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Sheffield Kidney Institute: Bridging the Gap Between CKD and C-K-D Epidemiology
- 1. Sheffield Kidney Institute CKD Epidemiology Worldwide CKD versus C-K-D (Setting the record straight…) RCPE, October 2013 Professor Meguid El Nahas, PhD, FRCP Professor of Nephrology, Sheffield Kidney Institute Chairman, Global Kidney Academy Sheffield, UK
- 2. Sheffield Kidney Institute Epidemiologists Clinical Nephrologists CKD versus C-K-D: The Gap between Epidemiologists and Nephrologists CKD C-K-D
- 4. Sheffield Kidney Institute WHAT IS THE EVIDENCE??? Are Nephrologists capable of Critical Thinking?! EVIDENCE QUALITY INTERPRETATION USEFULNESS
- 5. Sheffield Kidney Institute US Population CKD Prevalence Stage/Category % number 1 GFR:>90 3.3 5.9 millions 2 89-60 3 5.3 millions 3 59-30 4.3 7.6 4 29-15 0.25 400,000 5 <15 0.2 345,000 Total 11 19.2millions CKD ESRD ESRD UK: 842/million
- 6. Sheffield Kidney Institute Incidence of ESRD US USRDS 2012
- 7. Sheffield Kidney Institute cCKD = Older People cCKD Epidemiology
- 8. Sheffield Kidney Institute Prevalence of CKD USA 0% 5% 10% 15% 20% 25% 30% 35% 40% Prevalenc e (%) 20-39 40-59 60-69 70+ Age Group (years) <2% >30% <1% >40-50%
- 9. Sheffield Kidney Institute NEOERICA, UK Stevens et al, 2007 >30%
- 10. Sheffield Kidney Institute De Lusignan et al, 2011 70% have CVD 80y
- 11. Sheffield Kidney Institute eGFR Decline with Age
- 12. Sheffield Kidney Institute Subjects with Co-Morbidities (HT/T2DM/CVD) Subjects without co-morbidity Creatinine clearance (ml/min) Age Decline in KF and Co-Morbidities Baltimore Longitudinal Study of Ageing Lindemann, 1985
- 13. Sheffield Kidney Institute Independent Predictors of incident cCKD ATS Chonchol et al, 2010 Baseline Carotid IMT
- 14. Sheffield Kidney Institute Risk of developing cCKD with Ageing Kshirsagar et al, 2008 +
- 15. Sheffield Kidney Institute Figure 2. Association of Subclinical Cardiovascular Disease Measures with Kidney Function Decline Shlipak et al. Page 11 NIH-PAAuthorManuscriptNIH-PAAuthorManuscript Progression of cCKD and Sub-Clinical CVD Shlipak et al, 2009
- 16. Sheffield Kidney Institute Figure 1. Association of Clinical Cardiovascular Disease with Kidney Function Decline Shlipak et al. Page 10 NIH-PAAuthorManuscriptNIH-PAAuthorManuscript Progression of cCKD and Overt CVD Shlipak et al, 2009
- 17. Sheffield Kidney Institute cCKD Age related decline in GFR + CVD
- 18. Sheffield Kidney Institute Microalbuminuria Marker of : Cardiovascular Disease
- 19. Sheffield Kidney Institute Albuminuria & Ageing NHANESIII 19% 32.7% Garg et al, 2002
- 20. Sheffield Kidney Institute MA // Atherosclerosis Hermans et al, HOORN Study Atherosclerosis
- 21. Sheffield Kidney Institute Minamino and Komuro, 2008 Ageing and Vascular Damage
- 22. Sheffield Kidney Institute Minamino and Komuro, 2008 Albumin Ageing and Vascular Damage
- 23. Sheffield Kidney Institute Steno Hypothesis Deckert et al. 1989 Albumin Leak Skin Albumin Leak Kidney
- 25. Sheffield Kidney Institute El Nahas, KI 2010 C-K-D( Cardio-Kidney-Damage)
- 26. Sheffield Kidney Institute Age impacts on outcomes in CKD O’Hare A et al. 2007 210,000 subjects, eGFR<60mls/minute/1.73m², outcomes at 3.5 years cCKD Death CVD Risk rCKD ESRD Risk
