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