Section 1: CKD Epidemiology

The Problem

Chronic Kidney Disease is an epidemic worldwide– Growth 6-8% per annum of dialysis patients

Accumulating data re: possibility of delaying the progression of kidney disease, using multiple drug and behaviour intervention therapies.

Under-recognition at earlier stages of kidney dysfunction persists – Late referral– Lost opportunities for improved patient outcomes

•  

RRT Modalities

05000

10000150002000025000300003500040000

transplant Haemodialysis Home haemodialysis Peritoneal dialysis

36,542

DOD/0503-04

Patients Accepted in the UK for Renal Replacement Therapy

0

50

100

150

200

250

300

80 81 82 83 84 85 86 87 88 90 91 92 93 94 95 96 97 98 99

2000

2001

Year

Ag

e S

pec

ific

Ra

te p

er M

illio

n

0 - 44

45 - 64

65+

Diabetics

Total

0

1000

2000

3000

4000

5000

6000

7000

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

Nu

mb

er

Donors

Transplants

Waiting List

Cadaveric Kidney Donors & Transplants and

End of Year Kidney Waiting List, UK, 1994-2003

DOD/0503-04

Prevalence of renal replacement therapy

Take-on rates /pmp

England 98

Wales 118

France 200

Italy 260

USA 315

Estimates of Prevalence of CKD in the US: NHANES III

Stage DescriptionGFR

(ml/min/1.73 m2)

Prevalence(000s)

Prevalence(%)

1Kidney Damage with

Normal or GFR>90 5,900 3.3

2Kidney Damage with

Mild GFR60-89 5,300 3.0

3 Moderate GFR 30-59 7,600 4.3

4 Severe GFR 15-29 400 0.2

5 Kidney Failure<15 or

(or dialysis)300 0.1

Adapted from Am J Kidney Dis 2002; 39 (2, Suppl. 1): S17-S31

NICE: 2008 Classification of CKDwaking up to the impact of proteinuria

• Stage 1: GFR>90 + abnormal urinalysis • Stage 2: GFR 60-89 + abnormal

urinalysis• Stage 3A: GFR 45-59• Stage 3B: GFR 30-44• Stage 4: GFR 15-29• Stage 5: GFR <15 or dialysis dependent

Suffix P denotes presence of proteinuria (ACR>30 or PCR>50)

National Disease Prevalence Survey (%)

3.6

0.41.4

12

3.6

8.5

0

2

4

6

8

10

12

Diabetes CCF COPD Hypertension CHD CKD

CKD: A Typical GP Practice of 10000

90460

60

6

380

60

15

30

(GF

R)

(GF

R)

Sta

ge

of

Kid

ney

Dis

ease

11

22

33

44

55

Incident Rates by Primary Diagnosis

(per million population, unadjusted)

USRDS, 2000

Obesity Trends: UK

Life expectancy: UK