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Chronic Kidney Disease in the Community -Indian Scenario
by
Dr. Vidya N. Acharya; MD; FAMS;Hon. Secretary - National Kidney Foundation - India
Director - Professor; Post Graduate Studies inNephrology; Muljibhai Patel Society for Research
in Nephro - Urology and Hospital - Nadiad - South Gujarat - India
India - The Hard Economic Facts.
Population = 1000 million and growing
Per capital Income = Rs.12989/year
One US $ = Rs. 46 - 47
Earning > Rs.50,000 = 2.2% of population
No. of poor = 36% of population
Cost of a renal Tx. = Rs. 2,50,000
June, 2003
June, 2003
Chronic Kidney Disease in India - Hospital Based Data
Comparison of data on C.R.F. from Chennai and ChandigarhCompared [hospital data]
Channai - % Chandigarh - %[Mani M.K.] [Sakuja - Sud]
*Chronic Glomerulonephritis 17.44 37.0*Diabetic Nephropathy 27.60 24.0*Chronic Interstitial Nephritis 20.39 14.0*Nephrosclerosis 11.0 13.0
Ref. Kidney Intl. Sup. No. 83; Feb., 2003Community based data may be in variance with selective hospitalbased data June, 2003
Demographics
0
10
20
30
40
50
60
1 2 3
%
Male adults Female adults Children
Chronic Kidney Disease in the Community Mumbai 2002 - Age and
Sex Distribution of the screened population- n =
3218
June, 2003
0
10
20
30
40
50
60
70
80
90
1 2 3 4 5Hindu Muslim Christian Sikh Others
Demographic Data - Mumbai 2002Distribution by Religion - n = 3218
June, 2003
11.210.6
5.3
7.4
0
2
4
6
8
10
12
1 2 3 4
1= Hypertensive nephrosclerosis2= Diabetic renal disease3=Stone disease4=Miscellaneous (GN 3.5%, UTI 3.4%, others 0.5%)
Chronic Kidney Disease Detected in the community:Mumbai 2002
n=3218
CKD=34.7%
Chronic Kidney Disease in the Community Mumbai Data - 2002 [H]
High Risk Group [H] n = 748 Diabetics 122 16% Adults 98.7%
Children 1.3%below 18 yrs.
Non Diabetic 626 84% Hypertensives 210 28% Non. Hypertnvs. 538 72% Combined Diabetics with Hypertensives n = 80/122 = 66%
June, 2003.
Urinary abnormalities in the high risk group - Mumbai 2002 - n = 748
94
87
97
6
13
3
80
85
90
95
100
105
1 2 3
Series2
Series1
Positive
Negative
Proteinuria Hematuria Pyuria
June, 2003
Demographic Data of the High Risk Group -Mumbai 2002 -
Weight distribution [in Kgs.] - n = 748
Entire group 63.6 + 13 (4-110)Diabetic 65.0 + 13 (4-92) Non Diabetic64.2 + 9 (15-110)
Difference in weight not statistically significant
June, 2003
Chronic Kidney Disease: High Risk Group - n = 748
Non-DM 84%
DM16%
Adults 15.7%
Children 0.3%
June, 2003
Chronic Kidney Disease in the Community [H]Mumbai Data - 2002 [contd]
Duration of DiabetesMean in years 4.28 ± 5.18 Range 1 year to 23 yearsDiabetes/AgeMean 52.4 ± 13.5 yrs. Range 2 years - 85 yearsDiabetes and Therapy [OHA and/or Insulin]Not on treatment = 30/122 = 25%On treatment = 92/122 = 75%
June, 2003.
Chronic Kidney Disease in the Community [H] Mumbai Study - Blood Pressure values - n=748
Diabetics/Non Diabetics.
Mean RangeDiabetics Systolic B.P. 132 ± 23mmHg 100 - 180mmHg
Diastolic B.P. 82.6 ± 9.9mmHg 60 - 100 mmHg
Non Systolic B.P. 132.4 ± 21.10mmHg 100 - 201mmHgDiabetics Diastolic B.P. 87 ± 15mmHg 50 - 140 mmHg
June, 2003.
Urinary abnormalities in Diabetics - Mumbai 2002 n=121
5
2.5
0.5
0
1
2
3
4
5
6
1 2 3+ + +Proteinuria
%
%
%
June, 2003
Urinary abnormalities in Diabetics Mumbai - 2002 - n=121
5
2.5
0.5
0
1
2
3
4
5
6
1 2 3+ + +Proteinuria
%
%
%
June, 2003
Chronic Kidney Disease in the Community [H]Mumbai - 2002 [H] - Hypertensives - n = 748.
Known Hypertensives = 210 [28%]Not known Hypertensives = 538 [72%]Duration of Hypertension in yrs.Mean 1.4 ± 3.24B.P. levels Systolic 133.8 ± 24mmHg Range 120 - 190 mmHg
Diastolic 84.3 ± 12.5mmHg Range 70 - 105mmHgNot knownHypertensiveB.P. levels Systolic 131 ± 21mmHg Range 100 - 210mmGh.
