Chronic Kidney Disease EKHA: World Kidney Day EKHA: World Kidney Day Chronic Kidney Disease Can...

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Transcript of Chronic Kidney Disease EKHA: World Kidney Day EKHA: World Kidney Day Chronic Kidney Disease Can...

  • EK H

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    Chronic Kidney Disease

    Can dialysis be prevented?

    Ron Gansevoort, nephrologist University Medical Center Groningen

    The Netherlands

    Brussels, March 5, 2013

  • Nr. of patients on Renal Replacement Therapy

    284,000

    1995 2000 2005 2010 2015

    360,000 435,000

    503,000 ~565,000

    ERA-EDTA Registry

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    Direct medical costs: ~21 billion Euro/yr

    Calculated for the EU-27 countries

  • 2. Dialysis is nowadays also started in elderly and frail patients, who were previously not accepted for dialysis

    ✚ Europe has an aging population

    The number of patients on RRT increases EK

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    3. Death rates due to cardiovascular disease have decreased. Consequently these patients now face the chronic complications of atherosclerosis: a.o. kidney failure

    Why?

    1. Changes in lifestyle have led to more diabetes and hypertension, the main causes for chronic kidney disease

  • How to prevent progression of CKD?

    Kidney function

    0%

    10%

    Follow-up (years)

    0 1 2 3 4 5 6 7 8 9 10

    Late intervention

    Early intervention

    Start dialysis

    60%

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  • Can we detect CKD in an early phase?

    Duration of diabetic kidney disease (years)

    10

    30

    100

    1.000

    10.000

    3.000

    0

    30

    60

    90

    120

    U rin

    ar y

    pr ot

    ei n

    lo ss

    (m g/

    d)

    K id

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    fu nc

    tio n

    (% )

    Normal

    Moderately increased

    Severely increased

    Normal

    Impaired

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    Kidney function

    Urinary protein loss

    Dialysis

  • Incidence of Renal Replacement Therapy EK

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    Urinary protein loss positive Urinary protein loss negative

    0.01

    0.1

    1.0

    10

    100

    1000

    Kidney function (%) 0 30 60 90 120

    Number of subjects starting RRT per 1000 screenees

    Iseki et al, Am J Kidney Dis 2004

    Screening the general population, n=95.252, follow-up: 7 years

    Simple dipstick test:

  • EK H

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    Matsushita et al, Lancet 2010, Gansevoort et al, Kidney Int 2011

    Meta-analysis of 41 cohort studie including more than 1.5 million people

    Incidence of (cardiovascular) mortality

    Kidney function (%) Kidney function (%)

  • The new International Classification of CKD

    Urinary protein loss

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    300 mg/d

    >90%

    60-90%

    45-60%

    30-45%

    15-30%

  • CKD amplifies cardiovascular risk EK

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    Atherosclerosis Coronary artery disease

    Valvular disease Left ventricular hypertrophy

    Decreased coronary perfusion Arrhytmias

    Early CKD Kidney function >60% Urinary protein loss +

    Mild to moderate CKD Kidney function 60 – 30%

    Severe CKD Kidney function

  • 27,5 32,9 41,1 48,8

    58,0

    34,6 28,1 25,9

    24,4 7,5

    37,9 39,0 33,0 26,8 34,5

    0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

    100%

    Normal 60 - 45% 45 - 30% 30 - 15%

  • 40,9

    19,9

    36,9

    18,8

    23,9

    12,4

    15,3

    7,212,1

    5,6

    0

    5

    10

    15

    20

    25

    30

    35

    40

    45

    30 35 40 45 50 55 60 65 70 75 80

    Age (years)

    Normal kidney function

    60 - 45%

    45 - 30%

    30 - 15%

  • Costs attributable to CKD

    2012 Reports of the US MediCare and Renal Database System

    Population Costs

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    RRT 0.1% RRT 6.8%

  • Interventions to improve prognosis? EK

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    Strict blood pressure control Lowering of urinary protein loss (RAASi)

    Strict diabetes regulation Stop smoking Fight obesity

    Use healthy food

    Can cardiovascular disease in CKD be prevented?

    medication diet

    Strict blood pressure control Strict diabetes regulation

    Lowering cholesterol Stop smoking Fight obesity

    Use healthy food

    diet medication

  • Food and CKD EK

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  • Medication and food interact EK

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    Kidney Events

    Cardiovascular events

    Normal blood pressure lowering agents

    Normal blood pressure lowering agents

    RAAS inhibitors

    RAAS inhibitors

    Lambers Heerspink et al, J Am Soc Nephrol 2012

    RENAAL / IDNT studies, N=1177 patients Diabetic kidney disease, protein loss > 300 mg/d

  • Prevention works !!! EK

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    2012 Report of the US Renal Database System Adjusted for age and gender

  • Patient awareness of early CKD is low EK

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    than 30% function Less

    than 30% function

    Less than 10% function

    no symptoms

    life threatening

    symptoms

    Fatigue

    Itching

    Nausea

    Loss of appetite

    Weight loss

  • Screening for early CKD is inadequate EK

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    2012 Report of the US Renal Database System

    Kidney function Urinary protein loss

    Both tests

  • 50

    55

    60

    65

    70

    75

    80

    85

    90

    95

    100

    Normal 60-45 45-30 30-15

  • TAKE CARE

    BETTER START WORKING!

    DOCTORS

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    We need guidelines

  • Key Messages EK

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    ay There is an alarming rise in Chronic Kidney Disease in Europe:

    - Late stage CKD, with need for renal replacement therapy - Early stage CKD, with a high risk for cardiovascular events

    High burden of disease for subjects involved (QoL and morbidity) and for the society at large (costs).

    Prevention is possible, but we need to increase awareness among doctors and patients to improve early identification of high risk patients, in whom treatment should be started.

    MEPs can help: - Implement guidelines, especially for general practice - Implement screening programs - Regulation of food industry, and influencing healthy behavior - Stimulate research (Horizon 2020)

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