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Chronic Kidney Disease: The Philippine Situation

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Chronic Kidney Disease: The Philippine Situation

  1. 1. CHRONIC KIDNEY DISEASE The Philippine Situation
  2. 2. <ul><li>National Nutrition and Health Survey </li></ul><ul><li>Philippine Renal Disease Registry </li></ul><ul><li>Mortality statistics </li></ul><ul><li>Survival data from a cohort study </li></ul>
  3. 3. NATIONAL NUTRITION SURVEY <ul><li>Resulted from the mandate of the Food and Research Institute (FNRI) of the Dept. of Science and Technology (DOST) </li></ul><ul><li>Objective: To assess the Philippine food situation and nutritional status of the population </li></ul><ul><li>Conducted every 5 years since 1978 </li></ul>
  4. 4. NNHeS 2003-2004 Objectives <ul><li>To assess the prevalence of lifestyle and nutrition-related risk factors and diseases among Filipinos 2 years and above </li></ul><ul><li>To aid in the development of health policies an programs for the prevention and control of lifestyle and nutrition-related diseases </li></ul>
  5. 5. NNHeS 2003-2004 Renal Report Chronic Kidney Disease Stages <ul><li>Stage GFR </li></ul><ul><ul><li>1 >=90 Normal or increased GFR </li></ul></ul><ul><ul><li>2 60-89 Mildly decreased GFR </li></ul></ul><ul><ul><li>3 30-59 Moderately decreased GFR </li></ul></ul><ul><ul><li>4 15-29 Severely decreased GFR </li></ul></ul><ul><ul><li>5 <15 Kidney failure </li></ul></ul>Based on guidelines of the Dialysis Outcomes Quality Initiative – US
  6. 6. NNHeS 2003-2004 Renal Report Renal function <ul><li>Abbreviated MDRD formula </li></ul><ul><ul><li>Predicted GFR = 186.3 * (serum creatinine) − 1.154 * age − 0.203 * (0.742 for women) * (1.21 if African American) </li></ul></ul><ul><li>Cockcroft & Gault formula </li></ul><ul><ul><li>Ccr (mL/min) = (140 − age)/sCr * weight/72 * 1.73/BSA, where age is in years, sCr is in mg/dL, weight is in kilograms, and BSA is body surface area using the formula: </li></ul></ul><ul><ul><li>BSA = 0.20247 × [height (m)] 0.725 × [weight (kg)] 0.425 </li></ul></ul>
  7. 7. NNHeS 2003-2004 Renal Report Prevalence of CKD in adults using predicted GFR from MDRD equation <ul><li>Stages of GFR </li></ul><ul><ul><li>1 >=90 72.8% </li></ul></ul><ul><ul><li>2 60-89 24.6% </li></ul></ul><ul><ul><li>3 30-59 2.2% </li></ul></ul><ul><ul><li>4 15-29 0.2% </li></ul></ul><ul><ul><li>5 <15 0.2% </li></ul></ul>The prevalence of CKD Stage 3-5 is 2.6%
  8. 8. NNHeS 2003-2004 Renal Report Prevalence of CKD in adults The population of Filipinos aged 20 years and above in 2005 was 46,627,172 A prevalence of 2.6% means that 1,212,306 adult Filipinos have CKD.
  9. 9. NNHeS 2003-2004 Renal Report Macroalbuminuria <ul><li>at least +1 proteinuria using the Multiple Reagent Strip for Urinalysis ® (Bayer Corporation) </li></ul>The prevalence of macroalbuminuria was 4.2%
  10. 10. NNHeS 2003-2004 Renal Report Microalbuminuria The prevalence of microalbuminuria was 18.5% This is equivalent to 8,626,027 Adult Filipinos
  11. 11. NNHeS 2003-2004 Renal Report Prevalence of CKD Stage 3-5 according to AGE 0.3% 1.0% 5.0% 2.9% 7.5% 20.7%
  12. 12. Mean level of GFR by age group: Philippine vs. US data 75 77 70+ 85 86 60-69 93 100 50-59 99 103 40-49 107 109 30-39 116 119 20-29 NHANES III U.S.A. NNHeS 2003 Philippines Age Group in Years
  13. 13. PHILIPPINE RENAL DISEASE REGISTRY <ul><li>Originated by the PSN in 1996 and later became a joint project with REDCOP </li></ul><ul><li>Collects data on ESRD patients who start hemodialysis, peritoneal dialysis and undergo kidney transplantation </li></ul>
  14. 14. NEW PATIENTS ON DIALYSIS 2001-2005 Number of Patients
  15. 15. NEW PATIENTS ON DIALYSIS: 2001-2005 ACCORDING TO DIALYSIS MODALITY Number of Patients
  16. 16. ACCEPTANCE RATE TO RRT PROGRAMS (PMP) Data from International Federation of Renal Registries website and the Philippine Renal Disease Registry 71 PMP 55 PMP 63 PMP 68 PMP Patients per million population
  17. 17. ACCEPTANCE RATE TO RRT PROGRAMS (PMP) Data from International Federation of Renal Registries website and the Philippine Renal Disease Registry 71 PMP 55 PMP 63 PMP 68 PMP Patients per million population
  18. 18. PRIMARY RENAL DISEASE OF ALL NEW DIALYSIS PATIENTS N = 5,997 20% 26% 38%
  19. 19. DISTRIBUTION OF TOP 3 CAUSES OF ESRD Number of Patients
  20. 20. NNHeS 2003-2004 Renal Report Prevalence of CKD Stage 3-5 according to AGE 0.3% 1.0% 5.0% 2.9% 7.5% 20.7% MEAN AGE – 2004 PRDR DATA ALL NEW DIALYSIS PTS 52 YEARS ESRD - DM NEPHRO 58 YEARS ESRD – HTN NEPHRO 57 YEARS ESRD – CGN 38 YEARS
  21. 21. END STAGE RENAL IS A BAD DISEASE TO HAVE Limited survival Expensive
  22. 22. Retrospective cohort study of 327 patients from NKTI and SLMC diagnosed to have ESRD 2000-2001 OVERALL SURVIVAL <ul><ul><li>12 month estimated survival rate - 53% (95%CI: 47-58) </li></ul></ul><ul><ul><li>24 month estimated survival rate - 36% (95%CI: 30-42 </li></ul></ul>
  23. 23. Results PATIENT GROUP <ul><ul><li>Service – n=198 (60%) Private – n=129 (40%) </li></ul></ul><ul><ul><li>Log rank test: chi2 = 29.62, p<.001 </li></ul></ul>
  24. 24. National Statistics Office Kidney disease is now no. 10 cause of mortality in the Philippines
  25. 25. GROWING PROBLEM OF CHRONIC KIDNEY DISEASE NNHes Population Survey Renal Disease Registry ESRD survival data National mortality data
  26. 26. Treatment is too expensive Prevention is the key
  27. 27. Kung hindi tayo ang kikilos Sino ang kikilos? Kung hindi ngayon, kailan pa?
  28. 28. <ul><li>The Philippine College of Physicians wishes to acknowledge the following for their invaluable contribution in the preparation of this module </li></ul><ul><li>Philippine Society of Nephrology </li></ul>

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