Primary Diagnoses for Patients Who Start Dialysis Talking Points: Diabetes is the major cause of end-stage renal disease (ESRD). Hypertension is the second most common cause. But, a substantial proportion of diabetics will have hypertension (blood pressure > 140/90 mm Hg) as an important contributing factor to their loss of renal function. References: United States Renal Data System (USRDS) 2000 Annual Data Report. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases – Division of Kidney, Urologic and Hematologic Diseases. USRDS Coordinating Center operated by the Minneapolis Medical Research Foundation. Internet Address: www.usrds.org
world kidney day
WORLD KIDNEY DAY (1)PURPOSE:• World Kidney Day was established to increase awareness of the need for detection programs for CKD & to improve prevention & treatment of CKD. 2.The motto of World Kidney Day: Kidney Disease is Common, Harmful and Treatable.
About 20 Million People With Chronic Kidney Disease (CKD) in the United States and ~20 Million More at Risk Estimates Suggest That About 10Percent of Adult Patients Worldwide May Have CKD
Dialysis Mortality: 20%General Population vs ESRD Dialysis Patients 100Annual CVD Mortality (%) 10 GP Male 1 GP Female GP Black 0.1 GP White Dialysis Male Dialysis Female 0.01 Dialysis Black Dialysis White 0.001 25-34 35-44 45-54 55-64 66-74 75-84 >85 Age (years)RN Foley, PS Parfrey, and MJ Sarnak; Clinical epidemiology of cardiovascular disease in chronic renal disease AJKD, 1998 32(5):S112-S119
Most People with CKD will DiePrematurely from their Increased Risk of Cardiovascular andCerebrovascular Disease Beforethey Develop End-Stage Kidney Failure
WHY WORLD KIDNEY DAY?• Chronic, non-communicable diseases (i.e. CVD, HTN, DM and CKD) have now replaced communicable diseases as the LEADING THREAT to public health & health budgets worldwide• Deaths… – Attributed to infectious diseases will decline by 3% over the next decade – Attributed to chronic diseases will increase by 17% over the same time frame
InterconnectionsBetween Obesity, Diabetes Mellitus, High Blood Pressure, and Chronic Kidney Disease (CKD)
Diabetes Is the Most Common Primary Diagnosis in Patients With Kidney Failure 350 Hypertension Prevalent Dialysis 45% 27% (2003: 324,826) 300 Diabetes Number of Patients 8% Glomerulonephritis 250 (thousands) 20% 200 Other Prevalent Transplant 150 (2003: 128,131) 100 Incident Dialysis 50 (2003: 100,499) 0 ′88 ′90 ′92 ′94 ′96 ′98 ′00 ′02 YearESRD = end-stage renal disease.USRDS 2005 Annual Data Report. The data reported here have been supplied by the USRDS. The interpretationand reporting of these data are the responsibility of the author(s) and in no way should be seen as an officialpolicy or interpretation of the U.S. government. Available at: www.usrds.org. Accessed December 6, 2005.
Primary Diagnoses for Patients Who Start Dialysis Other 10% Diabetes Glomerulonephritis 13% 50% Hypertension 27%United States Renal Data System(USRDS) 2005 Annual Data Report •WWW.USRDS.ORG
Potentially Preventable Causes of CKD Cause Responsible for % of CKD1.Diabetes Mellitus/Obesity 45%2.Hypertension 27%___________________________________________ ____Total Potentially PreventableCases of CKD 72%NOTE: Since both of these disorders are in large part related to unhealthy nutritional intake and/or
DEFINITION OF OBESITY• Overweight: BMI 25.0 -29.0 kg/m2• Obese: BMI ≥30 kg/m2• Morbidly Obese: ≥35kg/m2• Abdominal Obesity: Waist circumference ≥102 cm in men; ≥88 cm in women
OBESITY RISK FOR ADVANCEDBMI ≥ 25 at 20 years old CKD OR for Incidence of Advanced CKDStratified by Comorbidity No Diabetes 2.4( CI: 1.6-3.6) No Hypertension 3.6 (1.8-7.1) No Diabetes or Hypertension 3.0 (1.4-6.4)Stratified by Type of CKD Diabetic Nephropathy 5.2 (3.2-8.4) Nephrosclerosis 3.0 (1.6-5.5)
Percentage of population that is overweight (BMI 25-29kg/m2) Percentage of population that is obese (BMI≥30kg/m2Kelley et al, Int J Obesity 2008;32:1431-1437
Challenges of CKDManagement problems, enormouseverywhere, are particularly great, evenoverwhelming, in developing countries:1. Little awareness of CKD or itsconsequences2. Few financial resources forprevention, detection or treatment3. Little expertise4. High prevalence of CKD
Today There are Many Safe and Effective Treatments That Prevent or Slow the Progression of Chronic Kidney Disease
Simple Methods for Detection of CKD1. Urine Albumin, including Microalbumin (indicator of kidney disease especially of small blood vessels in kidney)2. Serum Creatinine (indicator of kidney function)3. Blood Pressure
What Can WKD Do (1)?1. Advertise/Educate i. The public-at –large ii. National, regional and local governments, insurers and other health related organizations (eg, the pharmaceutical industry) iii. Health care professionals (There is abundant evidence that medical care is suboptimal nationally, even when financial resources are not a limiting factor).