Diastolic 86 ± 15mmHg Range 50 - 90mmHg
Differences in B.P. levels between known and not knownhypertensives - not significant.
June, 2003.
4.7
1.4
5
2
0
1
2
3
4
5
6
1 2 3 41+ 2+ 3+ 4+
Mumbai 2002 Data [H]Hematuria in Hypertensives (%)
June, 2003
Chronic Kidney Disease in the CommunityMumbai - 2002 [O + N + H] n = 3218
Renal Diseases Detected 34.7%
Hypertensive Nephrosclerosis = 11.2%Diabetic Renal Disease = 10.6%Stone Disease = 5.3%Miscellaneous Renal Diseases = 7.4%
These include Urinary Tract Infeciton [3.4%]GMN [3.5%] ADPKD: Genito-Urinary Tuberculosis +Urinary Obstruction + Benign Prostatic enlargement[0.5%]
June, 2003.
150(65.0%)
MALE
FEMALE
81(35.0%)
Demography - Bharuch Data -SEX DISTRIBUTION
June, 2003
GROUP <=10 11-20 21-40 41-60 >60 TOTAL
Overall 22 20 93 64 32 231 (%) (9.5) (8.7) (40.3) (27.7) (13.9) Males 13 12 58 43 24 150 (%) (8.7) (8.0) (38.7) (28.7) (16.0)
Females 9 8 35 21 8 81(%) (11.1) (9.9) (43.2) (25.9) (9.9).
Demography - Bharuch Data -Distribution - Age in Years
*
June, 2003
GROUP NORMAL ABNORMAL TOTAL
BHARUCH 139 (61.2%) 92 (39.8%) 231
Chronic Kidney Disease inthe Community - Bharuch Data
June, 2003
URINARY PROTEINURIA (92)
0
10
20
30
40
50
60
Trace '+1 '+2 '+3 '+4
58(63.0%)
20(15.2%)
9(6.5%) 3
(3.3%)
11(12.0%)
Chronic Kidney Disease inthe Community - Bharuch Data
June, 2003
PROTEINURIA IN DIABETES (62)
0
5
10
15
20
25
30
35
Trace '+1 '+2 '+3 '+4
33(53.2%)
12(19.4%)
5(8.1%)
3(4.8%)
9(14.5%)
Chronic Kidney Disease inthe Community - Bharuch Data
June, 2003
PROTEINURIA IN HYPERTENSIVES
0
2
4
6
8
10
12
14
16
Trace '+1 '+2 '+3 '+4
16(55.2%)
6(20.7%)
1(3.4%)
2(6.9%)
4(13.8%)
Chronic Kidney Disease inthe Community - Bharuch Data
June, 2003
CREATININE STATUS
0
50
100
150
200
250
<=1.5 1.5-3.0 3.0-5.0 >5.0
218(94.5%)
6(2.6%)
3(1.1%)
4(1.6%)
Chronic Kidney Disease inthe Community - Bharuch Data
June, 2003
Chronic Kidney Disease in the Community [Data on Bharuch Camp] n = 231
Types of Diseases Detected
* Diabetic Renal Disease = 26.8%* Renal Stone Disease = 17.3%* Hypertensive nephrosclerosis = 16.88%* Urinary Tract Infection = 16.5%* Chronic Renal Failure = 5.6%* Glomerulonephritis with nephrotic syndrome = 3.5%* Benign prostatic hypertrophy = 1.3%
June, 2003.
Chronic Kidney Disease in theCommunity - Mumbai, Udaipur &Bharuch
Disease state Mumbai Udaipur BharuchHypertensive neph. 11.2 30.4 16.88Diabetic renal dis. 10.6 12.6 **26.8Stone Disease 5.3 **34.4 * 17.3Miscellaneous 7.4 12.4 10.8
* p < 0.05** p < 0.001
Miscellaneous group includes GMN, ADPKD, UTI, UrinaruObstruction, Genitourinary TB, Benign Prostate enlargement
June, 2003
Nephrologists as programme developers for the community* Need shift in perspective and use of different sets of analytical skills.* Evaluation of individual community health needs* Measures to counter renal problems as seen in individual communities.
June, 2003
There is a continuing cry for preventive aspects of nephrological disorders, which demands :
* Commitment* Honesty* Accountability* Integrity* Responsibility
June, 2003
Our Grateful Thanks to
* Giants International - Mumbai* Lions Clubs - Mumbai* Rotary Clubs of Mumbai, Udaipur,
Kanpur* Bharuch Junior Chamber
with Dr. Hiren Shah /JC Umesh Shah
June, 2003
[Contd.]
* Prempuri Ashram - Mumbai* Dr. Mukesh Barjathia - Udaipur* Dr. Dilip Sinha - Kanpur* Drs. Niranjan Kulkarni, Dr. Hemal Shah,
and others from Muljibhai Patel UrologicalHospital - Nadiad - South Gujarat
* Drs. Vasanti Balvalli.* Dr. Vishwanath Billa * Dr. Jyotsna Zope
June, 2003
THANK YOU