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Dr obrador nc ds ckd prev & keep mexico v2 ac 1 25-13
- 1. Initiatives for Prevention of Chronic Kidney Disease Gregorio T. Obrador, MD, MPH Dean & Professor of Medicine Universidad Panamericana School of Medicine President, Board of Directors Mexican Kidney Foundation Co-Chair Kidney Disease Prevention Network
- 2. CKD Prevention Initiatives Epidemiology of ♦ Non-communicable diseases (NCDs) ♦ Chronic kidney disease (CKD) ● KEEP Mexico and Latin American CKD Clinical Practice Guidelines initiatives ● Conclusions
- 3. NCDs are the Most Common Cause of Death Worldwide WHO 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Non-communicable Diseases
- 4. ● 36 million deaths (63%) due to NCDs ● In low- and middle- income countries, 29% of the deaths due to NCDs occur in people younger than 60 years ● Projected 15% increase between 2010-2020.
- 6. Four Modifiable Risk Factors
- 11. Diabetes Prevalence in Mexico 23% don’t know
- 12. Diabetes Prevalence in Mexico ENSANUT 2006
- 13. Diabetes Control ENSANUT 2006
- 14. Diabetes is the Main Cause of Death in Men and Women
- 15. Diabetic Nephropathy is the Most Expensive Complication of Diabetes Diabetes Care 27:104-109, 2004
- 16. Hypertension Prevalence in Mexico
- 17. 43.2% of the Adult Population Has Hypertension in Mexico ENSANUT 2006
- 18. Hypertension Prevalence is Increasing in Mexico
- 19. High Prevalence of Overweight and Obesity in Mexico ENSANUT 2006
- 20. At least, 8.5% of the Adult Mexican Population Have CKD Stages 3-5 CKD 1 62.5% 626,034 pmp CKD 2 29.0% 289,181 pmp CKD 3 8.1% 80,788 pmp CKD 4 0.3% 2,855 pmp CKD 5 0.1% 1,142 pmp Amato et al, Kidney Int 68:S11-S17, 2005
- 21. Number of Patients on Dialysis in Mexico Peritoneal dialysis 45,639 Hemodialysis 19,097 ESRD without access 65,006 TOTAL 129,472 UNAM Study, 2010
- 22. Dialysis Costs in Mexico
- 23. Kidney Transplants in Mexico
- 24. CKD Prevention CKD KRT Risk 1 2 3 Normal 4 5 Dialysis factors Transplant KEEP Primary Secondary Tertiary Prevention Prevention Prevention Prevent CKD Early detection & prevention Treat advanced development of progression/complications CKD Levey et al. Am J Kidney Dis 53:522-35, 2009
- 25. CKD Prevention Initiatives Epidemiology of ♦ Non-communicable diseases (NCDs) ♦ Chronic kidney disease (CKD) KEEP Mexico and Latin American Clinical Practice Guidelines initiatives ● Conclusions
- 26. KEEP Mexico ● KEEP is a free kidney health screening program designed to raise awareness about kidney disease among high risk individuals, and provide free testing and educational information, so that kidney disease and its complications can be prevented or delayed ● Developed by the NKF more than 10 years ago and over 100,00 people have participated in KEEP US ● In 2008, KEEP was adapted for use in Mexico by the Mexican Kidney Foundation ● Pilot program began in 2008 in Mexico City and Guadalajara, Jalisco
- 27. KEEP Mexico
- 28. Methods ● Age, gender, education, employment, insurance ● Tobacco and ETOH use Questionnaire ● Personal and family history of DM, HTN, or CKD ● Past medical care ● Height, weight, body mass index (BMI) Physical exam ● Blood pressure ● Albuminuria (Clinitek) ● Scr (eGFR by MDRD) Lab tests ● Glucose (AccuCheck) ● Hemoglobin (Hemocue) ● Calcium, phosphorus, and iPTH (≥ CKD 3)
- 29. Kidney Int 70 (Suppl 116):S2-S8, 2010 Am J Kidney Dis 57(3): 361-370, 2011
- 31. CKD Prevalence (N=4,970)
- 32. CKD Prevalence by Risk Factor
- 33. Awareness of CKD & Previous Medical Attention
- 34. CKD Prevalence in the Pilot Program KEEP Mx versus KEEP US
- 35. Jalisco’s Demonstration Project ● Consisted in adapting KEEP to do rapid and massive screening of diabetic patients attending clinics of the Jalisco State’s Secretariat of Health ● Sponsored by the Federal Government (Popular Insurance) and the Jalisco State’s Secretariat of Health ● Coordinated by the Mexican Kidney Foundation with support from the National Institute of Public Health
- 36. CKD Prevalence in 7,689 Diabetic Patients Screened in 8 Weeks
- 37. CKD Prevalence in 7,689 Diabetic Patients Screened in 8 Weeks
- 39. Latin American CKD 1-5 Clinical Practice Guidelines Available in the following homepages ●Latin American Society of Nephrology (www.slanh.org) ●Mexican Kidney Foundation (www.fundrenal.org.mx) ●Spanish Society of Nephrology (www.sen.org) ●International Society of Nephrology (www.isn.org)
- 40. CKD Prevention Model CKD KRT Risk 1 2 3 Normal 4 5 Dialysis factors Transplant Database KEEP LATIN AMERICAN CLINICAL PRACTICE GUIDELINES Guidelines Care model IN PROGRESS Financing IN PROGRESS Outcomes IN PROGRESS