What Can WKD Do (2)?2. Advocate i. With National, State and Local Governments for Better Kidney Disease: - Education - Prevention - Detection - Treatment ii. With Other Major Organizations; e.g., Insurance Agencies, Large Health Care Providers, Universities, etc.
What Can Be Done (2)?2. Conduct Detection and Treatment Programs i. Particularly for high risk groups. ii. Employ inexpensive methods of detection and treatment (Experience of Dr. Manis from Chennai, consider using non-physicians where possible). iii. Collaboration with other like-minded organizations will increase efficiency and effectiveness – especially for a nation as populous and with as many volunteer health organizations as India.
What Can Be Done (4)?4. Ultimately, the costs of prevention, detection and treatment programs nationally will require resources that can only be provided by such national or regional organizations as governments or other third party insurers – But this is for the future.
WORLD KIDNEY DAY A SUCCESS STORY:There has been an overwhelmingresponse around the world toWorld Kidney Day.
WKD Successes (1)• Outstanding response from around the world: – 45 participating countries - 2006 – 63 participating countries - 2007 – 90 participating countries & territories – 2008 – Over 100 participating countries & territories -2009
WKD Successes (2)Participating Countries – from Albania to Zimbabwe – In many countries, activities in many different places – Participating organizations included: societies, foundations, universities, colleges, hospitals associations, trusts and individuals – Local activities focused on raising awareness across all key audiences: – Public-at -large, Government ministers and Health Officials, Physicians and Allied Health Professionals
World Kidney Day Los Angeles 2010 (2)Many Southern California Organizations joined together for this event (continued)March, 20104. Kidney Disease Lectures at Scheduled Hospital Conferences, Universities - Academic Nephrologists
World Kidney Day Los Angeles 2010 (1)Many Southern California Organizations joined together for this eventMarch 7, 20101. Polycystic Kidney Disease / KidneyWise WalkMarch 11, 20102. Minority community education program and focus groups – Drew Postgraduate Medical School, Community Organizations3. KEEP Dectetion Program– National Kidney Foundation
World Kidney Day Los Angeles 2010 (3)Many Southern California Organizations joined together for this event (continued)March 13, 20095. CKD Management Training for MD’s, RN’s, General Internists, Family Practitioners, Nurse Practitioners and Specialists, Case Managers – Kaiser Permanente Health Care System and Foundation, Los Angeles County Department of Health Services
World Kidney Day Los Angeles 2010 (4)Many Southern California Organizations joined together for this event (continued)March, 2008, 2009 And 20106. Innumerable planning meetings and individual activities – By representatives of all of the above organizations and entities7. In Washington and elsewhere, meeting with government officials, editorials, the media and many many other activities
Interconnections Between Obesity, Diabetes Mellitus (DM), High Blood Pressure, and Chronic Kidney Disease (CKD) Relationships between Obesity, Diabetes & CKD: i. Obesity predisposes to both Diabetes & CKD ii. Diabetes is the most common cause of end-stage CKD that requires chronic dialysistreatments or renal transplantation iii. Roughly one-third of people with Diabeteswill develop CKD
Interconnections Between Obesity, Diabetes Mellitus, High Blood Pressure, and Chronic Kidney Disease (CKD)Relationships between Obesity, Diabetes & CKD:(continued)iv. Diabetes is easy to detect, can be preventedin most cases, and can usually be treatedeffectively in most cases.
