NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

1. NATIONAL KIDNEY AND TRANSPLANT INSTITUTE Romina A. Danguilan, MD, FPCP, FPSN Chair, Department of Adult Nephrology National Kidney And Transplant Institute Quezon City 25 June 2009

2. National Kidney and Transplant Institute (NKTI) • The largest tertiary referral center of the DOH for the prevention, diagnosis and management of diseases involving the kidneys and urinary tract, and for the treatment of end-organ damage through organ transplantation • The Renal Disease Control Program (REDCOP)is the public health arm of the DOH for renal disease and organ donation and transplantation, through the NKTI • Comprehensive public education program, and advocacy for the maintenance of renal health and the prevention of kidney disease. • Research on renal diseases • Patient services through medical missions • Quality assurance

3. Renal Disease Control Program (REDCOP) • Flagship project: The Philippine Renal Disease Registry (A National Registry) • Registry started by the Philippine Society of Nephrology in the mid-1990s, but with <50% data capture since it was purely voluntary • In 2000, it became a partnership between PSN and the NKTI, to provide logistical and administrative back-up, and assigned to the REDCOP

4. Renal Disease Control Program (REDCOP) • Flagship project: The Philippine Renal Disease Registry (A National Registry) • It was linked to BHFS to make participation mandatory for licensing of dialysis and transplant facilities • It was linked to Philhealth to make participation mandatory for Philhealth accreditation • In 2009, it was absorbed by the DOH under the NEC, still to be administered by REDCOP

5. The Philippine Renal Disease Registry (PRDR) CHRONIC KIDNEY DISEASE REGISTRY ESRDREGISTRY CHRONIC KIDNEY DISEASE REGISTRY Looks at the acceptance rate into a renal replacement therapy program. Pathologic causes of renal disease. Hemodialysis Registry Peritoneal Dialysis Registry Kidney Biopsy Registry Kidney Transplant Registry

6. PRDR • OBJECTIVE: To determine trends in the demographics of ESRD patients on dialysis and who received a kidney transplant from 2001-2008. • METHODOLOGY • Collection of data on a quarterly basis from 397 dialysis units and 24 transplant centers with 98% data capture. • Submission of data is mandated by the Bureau of Health Services of DOH, as a requirement for licensing. • Dialysis and Transplant Centers are oriented as to the data collection methods.

7. PRDR • METHODOLOGYcont • Standard PRDR forms are completed by dialysis and transplant center personnel and collected by • PRDR Central Office based at REDCOP for the National Capital Region (NCR), • and by DOH Regional Coordinators for centers outside NCR, who then send the forms to the Central Office by mail. • All the data are reviewed, checked for completion and internal consistency. • Any inconsistencies are clarified by calling on the dialysis or transplant facility. • Reports are generated looking at frequencies, averages and percentages. • Annual Report is generated.

8. NUMBER OF DIALYSIS CENTERSACCORDING TO TYPE OF DIALYSIS Number of Centers

9. NEW PATIENTS ON DIALYSIS Number of Patients (7%) (7%)

10. INTERNATIONAL COMPARISONS% DISTRIBUTION OF DIALYSIS PATIENTS BY MODALITY USRDS 2008 Annual Report

11. INTERNATIONAL COMPARISONSINCIDENCE OF ESRD, 2006 (PMP) PHILIPPINES: Acceptance Rate into RRT = 84 PMP in 2008 Up from 55 PMP in 2002, and 71 PMP in 2005 USRDS 2008 Annual Report

12. NEW DIALYSIS PATIENTSNCR VS REGIONS Number of Patients 59 PMP 255 PMP

13. INTERNATIONAL COMPARISONSPREVALENCE OF ESRD, 2006 (PMP) USRDS 2008 Annual Report

14. PREVALENCE AND NEW PATIENTS STARTING DIALYSIS

15. DISTRIBUTION OF TOP 3 CAUSES OF ESRD Number of Patients (42%) DM - Diabetes mellitus GN - Chronic glomerulonephritis HPN - Hypertensive nephrosclerosis

16. INTERNATIONAL COMPARISONS% OF INCIDENT DIALYSIS PXS WITH DIABETES USRDS 2008 Annual Report

17. AGES OF NEW DIALYSIS PATIENTS in 2008 Number of Patients

18. AGE AND GENDER OF NEW DIALYSIS PATIENTS, 2008

19. CONCLUSIONS • The acceptance rate into RRT is only 84 PMP • Majority of patients are treated with hemodialysis (93%), a capital-intensive form of therapy vs peritoneal dialysis • Dialysis patients were mostly males (1.44:1) aged between 40-70 yrs • The most common cause of ESRD is diabetes (42%)

20. NUMBER OF NEW KIDNEY TRANSPLANTS Number of Patients 35% decrease

21. PRIMARY RENAL DISEASE OF NEW KIDNEY TRANSPLANTS Number of Patients

22. LENGTH OF TIME ON DIALYSIS PRIOR TO KIDNEY TRANSPLANT Number of Patients

23. AGE OF RECIPIENTS AGE OF DONORS Number of Patients Number of Patients Mean age: 43 yrs Mean age: 30 yrs Range : 7-77 Range: 9-59

24. GENDER OF RECIPIENTS AND DONORS Number of Patients M:F 3.7:1 M:F 1.8:1

25. DONOR SOURCE Number of Patients (67%) 3.9% (28%) (5%)

26. REDCOP • National Advocacy Campaign for kidney transplantation from deceased donors: tri-media coverage, lay fora, seminars • Lay community • Govt physicians • Despite the continuous advocacy campaign, the PRDR reports that living donors comprise 96% of donor kidneys from 1999-2001

27. REDCOP • National survey on knowledge, attitudes, perceptions of Filipinos on organ donation in 2001 and 2005 • OBJECTIVE OF SURVEY 2001 • To determine the reasons for the small numbers of transplants from deceased donors • The results led to a more intensive advocacy campaign addressing public concerns on organ donation • OBJECTIVE OF SURVEY 2005 • To determine if the improved advocacy campaign was effective in increasing KT from deceased donors

28. National survey on knowledge, attitudes, perceptions of Filipinos on organ donation • OBJECTIVE • Compare KAP of Filipinos on organ donation based on the 2 surveys. • To determine factors favoring organ donation • To determine whether the advocacy campaign was effective in increasing KT from deceased donors • METHODS • 2 surveys performed in 15 regions using multi-stage sampling • 2001: 2,000 respondents 2005: 2,140 • Structured questionnaire

29. Comparison of National Survey on knowledge, attitudes, perceptions of Filipinos on organ donation

30. Comparison of National Survey on knowledge, attitudes, perceptions of Filipinos on organ donation • Factors that disadvantaged deceased organ donation • Poor understanding of concept of “brain death” • Organ donation is against one’s religion • Fear of the operation/post-operative effects • Factors significantly correlated with consent for organ donation in 2001 survey • Single civil status • Higher education • Higher monthly income

31. NUMBER OF TRANSPLANT RECIPIENTS FROM DECEASED DONORS Number of Transplant Recipients from Deceased Donors 7% 2.6% 3.9%

32. Comparison of National Survey on knowledge, attitudes, perceptions of Filipinos on organ donation • There has been a steady increase in the numbers of KT from deceased donors through 2008, though the % remains low • Public information campaigns should be strengthened • Concept of “brain death” needs careful explanation • Operative/post-operative effects should be clear • Procedures with the least effect on the donor physically, should be used (lap nephrectomy)