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Number of patients worldwide treated with chronic dialysis from 1990 to 2010

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. $. $. $. $. $. $. Predicted costs for chronic dialysis worldwide per decade from 1980 until 2010 . 1200. 1000. 800.

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Number of patients worldwide treated with chronic dialysis from 1990 to 2010

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  1. 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

  2. $ $ $ $ $ $ Predicted costs for chronic dialysis worldwide per decade from 1980 until 2010 1200 1000 800 Medical costs for dialysis per decade in $ billions USD 600 400 200 0 1981-1990 1991-2000 2001-2010 Lysaght et al., J Am Soc Nephrol, 2002

  3. Globally 1,800,000 patients with endstage renal failure 300,000,000 people with kidney malfunction (e.g. albuminuria), which gives them a markedly increased chance to develop heart failure and diabetes

  4. The Global Burden of Cardiovascular Disease Mortality (1990-2020) 5.7 3.9 4.1 2.0 2.1 96% 3.6 0.8 37% 1.6 157% 119% 2.0 1.3 0.6 0.8 130% 1.4 139% 0.6 1990 144% 2020 * In million subjects World High inc. countries Mid/low inc. countries 1990 2020 10.6 m 20.2 m 4.1 m 5.6 m 6.5 m 14.5 m

  5. Increase of diabetes worldwide in the period 2000 to 2030 2000 2030 52.4 42.3 30.7 18.6 33.8 80.9 16.7 71% 127% 22.8 102% 28.3 255% 9.1 32.9 211% 18.2 0.9 1.6 78% 81% * In million subjects World High inc. countries Mid/low inc. countries 2000 2030 154 m 370 m 55 m 84 m 99 m 286 m WHO, March 2003

  6. Kidney Failure, Heart Failure, and Diabetes; Number of patients and costs; USA 2002 Numbers Costs 19% 5.8% 25.1% 20.7% 41.3% 48.1% 1.1% 7.8% Dialysis/Tx Heartfailure Total Medicare Diabetes CKD

  7. Mild renal dysfunction is (Albuminuria and slight decrease in GFR) is highly prevalent K/DOQI Clinical Practical Guidelines Am J Kidney Dis 2003 Coresh et al; Am J Kidney Dis 2004 De Zeeuw et al; Kidney Int; in press

  8. PREVEND; Albuminuria predicts moderate CKD (stage 3) (4 yr) 70 60 50 40 30 20 10 0 58 Stage 3 CKD (%) 22 13 9 0 - 14 30 - 300 15 – 29 >300 Albuminuria (mg/day) Verhave et al. Kidney Int 2004

  9. PREVEND; Albuminuria predicts CV death in the general population (+3 yr) 35 30 25 20 15 10 5 0 29.1 CV death (% per 1000 pj) 11.2 4.5 3.5 0 - 14 30 - 300 15 – 29 >300 Albuminuria (mg/day) Hillege et al; Circulation 2002;106(14):1777-82

  10. PREVEND; Albuminuria predicts new onset diabetes (4,2 yr) 14 12 10 8 6 4 2 0 11.8 7.9 New onset Diabetes (%) 4.3 2.2 0 - 14 30 - 300 15 – 29 >300 Albuminuria (mg/day) Brantsma et al; Diabetes Care 2005

  11. IRMA 2; Treatment associated with lowering of albuminuria reduces progression to diabetic nephropathy 20 Control + Conv tx AIIA (Irbesartan 150 mg) AIIA (Irbesartan 300 mg) 15 Risk Reduction 70% 10 Diabetic Nephropathy (%) 5 0 0 3 6 12 18 22 24 Follow-up (months) Parving H-H et al. N Engl J Med 2001;345:870–8.

  12. BENEDICT; Treatment associated with lowering of albuminuria reduces progression to microalbuminuria 15 Placebo + Conv tx Risk Reduction 50% 10 Transition to Microalbuminuria(%) 5 ACEi (trandolapril) 0 0 6 12 18 24 30 36 42 48 Months Ruggenenti et al; N Engl J Med 2004

  13. PREVEND-IT; Treatment associated with lowering of albuminuria reduces CV mortality in the general population 0.10 Risk Reduction 44% Placebo 0.05 CV mortality (%) ACEi (fosinopril) 0 10 20 30 40 0 Months Asselbergs et al; Circulation 2004

  14. Meta-analysis; Treatment associated with albuminuria reduction reduces incidence of new onset diabetes 14 12 10 8 6 4 2 0 7.7 New onset Diabetes (% per 4.1 yr) Risk Reduction 39 % 4.7 Conventional BP lowering ACEi AII-A Lindholm LH; J Hypertens 2003

  15. PRIME; Early and Late intervention with AIIA are cost saving in type 2 diabetes 45,000 Placebo + Conventional Tx 35,000 Late AIIA (Irbesartan) 25,000 Cumulative costs per patient (€) Early AIIA (Irbesartan) 15,000 5,000 0 0 2 4 6 8 10 12 14 16 18 20 22 24 Years since baseline age of 58 Palmer et al; Diabetes Care 2004

  16. Conclusions • Early kidney failure is a common problem, affecting about 10% of the adult population • Early kidney failure is to detect with simple urine tests • Early kidney failure carries an increased risk for cardiovascular disease • Early kidney failure will ultimately result in need for dialysis and transplantation • When treatment (with generally available drugs) is started early, prevention of progressive renal and cardiac disease seems feasible • These approaches seem cost effective

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