World Kidney Day-

2018
Prevalence of ESRD has been rising steadily

USRDS ADR, 2007

CKD as a Public Health Issue
• The approximate prevalence of CKD is 800 pmp in India
• The reported ESRD incidences is 160–232 pmp and the
projected ESRD prevalence was 785–870 pmp
• Screening and Early Evaluation of Kidney Disease” (SEEK),
a community-based voluntary health screening program
reported a very high prevalence of 17.4% of CKD
• Increases risk for all-cause mortality, CV mortality, kidney
failure (ESRD), and other adverse outcomes.
• 6 fold increase in mortality rate with DM + CKD

ESRD, end stage renal disease

1. Nephrol Dial Transplant. 2005;20(8):1638-42.
2. Kidney Int. 2006;70(12):2131-3.
Pmp-per million population 3. Coresh et al. JAMA. 2007. 298:2038-2047.
CKD as a Public Health Issue
• Indian Data
Small changes make a big difference

•A GFR loss of
> 1 mL/min/year
beginning at age
25 can result in
end-stage renal
disease within a
normal lifespan.

Lee A Hebert et al. Kidney International (2001) 59, 1211–1226

Who is at risk for CKD
• Adults with diabetes, high blood pressure, or both have a higher
risk of developing CKD than those without these diseases.
• Other risk factors for CKD include heart disease, obesity, and a
family history of CKD.
CKD-CVD-Diabetes Link: CKD is a
Disease Multiplier
 THE KIDNEY COMPASS
“Get Your Bearings on
Kidney Disease”
HYPERTENSION

BONE DISEASE CKD ANEMIA

DIABETES
PROTEINURIA
SAVE YOUR KIDNEYS AND SAVE YOUR HEART
 Diabetes and hypertension are
leading causes of kidney failure

Incident ESRD rates, by primary diagnosis, adjusted for age, gender, & race.

ESRD, end stage renal disease

USRDS ADR, 2007
CKD IS A CORONARY DISEASE QUIVALENT

• Two New England

Journal publications
indicate that
Cardiovascular
survival is directly
related to a patient’s
kidney function!!

NS Anavekar, et al. N Engl J Med 2004;351:1285-95

AS Go, et al. N Engl J Med 2004;351:1295-305
Complications of CKD
Complications of CKD
Hypertension
• 80% HD patients, 50%
PD patients
• CKD progression
associated with HTN
• HTN associated with
level of eGFR

Buckalew VM, et al. AJKD 1996; 28: 811-821

Complications of CKD
Anaemia

NHANES III
Complications of CKD
Cardiovascular disease

Go et al. NEJM 2004; 351:1296-1305

Gaps in CKD Diagnosis
CKD Screening in Primary Care
(% of patients)
60

50

40

30

20

10

0
Not Appropriately Tested Appropriately tested - no diagnosis Appropriately tested - accurate diagnosis

% of Patients

Szczech, Lynda A, et al. "Primary Care Detection of Chronic Kidney Disease in Adults with Type-
2 Diabetes: The ADD-CKD Study (Awareness, Detection and Drug Therapy in Type-2 Diabetes
and Chronic Kidney Disease)." PLOS One - In press (2014).
Early treatment can make a
difference
100

No Treatment

Current Treatment

Early Treatment
GFR (mL/min/1.732)

10
Kidney Failure
0
4 7 9 11

Time (years)
Kidneys and Women health
Women and CKD

• CKD affects approximately 195 million

women worldwide
• Currently the 8th leading cause of death
in women, with close to 600,000 deaths
each year

Data on prevalence and mortality in women taken from GBD

website: https://vizhub.healthdata.org/gbd-compare/
Women and CKD
• CKD is more likely to develop in women
compared with men
• Prevalence of CKD is 14% in women and
12% in men
• However, the number of women on
dialysis is lower than the number of men.

https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC4934905/
Women and CKD reasons
• CKD progression is slower in women
compared to men
• Psycho-socioeconomic barriers such as
lower disease awareness and uneven access
to care
• This lead to late or no start of dialysis
among women

https://www.ncbi.nlm.nih.gov/pubmed/272
52402
Kidney Disease & Pregnancy
• CKD is a risk factor for adverse pregnancy
outcome and reduced fertility
• Increased risk for negative outcomes for
the mother and the baby
• Pregnancies in women with advanced
CKD are with high rates of hypertensive
disorders and preterm births

http://www.sciencedirect.com/science/articl
e/pii/S1548559507000055
Women and CKD: Need to tackle the
issue
• Equitable healthcare access for women
• Increase awareness and education
• Facilitate women’s access to treatment for
better health outcomes.
• Early diagnosis in pregnancy to allowing
planning of therapeutic interventions.
CKD - Summary
• In creasing prevalence of CKD in the population.
• Early detection and prevention of progression.
• Early involvement of nephrologists in the care (when
GFR<30).
• Treatment of Manifestations and complications.
• Renal Replacement Therapy
o Timely referral for Access
o Timely Transplant Work up.