Retardation Of Renal Disease Progression
Transcript of Retardation Of Renal Disease Progression
Malaysian Society of NephrologyMinistry of Health Malaysia
Retardation Of Renal Disease Progression
Introduction
WHY DO WE BOTHER
PREVENTING RENAL FAILURE ?
The Burden of ESRD:
Economic dialysis is a costly treatment incidence of ESRD is still increasing especially
in the older age groups
Medical
Socialquality of life, work rehabilitation
End Stage Renal Disease
Global maintenance dialysis population from 1990 to 2010
Access and Equity More Than 80% Of Dialysis Patients Are
From USA, Europe And Japan
The Developing World With 80% Of The World’s Population Has Less Than 20% Of Its Dialysis Patients
The Capability To Provide Dialysis Treatment Is Directly Related To The Wealth Of The Country.
End Stage Renal Disease
Developing countries cannot provide RRT for all patients
Prevention of ESRD may reduce the burden to the healthcare system.
Prevention Of ESRD
Renal Replacement Therapy in Malaysia Prevalence Rate 1980 - 2003
The Economic Burden Of Chronic Renal Failure
Prevention of ESRD may prevent other co-morbid conditions from developing
In particular, there is a high prevalence of Cardiovascular diseases in patients with Chronic kidney disease
The Medical Burden Of Chronic Renal Failure
Cardiovascular mortality in dialysis patients is 10 – 20 times higher than in the general population (GP)
INCREASED BURDEN
OF DIABETES
NATIONAL HEALTH AND MORBIDITY SURVEYMALAYSIA 1996
Prevalence of Diabetes Mellitus – 7%
Prevalence of impaired GTT - 5%
Indians had the highest prevalence of DM followed by Chinese, Malays and other indigenous groups
( Lim TO et al, Med J Malaysia 2000)
Epidemic of Diabetes Mellitus
Year 2000 2001 2002 2003
New Dialysis Patient 1811 2036 2223 1992
% unknown cause 30 31 31 30
% diabetic nephropathy 45 46 50 51
% glomerulonephritis 9 7 6 5
% SLE 2 2 1 1
% polycystic kidney disease 1 2 1 1
% obstuctive nephropathy 3 4 3 3
% toxic nephropathy 0 1 0 0
% miscellaneous 9 8 7 8
RENAL REPLACEMENT PROGRAM-MALAYSIAPrimary Renal Disease 2000 – 2003
ESRD due to diabetes is frequently accompanied by other organ complications of diabetes
The Medical Burden Of Chronic Renal Failure
Increasing age in patients accepted
for dialysis
Increased Co-morbidity
The Medical Burden Of Chronic Renal Failure
Dialysis Treatment Rate by Age Group 1980 - 2003
WHY DO WE BOTHER
PREVENTING RENAL FAILURE ?
Retarding The Progression Of Renal Failure
The need to retard the progression of renal failure is obvious.
Who should take the lead and be the driving force?
Prevention Of Renal Failure
Who should take the lead?
The primary care physician and the
nephrologists
PRIMARY CARE PHYSICIAN
Screening
Diagnosis
Treatment
NEPHROLOGISTS
Diagnosis
Management
Pre Dialysis care
Prevention Of Renal Failure
RENAL DISEASE
CHRONIC RENAL FAILURE
DIALYSIS OR Tx
COMPLICATIONS OF RRT, MORBIDITY/MORTALITY
RENOPROTECTION
Will it work?
Recent studies have shown that certain
strategies in the management of diabetic
nephropathy and the non diabetic proteinuric
renal disease can lead to decreased rate of
progression of renal failure.
Prevention Of Renal Failure
-60%
-50%
-40%
-30%
-20%
-10%
0%
rela
tive
ris
k (%
)
REIN(n=352)
CAPTOPRIL(n=409)
RENAAL(n=1513)
IDNT(n=1715)
Less Need Of Dialysis For Non Diabetic And Diabetic Renal Disease With Renin – Angitensin Blockade
Management of ESRD poses an immense challenge to healthcare systems all over the world
Incidence continue to increase and nearly half of the patients are diabetic
Patients with ESRD have many other medical complications especially CVD
Retarding the progression renal failure in patients with CKD may reduce the burden of ESRD
Conclusion
Good doctor relieve disease
Better doctor cure disease
Superior doctor prevent disease
Old Chinese saying…….