Post on 15-Nov-2014
ANEMIA IN CKDA MAN WITH DOUBLE RECORD
Done by M.D Hani Shaban Nephrologist Department of Hammoud Hospital
Epidemiology Worldwide 50 million people have chronic kidney disease (CKD) CKD affects 11% of the US population ESRD has doubled over the last 10 years to 453,000 people in the US Management of CKD is expensive, accounting for 24% of Medicare expenditures Adverse outcomes of CKD can be prevented or delayed by early detection and treatment
Incidence of ESRD Resulting from Primary Diseases
19% 3% 12% 23%Diabetes Hypertension Glomerulonephritis Cystic Kidney Other Causes
43%
Diabetes: Increasing prevalence worldwide
prevalence of diabetes worldwide (in million)333
rise of prevalence of diabetes 19952025170%
15041%
30developed developing
1985
2000
2025
http://www.idf.org
Hypertension: increasing global burdenNumber of people (in million) with hypertension (>140/90) aged 20 years and older154 150
120 107 100 91 76 52 59 57 36 36 64 40 75
47
Keamy Lancet 2005; 365 217
Establised economy
former USSR
972 million
India
Latin America
Middle east
China
Asia
Africa
2000
2025 1.56 billion
?Why talk about CKD
diabetes CKD
hypertension
The major risk factors for CKD are diabetes and hypertension
Urinary abnormalities (GFR 90 ml/min)
ST AGES OF Chroni c Ki dney Di sease (CKD) Mildly impairedModerate CKD (GFR 30 - 59 ml/min) Severe CKD (GFR 15 - 29 ml/min)
(GFR 60 - 89 ml/min)
ESRD (GFR < 15 ml/min)
Stages of CKD
Prevalence Estimates of CKD in the USStage1
DescriptionKidney damage with normal or increased GFR Kidney damage with mild decrease in GFR Moderate decrease in GFR Severe decrease in GFR Kidney Failure
GFR(mL/min/1.73 (m290>
Prevalence5,900,000
Prevalence (%)3.3
2 3 4 5
60-89 30-59 15-29 (or dialysis) 15 60
45-59
30-44 GFR ml/min/1.73sq.m
15-29
60
45-59
30-44 GFR ml/min/1.73sq.m
15-29
30%16% 14% 15% 15% 12% 10% 9% 8% 7% 6% 5% 3% 2% 0% < 20 20-22 22-24 24-26 26-28 28-30 30-32 32-34 34-36 36-38 38-40 40+ 2%
Mean 27.9 +/- 5.4 Median 27.9n = 131,484
12%
4%
Hematocrit (%)
*131,484 patients who began dialysis between 4/1/95 and 6/30/97. Obrador, J Am Soc Nephrol 1999, 10:1793-1800.
Majority of CKD Patients Not Treated for Anemia Prior to Renal Replacement TherapyrHuEPO use Not treated 77%
Treated 23%N = 155,076
Obrador et al. J Am Soc Nephrol. 1999;10:1793-1800.
The Significance of Anemia in Chronic Kidney Disease
CopyrightMedReviews,LLC.McCulloughPA,LeporNE.TheDeadlyTriangleofAnemia,RenalInsufficiency,andCardiovascularDisease: ImplicationsforPrognosisandTreatment.RevCardiovascMed.2005;6:6.ReviewsinCardiovascularMedicineisacopyrightedpublicationof MedReviews,LLC. Allrightsreserved. Relationshipbetweenchangesinhemoglobin(Hb)levelovertimeandleftventricularmassindex(LVMI)inasubsetof66patientswithchronic congestiveheartfailurefromtheRandomizedEtanerceptNorthAmericanStrategytoStudyAntagonismofCytokinesTrial.*P11