Upload
tal
View
28
Download
2
Tags:
Embed Size (px)
DESCRIPTION
The world-wide epidemiology of CKD and KDIGO Norbert Lameire Em prof Medicine University Hospital Gent, Belgium. Number of patients worldwide treated with chronic dialysis from 1990 to 2010. 2,500,000. 1,490,000. 426,000. 1990. 2010. 2000. Lysaght, J Am Soc Nephrol, 2002. - PowerPoint PPT Presentation
Citation preview
The world-wide epidemiology of CKD
and KDIGO
Norbert LameireEm prof Medicine
University HospitalGent, Belgium
Lysaght, J Am Soc Nephrol, 2002
Number of patients worldwide treated with chronic dialysis from 1990 to 2010
1990 2000 2010
426,000
1,490,000
2,500,000
Incidence of ESRD in EuropeTa
ke-o
n-ra
te p
mp
Jager, van Dijk,NDT (in press-2007).
Incidence of ESRD in EDTA/ERA Registry from 1991-2001
Mild renal dysfunction is (Albuminuria and slight decrease in GFR) is highly prevalent
Stage Description GFR (ml/min/1/73
m2)
Est. Prevalence
USA
Est. Prevalence
GRONINGEN
1 Albuminuria, normal or GFR > 90 3.3% 1.3%
2 Albuminuria, mild GFR 60 - 89 3.0% 3.8%
3 Moderate GFR 30 - 59 4.3% 5.3%4 Severe GFR 15 - 29 0.2% 0.1%
5 Kidney Failure < 15 or RRT 0.2% 0.0%
Total 11.0% 10.5%
Coresh et al; Am J Kidney Dis 2004De Zeeuw et al; Kidney Int; Ali et al Doct Thesis,Aberdeen 2007
K/DOQI Clinical Practical Guidelines Am J Kidney Dis 2003
EstprevScotl
3.1%
> 500,000,000
INDIVIDUALS WITH CHRONIC KIDNEY DISEASE WORLDWIDE
Estrapolated from Coresh et al., Am J Kidney Dis, 2003
End points after 5 years of evolution of 27998 CKD patients (Kaiser-Permanente)
14,910,2
0,010,06
74,8
16,219,5
0,2 0,9
63,3
10,3
24,3
0,2 1,1
64,2
6,6
45,7
2,3
17,6
27,8
01020304050607080
60-89 Stage 2;60-89 Stage 3;30-59 Stage 4;15-29
Disenrolled Died(prior to dial/tx) Received txStart dialysis None of the above
No proteinuria Proteinuria
Keith et al, Arch Int Med 2004,164:659-664.
eGFR
%
Per person cumulative cost by stage of CKD (Kayser Permanente)
16212
38764
18964
33144
19106
41928
05000
1000015000200002500030000350004000045000
Stage 2 Stage 3 Stage 4
age-gender matched controls CKD casesUS $
Smith et al JASN, 15:1300-1306,2004
MDRD estimates
A sm a ll red uc tio n in the g ro w th o f ne w E S R F pa tie n ts m ak es a la rg e im p a c t on th e nu m b ers on d ia lys is
P re va le nce o f A us tra lia n d ia lys is p a tie n ts – ac tu a l d a ta to 20 0 2 w ith p ro je c tio ns to 2 0 2 0
A sm a ll re d u ctio n in the g ro w th o f n e w E S R F pa tien ts m a k es a la rg e im pa c t o n the nu m b ers o n d ia lys is
P re va le nce o f A u s tra lia n d ia lys is p a tie n ts – ac tu a l d a ta to 20 0 2 w ith p ro je c tions to 2 0 2 0
0
5000
10000
15000
20000
25000
1982 86 90 94 98 2 6 10 14 18
# o
f p
ats
6% in cre a se2% in cre a se
Why do we need Guidelines? Information overload Many effective treatments Increased outcomes research Identify gaps in clinical knowledge Need to quantify outcome related performance Increasing costs of medical care Realization of limited resources Improve accountability
Changing patient-physician relationships Higher expectations of an increasingly educated
public
Where are clinical guidelines coming from?