Interconnections Between Obesity, Diabetes Mellitus, High Blood Pressure and Chronic Kidney Disease (CKD)Relationships between Obesity, Diabetes &CKD : v. Tight glucose control in DM appears toreduce the risk for CKD. vi. Blood pressure control reduces the harmfulcomplications of DM. vii. DM is easy to detect, and in most cases, itcan be prevented and usually treated effectively.
Interconnections Between Obesity, Diabetes Mellitus, High Blood Pressure, and Chronic Kidney Disease (CKD) Relationships between CKD & high blood pressure: i. High blood pressure, like chronic kidney disease(CKD), is often silent and dangerous. ii. High blood pressure causes CKD. iii. CKD causes High blood pressure. iv. Both CKD and Hogh blood pressure arecommon and treatable.
Interconnections Between Obesity, Diabetes Mellitus, High Blood Pressure, and Chronic Kidney Disease (CKD) Relationships between Obesity, Diabetes, CKD,High blood pressure versus Vascular Disease: 1. Each of the above four conditions increasethe risk for Cardiovascular and CerebrovascularDisease. 2. This risk is often markedly increased. 3. Together these 4 diseases (Obesity,Diabetes, CKD and high blood pressure) cause alarge percentage of the illnesses and deaths inthe Developed and the Developing World.
Interconnections Between Obesity,Diabetes Mellitus, High Blood Pressure, and Chronic Kidney Disease (CKD)What can We do to Prevent and Treat these Related Diseases and Their Harmful Effects?
Diabetes: Tight Glucose & Blood Pressure Control and CV Outcomes Any Diabetic DM Microvascular Stroke Endpoint Deaths Complications 0% Reduction In Relative Risk 5% 10% -10 12% -20 24% * -30 32% 32% * 37% *P <0.05 compared to tight glucose control -40 * 44% Tight Glucose Control Tight BP Control * (Goal <6.0 mmol/l or 108 mg/dL) (Average 144/82 mmHg) -50 Bakris GL, et al. Am J Kidney Dis. 2000;36(3):646-661.
Suggested Goals for CKD Patients esp. with Diabetes and High Blood Pressure• Lifestyle modifications (no obesity, regular exercise)• BP 130/80 mmHg or lower, esp in diabetes or proteinuria)• Maximal reduction of proteinuria (<1 g/d)• Multiple BP lowering meds(3-4 meds or more, if needed)• ACEIs, ARBs, Diuretics, Beta-Blockers, Non- Dihydropyridine-CCBs• HbA1c at <7% (in diabetics)• Dietary protein restriction (0.6 - 0.8 kg/d)• Dietary sodium restriction (<2-3 g/d sodium)• Lipid-lowering therapy (diet, statins)
What Can Be Done (3)?3. New Direction: We are beginning to join with other disease focused groups and world health days that relate to kidney disease (for example, World Hypertension Day, possibly in the future, World Diabetes Day).
World Kidney Day-Plans For 2009(2) 2. Collaboration with World Hypertension Day. i. Share messages on websites, in printed messages? ii. Place links on respective websites? iii. Inaugurate combined programs in selected circumstances(2009 WKD will add a HTN focus). 3. Basic Principal: A message has the greatest impact when it is repeated many times and in different ways or by different groups.
World Kidney Day-Plans For 2009(3) i. It follows that we might all come closer to achieving our respective goals if Heart, Diabetes and Stroke join in this linkage effort with WHD and WKD. 4. Role for the Vascular Alliance? i. Coordinate such linkage efforts? ii. Facilitate the liaison between Vascular Alliance and target audiences (eg, Nurses, family practitioners, general internists, pharmacists, government ministries, etc.).
World Kidney Day – Future Plans1. Increase Public Health Message2. Bring all Kidney Disease Organizations together for a Unified Effort and Message (kidney foundations, societies of nephrology, patient organizations, community activists, medical schools, teaching hospitals, insurers)3. Each community to use WKD as time to announce goals and timelines for targeted improvements in prevention and health care for people with or at risk for kidney disease. WKD is also used to announce the status and successes of these efforts.
Potential Evolution in Goals for World Kidney DayThe goal is to use World Kidney Day as amechanism to stimulate people to work togetherto improve the health care system as it affectspublic health, preventative medicine and acuteand chronic medical care in their locality withregard to acute and chronic kidney disease .We want to have volunteers from kidneyfoundations, kidney patient organizations,societies of nephrology, other interestedorganizations and the public-at-large jointogether to attain these goals in their locality.