al, 2005 972m 1.56b Global Hypertension China 160m mostly untreated! 2000 2025 India 120m China 180 Africa 70 207m 270 150
- 24. Sheffield Kidney Institute Obesity and Urbanisation Urbanisation
- 25. Sheffield Kidney Institute Diabetes and Urbanisation Wang et al, 2005 Urbanisation
- 26. Sheffield Kidney Institute World 2000 2030 154 m 370 m 55 m 84 m Developed Developing 99 m 286 m 16.7 33.8 32.9 18.2 52.4 30.7 28.3 9.1 80.9 22.8 42.3 18.6 0.9 1.6 2000 2030 * In million subjects 102% 81% 71% 211% 255% 127% 78% THE GLOBAL BURDEN OF DIABETES (2000-2030) WHO, March 2003
- 29. Sheffield Kidney Institute Herbal Nephropathies Aristolochic Acid
- 32. Sheffield Kidney Institute Novel risk factors • Environment/Pollution: air and water • Climate change: through effect on communicable diseases, natural disasters and malnutrition • Thrifty “epigenotype”: Low Birth Weight
- 33. Sheffield Kidney Institute cCKD in Emerging Economies Poverty + Infections + Westernisation + Toxicity + LBW +……
- 34. Sheffield Kidney Institute CKD in the West Referred CKD rCKD
- 35. Sheffield Kidney Institute Figure 1.2: Percentage distribution of primary renal diagnosis of ESKD Primary renal diagnosis of ESKD patients - UK Dia betes Glom erulone phritis Rena lVascula rs D isease Pyel on eph ritis Hype rtension Polycystick idneydis ease Other Un certain aetiology 0 10 20 30 Percentagedistribution Primary renal diagnosis of ESKD pa - USA Diab etes Hy pe rtens ion G lom erulone phritis Polycystickidne y disease Urol ogicdi sease O ther Unc ertain aetiology Mis sing ca 0 10 20 30 40 Percentagedistribution Primary renal diagnosis of ESKD patients - BRAZIL 30 40 ribution Primary renal diagnosis of ESKD pat - Singapore 60 80 ribution Figure 1.2: Percentage distribution of primary renal diagnosis of ESKD Primary renal diagnosis of ESKD patients - UK Dia betes Glom erulone phritis Rena lVascula rs Disease Pyel on eph ritis Hype rtension Polycystick idneydis ease Other Un certain aetiology 0 10 20 30 Percentagedistribution Primary renal diagnosis of ESKD patients - USA Diab etes Hy pe rtension G lom erulone phritis Polycystickidne y disease Urol ogicdi sease O ther Unc ertain aetiology Mis sing caus e 0 10 20 30 40 PercentagedistributionPrimary renal diagnosis of ESKD patients - BRAZIL 20 30 40 gedistribution Primary renal diagnosis of ESKD patients - Singapore 40 60 80 gedistribution Causes of ESRD in the West
- 36. Sheffield Kidney Institute rCKD in Emerging Countries Glomerulonephritis AKI/CKD Diabetic Nephropathy Interstitial Nephropathies Renal Stone Disease
- 37. Sheffield Kidney Institute Causes of CKD in India DN, 31% UN, 16% HT, 13% CGN, 14% others, 11% TID, 7% Obs, 4% PKD, 3% Vascular, 1% n=45,748, 2004-2009 Source: Indian CKD Registry
- 38. Sheffield Kidney Institute rCKD in Emerging Economies Late Diagnosis…Late Referral
- 39. Sheffield Kidney Institute CKD stages at presentation I, 2% II, 4% III, 19% IV, 26% V, 49% n=45,748 Indian CKD Registry
- 40. Sheffield Kidney Institute CKD Screening Targeted WESTERN COUNTRIES: T2DM HYPERTENSION CARDIOVASCULAR DISEASE
- 41. Sheffield Kidney Institute CKD Screening: Targeted EMERGING COUNTRIES: T2DM HYPERTENSION CARDIOVASCULAR DISEAS + CHRONIC INFECTIONS NEPHROTOXICITY RENAL STONE DISEASE
- 42. Sheffield Kidney Institute CKD Screening CKD NOC Assignment ARGUE THE LACK OF INDICATION FOR CKD SCREENING!