- 41. Conclusions ● NCDs are the main cause of death worldwide ● High prevalence of CKD and risk factors for CKD in Mexico ● KEEP Mexico is an effective CKD screening program ● CKD Clinical Practice Guidelines are being disseminated and implemmented in an effort to improve outcomes in the Latin American region ● Efforts should focus on effective preventive measures
- 42. Acknowledgements ● National Kidney Foundation ● Univ Panamericana Sch Med ▪ John Davies ▪ Antonio Villa, MD, MSc ▪ Danielle Green ▪ Margarita Virgen, MD ▪ Allan Collins, MD ▪ Ximena Rubilar, RN ▪ Lesley Stevens, MD ▪ Jorge Arizmendi, MD ▪ Giggi Politoski ▪ Monica Gannon ● KEY Australia ▪ Anne Shephard ● Chronic Disease Research Group ▪ Mark Shephard ▪ Nan Booth, MSW, MPH ▪ Anne Wilson ▪ Shane Nygaard, BA ▪ Timothy Mathew ● Mexican Kidney Foundation ● Sponsors ▪ Nadia Olvera, MRS ▪ Secretariat of Health ▪ Evangelina Ferreira, RN ▪ Instituto Carso de Salud ▪ Daniela Ortiz de la Peña, RN ▪ Laboratorios Polanco ▪ Verónica Gutiérrez, RD ▪ Roche ▪ Leopoldo Garvey, MBA ▪ Genzyme ▪ Amgen ▪ Abbott ▪ Hemocue ▪ Beckman Coulter ▪ Bio-Rad
Editor's Notes
- Pink bars are NCD-related deaths in different regions of the world. With the exception of Africa, where communicable diseases are still the main cause of death, NCDs are the main cause of death worldwide.
- De la población mayor de 20 años 77% sab ían que tenían DM y 23% no sabían que tenían DM y fueron identificados a raíz de la encuesta
- DM is the main cause of death in men and women in Mexico. It has been estimated that 5 people die from complications of DM every 2 hours
- Más de la mitad no sabía que tenía HTA.
- Comparison of hypertension prevalence between Mexican Americans (NHANES) and Mexicans between 2000 and 2006
- The cost of hemodialyzing 19,097 current ESRD patients is about $320 million USD The cost of proving hemodialysis to the 65,006 ESRD who currently do not have access to dialysis has been estimated to be $1.2 billion USD
- Number of kidney transplants in Mexico between 1963 and 2011. In the latter year close to 2500 Tx´s were performed, of which 23% were from cadaveric donors and 77% from living donors.
- Data was collected from each participant through a standardized form. Height and weight were measured and BMI was calculated. Blood pressure was measured by trained personnel using manual sphygmomanometers after participants rested quietly for 5 minutes. Blood and urine specimens were obtained from all participants. In KEEP México City, on-site capillary blood measurements included glucose and hemoglobin, obtained with Accu-check Performa equipment and strips (Roche Diagnostics Operations, Inc., Indianapolis, Indiana) for glucose and Hemocue Hb 201 analyzer and micro-cuvettes (HemoCue AB, Ängellhom Sweden) for hemoglobin. Glucose levels were considered fasting if the participant had fasted for at least 8 hours, and otherwise were considered non-fasting. Additionally, 8 mL of venous blood was drawn with disposable vacutainers into 2 yellow-top tubes, centrifuged at 3000-4000 rpm for 10 minutes, and sent refrigerated to a central reference laboratory for measurement of serum creatinine with a Vitros 950 Chemistry System (Johnson & Johnson´s Ortho-Clinical Diagnostics, Inc., Rochester, New York). For patients with stage 3 CKD, serum calcium and phosphorus were measured with a Vitros 950 Chemistry System (Johnson & Johnson´s Ortho-Clinical Diagnostics, Inc., Rochester, New York) that uses Arsenazo-III dye for calcium and ammonium molybdate for phosphorus. Intact PTH was measured by a chemiluminescent immunoassay with a DXi800 equipment and Access Intact PTH reagent (Beckman Coulter, Inc., Fullerton, California). A random urine sample was also obtained for on-site measurement of microalbumin and ACR results with Clinitek Microalbumin Reagent Strips and the Clinitek Status analyzer (Siemens Healthcare Diagnostics Inc., Tarrytown, New York). Participants found to have abnormal kidney function or other abnormality were advised to follow up with their primary care physicians, or were referred to a clinic if they had no primary care physician. Follow-up calls were made 3 months after the screenings to determine if these participants had sought medical attention.
- 11 screening programs between September, 2008 and June, 2009
- Age groups = 18-30 17%, 31-45 35%, 46-60 32%, 61-75 14%, >75 3% 27% with primary (includes incomplete or no primary school), 34% high school, 39% more than high school Medical insurance = 88% public and 12% private Hypercholesterolemia (by history) = 32% Current smoking = 20%