CKD in Iran Presented by: SM Gatmiri, MD, Nephrologist Imam Khomeini Hospital, TUMSNRC In The Name...
Transcript of CKD in Iran Presented by: SM Gatmiri, MD, Nephrologist Imam Khomeini Hospital, TUMSNRC In The Name...
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- CKD in Iran Presented by: SM Gatmiri, MD, Nephrologist Imam Khomeini Hospital, TUMSNRC In The Name of God
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- CKD -A worldwide problem. -Rising incidence & prevalence.
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- CKD Definition 1 -Kidney damage 3months, -Structural (pathological) or -Functional (composition of blood or urine) or -Imaging abnormalities -With or without decreased GFR. OR
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- CKD Definition 2 -Presence of GFR
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- Stage 1: NL GFR (>90 mL/min/1.73 m2) & persistent albuminuria (1.8% of the total US adult population). Stage 2: GFR 60 to 89 mL/min/1.73 m2 & persistent albuminuria (3.2%). Stage 3: GFR 30 & 59 mL/min/1.73 m2 (7.7%). Stage 4: GFR 15 & 29 mL/min/1.73 m2 (0.35%). Stage 5: GFR of
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- The number of ESRD in US has increased from -10,000 in 1973 to -86,354 in 1983, & to -527,283 as of December 31, 2007.
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- In 2007 alone, 111,000 patients entered the US ESRD program. (Incidence: 440 PMP)
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- Patients with ESRD consume a disproportionate share of health care resources.
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- Total Medicare DM CHF Dialysis/Tx CKD Numbers 5.8% 1.1% 20.7%25.1% 41.3%48.1% 19% 7.8% CKD, CHF & DM; Number of patients & costs; USA 2002 Costs Collins AJ; USRDS database
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- The total cost of the ESRD program in the US was approximately $35.32 billion in 2007.
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- However CKD in the US, is under- diagnosed & under-treated.
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- Iran Area: 1.648 million Sq Km Population : 68,017,860 Median Age : 24.23,Life Expectancy : 69.96 Total Health Expenditure of GDP : 6%
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- ESRD in Iran 12% Prevalence : 357 PMP Incidence :66 PMP CKD epidemiology in Iran Mitra Mahdavi-Mazdeh- Assessment of HD patients , Iran ;NDT (2007)
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- Mean age difference in ESRD patients during last 10 years in Iran
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- Sex difference in ESRD patients during last 10 years
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- Causes of ESRD in the last 10 years in Iran
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- Sex difference in ESRD patients during last 10 years in Iran male to female ratio is 1.33.
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- Diabetes as the cause of ESRD in the last 10years
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- HTN & DM as the causes of ESRD in the last 10 years in Iran
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- The number Of ESRD will be doubled in next 10 years
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- Annual RRT Cost with total health expenditure of GDP of 6% -Dialysis sessions: 800Billion R for 13000 Pts (>60,000,000 R/Pts) -R Tx drugs =500 B R -for 12000 Pts (>40,000,000 R/Pts)
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- RRT program so far? Kidney Transplant CAPD HD centers
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- Time to change our approach: decrease ESRD number or its postponing
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- Mahdavi-Mazdeh :IJKD.vol:4,no:4, 2010 Population-Based Screening CKD in Iran:
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- What is Solution? We Should push for a CKD education To take serious high NL Cr To take serious HTN &Diabetes management CKD should be viewed as the third part of the deadly triangle with DM and CVD affecting the health & welfare of the general population
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- What is Our Common Task As -Nephrologists -Internist -GPs -Health Authorities?
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- Education 1. Primordial Prevention : Healthy Diet, Changes in Social, Cultural and Personal Habits 2. Early Detection, Referral and Control of HTN & DM Public Education Professional (Health Care Personnel) Education
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- CKD Patients receiving ACE-Is/ARBs NHANES III 19881994 & NHANES 19992002 patients age 60 & older; patients with eGFRs of less than 15 ml/min/1.73 m 2 are excluded. *Sample size less than 30, or coefficient of variation is not less than 30 percent.
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- Vascular Access: New Medical Evidence Form 2728 Data, May 2005-Dec 2006 82% of patients are using a catheter as their first outpatient access!!!! Only 13% of incident HD patients used a fistula as their first access. Assessment of HD patients , Iran ;NDT (2007)
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- AVF use in Canadian prevalent (53%) and incident (26%)patients. In Europe [prevalent(74%), incident(50%) AVF is the advocated access route in Iran [prevalent (91%), incident(37.5%)in Tehran]. Assessment of HD patients , Iran ;NDT (2007) Vascular Access
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- Message: -CKD & ESRD is increased & highly prevalent -A strong CVD risk factor.
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- Message -We can detect CKD with simple tests & there are treatments for CKD.
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- Message: -ESRD is increasing, more than increases in number of HD facility & Tx.
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- Message -We should consider CKD prevention & place initial focus on strategies that slow disease progression to postpone RRT.
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