Where are guidelines coming from?• Sages…, old wise men….,
Prof Medicine,Gent
Em Prof Medicine,Heidelberg
Em Prof Medicine, Gent
May the Force be with you…..
Prof Medicine,Santander
Rationale for a Global Initiative
There is an increasing prevalence of kidney disease worldwide. The complications and problems of patients with kidney disease are universal.
Resources may vary, but the science and evidence-based care of patients with kidney disease are independent of geographical location or national borders.
There is room for improving international cooperation in the development, dissemination and implementation of clinical practice guidelines.
KIDNEY DISEASE IMPROVING GLOBAL OUTCOMES (KDIGO)
Independently incorporated, non-profit foundation governed by an international board with the stated mission to:
Improve the care and outcomes of kidney disease patients worldwide by promoting coordination, collaboration, and integration of initiatives to develop and implement clinical practices guidelines.
KDIGO Board of Directors - 2007Garabed Eknoyan, USA (Co-Chair)Co-Chair)
Norbert Lameire, Belgium (Co-Chair)Co-Chair)
Mona Al-Rukhaimi, UAE
Sharon Andreoli, USA
Mustafa Arici, Turkey
Kamal Badr, Lebanon
Rashad Barsoum, Egypt
Gavin J. Becker, Australia
Ezequiel Bellorin, Venezuela
Fred Brown, USA
Emmanuel Burdman, Brazil
Evelyn Butera, USA
Jorge Cannata, Spain
Jeremy Chapman, Australia
Ricardo Correa-Rotter, Mexico
Olivier Coustere, France
Jonathon Craig, Australia
Bruce Culleton, Canada
Angel de Francisco, Spain
Paul de Jong, Netherlands
Jean-Yves DeVos, Belgium
Kai-Uwe Eckardt, Germany
Knut Erben, Germany
Dennis Fouque, France
Gordon Guyatt, Canada
Vivekanand Jha, India
Michelle Josephson, USA
Bertram Kasiske, USA
Adeera Levin, Canada
Nathan Levin, USA
Phillip Li, Hong Kong
Francesco Locatelli, Italy
Alison MacLeod, UK
Linda McCann, USA
Peter McCullough, USA
Sarala Naicker, South Africa
Brian Pereira, USA
Miguel Riella, Brazil
Jerome Rossert, France
Yusuke Tsukamoto, Japan
Raymond Vanholder, Belgium
Yves Vanrenterghem, Belgium
Giancarlo Viberti, UK
Rowan Walker, Australia
Hyan Wang, China
Jan Weening, Netherlands
David Wheeler, UK
Carmine Zoccali, Italy
KDIGO - Work Groups 2006
Evidence Rating – Alison MacLeod, UK Katrin Uhlig, USA Database Website – Raymond Vanholder, Belgium Nathan Levin, USAImplementation/ Regions with CPGs – Norbert Lameire, Belgium Francesco Locatelli, Italy
Implementation/ Regions without CPGs- Vivek Jha, Egypt E. Burdmann, Brazil
Mineral and Bone Disorder – Sharon Moe, USA Tilman Drüeke, France
Liaison Task Force – Raymond Vanholder, Belgium
KDIGO Initiatives
Clinical Practice Guideline Development Global Guideline Coordination Controversies Conferences Mineral and Bone Initiative International Evidence Review Team
KDIGO Activities in 2006 Controversies Conferences: Transplant Recipient; CKD a
Global Public Health Problem Position Statements: Definition, Evaluation and Classification
of ROD, Grading of Evidence and Recommendations of CPGs Guideline Coordination: Liaison Task Force, Annual
Organizational Meeting with 5 guideline organizations and ISN Coordination with WHO: Liaison member on Guideline
Development Groups, Incorporate CKD Staging in ICD 10-11, WHO Guidelines on Guidelines methodology
Clinical Practice Guidelines: Hepatitis C; CKD-MBD; Care of the Kidney Transplant Recipient
Definition and Classification of Chronic Kidney Disease.