- 27. Sheffield Kidney Institute cCKD cCKD have underlying CVD… As manifested by low GFR & Albuminuria & Therefore those with high GFR & Albuminuria Higher risk of dying from underlying CVD…
- 28. Sheffield Kidney Institute Epidemiologists CKD : Predictor of CVD Risk Associations…. Associations…. Associations…. Associations…. CVD “CKD” Computerised Databases
- 29. Sheffield Kidney Institute CKD Consortium, Lancet 2010 CKD and Mortality Risk
- 30. Sheffield Kidney Institute WHAT IS THE EVIDENCE??? Are Nephrologists capable of Critical Thinking?! EVIDENCE QUALITY INTERPRETATION USEFULNESS
- 31. Sheffield Kidney Institute Epidemiologists CKD : Predictor of CVD Risk Associations…. Associations…. Associations…. Associations…. CVD “CKD” Computerised Databases
- 32. Sheffield Kidney Institute Global CKD Screening Programmes Canada USA Mexico Cuba Morocco Egypt RSA Iceland Holland Germany UK Spain Belgium China Hong Kong Japan Korea Singapore Malaysia Thailand Australia Argentina Venezuela Brasil Chile Peru Bolivia Paraguay Italy Switzerland Norway Denmark Finland Iran
- 34. Sheffield Kidney Institute McCullough et al, 2012 IKF not CKD!
- 35. Sheffield Kidney Institute McCullough et al, 2012 Mostly Older People
- 36. Sheffield Kidney Institute McCullough et al, 2012 Quality of Studies Questionable!
- 37. Sheffield Kidney Institute WHAT IS THE EVIDENCE??? Are Nephrologists capable of Critical Thinking?! EVIDENCE QUALITY INTERPRETATION USEFULNESS
- 38. Sheffield Kidney Institute Epidemiologists CKD : Predictor of CVD Risk Associations…. Associations…. Associations…. Associations…. CVD “CKD” Computerised Databases
- 39. Sheffield Kidney Institute CKD Consortium, Lancet 2010 CKD and Mortality Risk
- 40. Sheffield Kidney Institute Lancet 2010 CKD and Mortality Risk
- 41. Sheffield Kidney Institute Life Expectancy and eGFR Gansevoort et al, 2013 age eGFR:120-45 eGFR:<45
- 42. Sheffield Kidney Institute KDIGO 2010 Lancet 2010
- 43. Sheffield Kidney Institute cCKD cCKD have underlying CVD… As manifested by low GFR & Albuminuria & Therefore those with high GFR & Albuminuria Higher risk of dying from underlying CVD…
- 44. Sheffield Kidney Institute WHAT IS THE EVIDENCE??? Are Nephrologists capable of Critical Thinking?! EVIDENCE QUALITY INTERPRETATION USEFULNESS
- 45. Sheffield Kidney Institute Chang and Kramer, 2011
- 46. Sheffield Kidney Institute + 0.003 (0.3%) 2013
- 47. Sheffield Kidney Institute Clase et al, 2011 - + CVD Outcome +/- eGFR and uACR
- 49. Sheffield Kidney Institute 2013 + = High risk of Bias _ = Not Clinically Useful
- 51. Sheffield Kidney Institute Epidemiologists CKD : Predictor of CVD Risk Associations…. Associations…. Associations…. Associations…. CVD “CKD” Computerised Databases
- 52. Sheffield Kidney Institute Older People with CVD = C-K-D cCKD = C-K-D
- 53. Sheffield Kidney Institute CKD C-K-D Epidemiologists Clinical Nephrologists The Gap between Epidemiologists and Nephrologists
Editor's Notes
- This has been confirmed since; for instance individuals with microalbuminuria tend to be those with more severe atherosclerosis (ATS) and vascular stiffness.