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RRT

RRT. 2,095,000. 1,065,000. 426,000. 1990. 2010. 2000. Lysaght , J Am Soc Nephrol, 2002. Adjusted incident rates & annual percent change Figure 2.2. Incident ESRD patients; Medical Evidence form data; rates adjusted for age, gender, & race.

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RRT

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  1. RRT 2,095,000 1,065,000 426,000 1990 2010 2000 Lysaght, J Am Soc Nephrol, 2002

  2. Adjusted incident rates & annual percent changeFigure 2.2 Incident ESRD patients; Medical Evidence form data; rates adjusted for age, gender, & race.

  3. There are 1,065,000 people on dialysis worldwide 90 % of them live in North America, Japan, and Europe, whose population is less than 20 % of world population

  4. K/DOQI CKD Classification Stage Description GFR 1 Kidney damage/normal GFR >90ml/min 2 Mild renal insufficiency 89-60 3 Moderate renal insufficiency 59-30 4 Severe renal insufficiency 29-15 5 Kidney Failure <15

  5. PRE-CKD X CKD 1 X CKD 2 CKD3 CKD4 X ESRF

  6. PRE-CKD CKD 1 CKD 2 CKD3 AT RISK CKD4 ESRF

  7. Risk Factors in CKD S P I Genetic/Relatives of CKD Race Gender Age Diseases: DM, HT, auto-immune, Rheumatic Infections: Malaria, HIV, HCV, Streptococcus

  8. USA UK

  9. Risk Factors in CKD S I P BP Glycaemia Dyslipidemia Weight Smoking INFECTIONS: HCV, HIV, Malaria, schisto

  10. HIV

  11. MRFIT Study

  12. AIRC, Jurkovitz et al, 2003

  13. Iseki et al, 2003

  14. PRE-CKD Established CKF CKD 1 CKD 2 CKD3 CKD4 ESRF

  15. Risk Factors in CKD S I P Modifiable BP Proteinuria Dyslipidemia Smoking

  16. Locatelli et al 1996

  17. Locatelli et al 1996

  18. Attman et al 1999

  19. Bonnet et al 2001

  20. DN Non-DN Orth 2002

  21. PRE-CKD Established CKF CKD 1 CKD 2 CKD3 CKD4 ESRF

  22. Proteinuria <1g/d Hypertension <125/75 Alcohol Lipids <5 Weight Smoking STOP

  23. ACEI/ARB NDCCB Renoprotection ACEI/ARB NDCCB b-blocker STATIN STOP Cardioprotection

  24. PRE-CKD X CKD 1 X CKD 2 CKD3 CKD4 X ESRF

  25. ESRD Lack of resources Lack Nephologists Lack Dialysis GUIDELINES Death

  26. What to do???????? • Community Health Education and Awareness Programmes (CHEAP) • Screening programmes • Train a new generation of Nephro-epidemiologists • Inform General practitioners • Train Community Health Work Assistants • Engage communities, NGO and Pharmaceutical industry

  27. PRE-CKD CKD 1 CKD 2 CKD3 AT RISK CKD4 ESRF

  28. K/DOQIAt-risk Population + CKD 1 • At-risk Population • DM, HT • Obese individuals • Relatives of CKD • Ethnic/racial populations at risk • Infections: malaria, Schisto, HCV, HIV

  29. DM Prevent PREVENTION Screen Treat

  30. IGT 2000:197m 2025:380m DM 2000:155m 2025: 300m DN 2000:15-30m 2025:30-60m

  31. Obesity/Glucose intolerance Da Qing IGT and Diabetes Study (Pan et al, 1997) Exercise (4h/week) Diet Diet + exercise Diabetes Prevention Programe (Molitch et al 2003) Metformin v Lifestyle modification Finnish Diabetes Prevention Study (Lindstrom et al, 2003) Lifestyle

  32. Obesity/Glucose intolerance Da Qing IGT and Diabetes Study (Pan et al, 1997) Exercise (4h/week) -36% Diet -31% Diet + exercise -42% Diabetes Prevention Programe (Molitch et al 2003) Metformin -31% Lifestyle modification -58% Finnish Diabetes Prevention Study (Lindstrom et al, 2003) Lifestyle -58%

  33. Diabetes prevention « if everybody exercised few hours a week, type 2 diabetes would be virtually nonexistent » Ken Goodrick M.D. (Baylor College of Medicine)TIME 5 February 2001

  34. HT Prevent PREVENTION Screen Treat

  35. Lifestyle Modifications & CKD • Salt Restriction • Weight Reduction • Exercise

  36. DASH-Salt Na: 141 mmol/d Na: 106 Na: 65

  37. Evolution

  38. PRE-CKD CKD 1 CKD 2 CKD3 CKD4 ESRF

  39. What to do???????? • Community Health Education and Awareness Programmes (CHEAP) • Screening programmes • Inform General practitioners • Train a new generation of Nephro-epidemiologists • Train Community Health Work Assistants • Engage communities, NGO and Pharmaceutical industry

  40. K/DOQIAt-risk Population + CKD 1 • At-risk Population • DM, HT • Obese individuals • Relatives of CKD • Ethnic/racial populations at risk • Infections: malaria, Schisto, HCV, HIV

  41. The oedematous woman - Gerard Dou 1662 (Louvre Museum)

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