A Position Statement from KDIGO
Kidney Int 67:2089-2100, 2005www.kdigo.org
KDIGO modifications from K/DOQI classification
Stage Description GFR (ml/min/1.73 m2)
1 Kidney damage with normal or GFR 90
2 Kidney damage with mild GFR 60-89
3 Moderate GFR 30-59
4 Severe GFR 15-29
5 Kidney failure < 15 (or dialysis)D for dialysis
T for transplant
clinically significant
routine reporting of eGFR based on a standardized serum creatinine
marker of CKD
Iseki K et al. Kidney Int 63:1468-1474, 2003
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
5
10
15UP ≥3+
UP 2+
UP 1+
UP -0 UP
Yrs after Screening Test
ESRD Incidence and Urinary Protein (UP) in Japan
Cum
ulat
ive
Inci
denc
e (%
)
4th KDIGOControversies Conference
CKD as a Global Health Problem: Approaches and
InitiativesCo-Chairs: Andrew Levy, Kai-Uwe
Eckardt, Adeera Levin, Allan Collins, Meguid El-Nahas
October 12-14, 2006
Conceptual model of CKD
Creatinine per method (IDMS 76 µmol/l)
Effect of creatinine calibration on distribution of eGFR
41,8
82,1
45,4
14,5 12,63,2 0,3 0,2
0102030405060708090
> 80 60-79 30-59 < 30
Uncalibrated Calibrated
Per
cent
age
of p
atie
nts
Calibration : - 0.23 mg/dl or 20.3 µmol/LClase et al, JASN 2002,13:2811-2816
Accuracy and precision of the abbreviated MDRD formula in healthy and CKD
populations
Rule et al Ann Intern Med. 2004;141:929-937.
Prevalence of CKD in East Kent• Population of East Kent: 688.193• Stable renal function at follow up determination
• Laboratory results in 2 labs:• Screat ≥ 2.03 mg/dl in men; ≥ 1.53 mg/dl in womenResults: prevalence of CKD: 5554 pmpMedian GFR: 28,5 ml/min; median age: 83 yrs (18-103yrs)Unknown to renal services: 84,8%
Outcomes of referred group: mean survival 29.1 months of unreferred group: mean survival 27.4 months (p< 0.001)
John et al AJKD 43:825-835,2004
Progression of CKD in a large group of unreferred patients in East Kent
0102030405060708090
< 2.O 2.0-2.9 3.0-3.9 4.0-4.9 >5
< 70 70-80 > 80 age
Rate of decline in GFR (ml/min/1.73m²
Percentage
John et al AJKD 43:825-835,2004.
Who to screen?Target groups should include patients with
hypertension, diabetes and cardiovascular disease.
Other groups might include families of patients with CKD, individuals with hyperlipidemia, obesity, metabolic syndrome, smokers, patients treated with medications with potential toxicity to the kidneys, some infectious diseases (HIV, HBV, HCV), cancer patients, and age > 60 years.
CVDInfections-HIV,-HBV,HCV- malaria,TBMalignancies
Levey et al, KI,2007 (in press).
Public health policy • Governments should adopt a public health policy
for CKD. CKD is an integral part of a cluster of chronic diseases, including hypertension, diabetes, and cardiovascular disease. Within each of these groups, the CKD population is the group at highest risk and highest priority for intensivecare and close monitoring. Governments should partner with non-governmental organizations and industry (at the regional, national, and international level) to support the incorporation of CKD into public health agendas.
• Governments should support programs for detection, surveillance, evaluation and management of CKD. The program would document the prevalence, incidence, outcomes, care and education of the public and health care providers. Specific recommendations for screening and surveillance will be included in the published position statement.
• Governments should support a public awareness program for CKD. The public awareness program should present a simple message: CKD is common, harmful and treatable, and individuals should “Know Their A, B, C’s:” Albuminuria, Blood Pressure, Cholesterol, Diabetes, Estimated GFR, …”
Thank you