CHRONIC KIDNEY DISEASE The Philippine Situation

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CHRONIC KIDNEY DISEASEThe Philippine Situation
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National Nutrition and Health Survey

• Philippine Renal Disease Registry

• Mortality statistics

• Survival data from a cohort study

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NATIONAL NUTRITION SURVEY

• Resulted from the mandate of the Food and
  Research Institute (FNRI) of the Dept. of Science
  and Technology (DOST)
• Objective To assess the Philippine food
  situation and nutritional status of the
  population
• Conducted every 5 years since 1978

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NNHeS 2003-2004 Objectives

• To assess the prevalence of lifestyle and
  nutrition-related risk factors and diseases among
  Filipinos 2 years and above

• To aid in the development of health policies an
  programs for the prevention and control of
  lifestyle and nutrition-related diseases

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NNHeS 2003-2004 Renal Report Chronic Kidney
Disease Stages

• Stage GFR
• 1 gt90 Normal or increased GFR
• 2 60-89 Mildly decreased GFR
• 3 30-59 Moderately decreased GFR
• 4 15-29 Severely decreased GFR
• 5 lt15 Kidney failure

Based on guidelines of the Dialysis Outcomes
Quality Initiative US
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NNHeS 2003-2004 Renal Report Renal function

• Abbreviated MDRD formula
• Predicted GFR 186.3 (serum creatinine)- 1.154
  age- 0.203 (0.742 for women) (1.21 if
  African American)
• Cockcroft Gault formula
• Ccr (mL/min) (140 - age)/sCr weight/72
  1.73/BSA, where age is in years, sCr is in mg/dL,
  weight is in kilograms, and BSA is body surface
  area using the formula
• BSA 0.20247 height (m)0.725 weight
  (kg)0.425

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NNHeS 2003-2004 Renal Report Prevalence of CKD
in adultsusing predicted GFR from MDRD equation

• Stages of GFR
• 1 gt90 72.8
• 2 60-89 24.6
• 3 30-59 2.2
• 4 15-29 0.2
• 5 lt15 0.2

The prevalence of CKD Stage 3-5 is 2.6
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NNHeS 2003-2004 Renal Report Prevalence of CKD
in adults
The population of Filipinos aged 20 years and
above in 2005 was 46,627,172
A prevalence of 2.6 means that 1,212,306 adult
Filipinos have CKD.
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NNHeS 2003-2004 Renal Report Macroalbuminuria

• at least 1 proteinuria using the Multiple
  Reagent Strip for Urinalysis (Bayer Corporation)

The prevalence of macroalbuminuria was 4.2
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NNHeS 2003-2004 Renal Report Microalbuminuria
The prevalence of microalbuminuria was 18.5
This is equivalent to 8,626,027 Adult Filipinos
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NNHeS 2003-2004 Renal Report Prevalence of CKD
Stage 3-5according to AGE
20.7
7.5
5.0
2.9
0.3
1.0
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Mean level of GFR by age group Philippine vs.
US data
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PHILIPPINE RENAL DISEASE REGISTRY

• Originated by the PSN in 1996 and later became a
  joint project with REDCOP
• Collects data on ESRD patients who start
  hemodialysis, peritoneal dialysis and undergo
  kidney transplantation

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NEW PATIENTS ON DIALYSIS 2001-2005
Number of Patients

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NEW PATIENTS ON DIALYSIS 2001-2005ACCORDING TO
DIALYSIS MODALITY
Number of Patients

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ACCEPTANCE RATE TO RRT PROGRAMS (PMP) Data from
International Federation of Renal Registries
website and the Philippine Renal Disease Registry
71 PMP 55 PMP 63 PMP 68 PMP
Patients per million population
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ACCEPTANCE RATE TO RRT PROGRAMS (PMP) Data from
International Federation of Renal Registries
website and the Philippine Renal Disease Registry
71 PMP 55 PMP 63 PMP 68 PMP
Patients per million population
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PRIMARY RENAL DISEASE OF ALL NEW DIALYSIS
PATIENTS
N 5,997
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26
38
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DISTRIBUTION OF TOP 3 CAUSES OF ESRD
Number of Patients
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NNHeS 2003-2004 Renal Report Prevalence of CKD
Stage 3-5according to AGE
MEAN AGE 2004 PRDR DATA ALL NEW DIALYSIS PTS
52 YEARS ESRD - DM NEPHRO
58 YEARS ESRD HTN NEPHRO 57
YEARS ESRD CGN 38
YEARS
20.7
7.5
5.0
2.9
0.3
1.0
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END STAGE RENAL IS A BAD DISEASE TO HAVE
Limited survivalExpensive
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Retrospective cohort study of 327 patients from
NKTI and SLMC diagnosed to have ESRD
2000-2001OVERALL SURVIVAL
12 month estimated survival rate - 53 (95CI
47-58) 24 month estimated survival rate - 36
(95CI 30-42
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ResultsPATIENT GROUP
Service n198 (60) Private n129
(40)
Log rank test chi2 29.62, plt.001
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National Statistics Office
Kidney disease is now no. 10 cause of mortality
in the Philippines
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GROWING PROBLEM OF CHRONIC KIDNEY DISEASE
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Treatment is too expensive
Prevention is the key
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Kung hindi tayo ang kikilosSino ang kikilos?
Kung hindi ngayon, kailan pa?
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• The Philippine College of Physicians wishes to
  acknowledge the following for their invaluable
  contribution in the preparation of this module
• Philippine Society of Nephrology