CHRONIC KIDNEY DISEASE

The Philippine Situation

National Nutrition and Health Survey

Philippine Renal Disease Registry

Mortality statistics

Survival data from a cohort study

NATIONAL NUTRITION SURVEY

Resulted from the mandate of the Food and Research Institute (FNRI) of the Dept. of Science and Technology (DOST)

Objective: To assess the Philippine food situation and nutritional status of the population

Conducted every 5 years since 1978

NNHeS 2003-2004

Objectives

To assess the prevalence of lifestyle and

nutrition-related risk factors and diseases

among Filipinos 2 years and above

To aid in the development of health policies

an programs for the prevention and control

of lifestyle and nutrition-related diseases

NNHeS 2003-2004 Renal Report Chronic Kidney Disease Stages

Stage GFR

1 >=90 Normal or increased GFR

2 60-89 Mildly decreased GFR

3 30-59 Moderately decreased GFR

4 15-29 Severely decreased GFR

5 <15 Kidney failure

Based on guidelines of the Dialysis Outcomes Quality Initiative – USBased on guidelines of the Dialysis Outcomes Quality Initiative – US

NNHeS 2003-2004 Renal Report Renal function

• Abbreviated MDRD formula

– Predicted GFR = 186.3 * (serum creatinine)−

1.154 * age− 0.203 * (0.742 for women) * (1.21 if African American)

• Cockcroft & Gault formula

– Ccr (mL/min) = (140 − age)/sCr * weight/72 * 1.73/BSA, where age is in years, sCr is in mg/dL, weight is in kilograms, and BSA is body surface area using the formula:

– BSA = 0.20247 × [height (m)]0.725 × [weight (kg)]0.425

NNHeS 2003-2004 Renal Report Prevalence of CKD in adults

using predicted GFR from MDRD equation

Stages of GFR

1 >=90 72.8%

2 60-89 24.6%

3 30-59 2.2%

4 15-29 0.2%

5 <15 0.2%

The prevalence of CKD Stage 3-5 is 2.6%

NNHeS 2003-2004 Renal Report Prevalence of CKD in adults

The population of Filipinos aged 20 The population of Filipinos aged 20 years and above in 2005 was years and above in 2005 was

46,627,17246,627,172

A prevalence of 2.6% means that1,212,306 adult Filipinos

have CKD.

NNHeS 2003-2004 Renal Report Macroalbuminuria

at least +1 proteinuria using the

Multiple Reagent Strip for Urinalysis®

(Bayer Corporation)

The prevalence of macroalbuminuria was

4.2%

NNHeS 2003-2004 Renal Report Microalbuminuria

The prevalence of microalbuminuria was

18.5%

This is equivalent to

8,626,027 Adult Filipinos

NNHeS 2003-2004 Renal Report Prevalence of CKD Stage 3-5

according to AGE

0

5

10

15

20

25

20-29 30-39 40-49 50-59 60-69 70+

Stage 3 Stage 4 Stage 5

0.3%0.3% 1.0%1.0%

5.0%5.0% 2.9%2.9%7.5%7.5%

20.7%20.7%

Mean level of GFR by age group: Philippine vs. US data

Age Group in Years

NNHeS 2003Philippines

NHANES IIIU.S.A.

20-29 119 116

30-39 109 107

40-49 103 99

50-59 100 93

60-69 86 85

70+ 77 75

PHILIPPINE RENAL DISEASE REGISTRY

Originated by the PSN in 1996 and later became a joint project with REDCOP

Collects data on ESRD patients who start hemodialysis, peritoneal dialysis and undergo kidney transplantation

NEW PATIENTS ON DIALYSIS 2001-2005

5997

4363 4409

5070

5597

2000

3000

4000

5000

6000

7000

2001 2002 2003 2004 2005

Number of Patients

NEW PATIENTS ON DIALYSIS: 2001-2005

ACCORDING TO DIALYSIS MODALITY

5997

4363 4409

50705597

0

1000

2000

3000

4000

5000

6000

7000

2001 2002 2003 2004 2005

TOTAL

HD

PD

Number of Patients

ACCEPTANCE RATE TO RRT PROGRAMS (PMP)

Data from International Federation of Renal Registries website and the Philippine Renal Disease Registry

0 50 100 150 200 250 300

US

MEXICO

CANADA

SPAIN

INDIA

KOREA

AUSTRALIA

MALAYSIA

CHINA

INDONESIA

PHIL 2005

PHIL 2004

PHIL 2003 71 PMP55 PMP63 PMP68 PMP

Patients per million population

ACCEPTANCE RATE TO RRT PROGRAMS (PMP)

Data from International Federation of Renal Registries website and the Philippine Renal Disease Registry

0 50 100 150 200 250 300

US

MEXICO

CANADA

SPAIN

INDIA

KOREA

AUSTRALIA

MALAYSIA

CHINA

INDONESIA

PHIL 2005

PHIL 2004

PHIL 2003 71 PMP55 PMP63 PMP68 PMP

Patients per million population

PRIMARY RENAL DISEASE OF ALL NEW DIALYSIS PATIENTS

0 500 1000 1500 2000 2500

DM

GN

HPN

CPN

UNK

OBSTR

GOUT

APKD

OTHERS

HD PDN = 5,997

20%

26%38%

DISTRIBUTION OF

TOP 3 CAUSES OF ESRD

0

500

1000

1500

2000

2500

DM GN HPN

2002 2003 2004 2005

Nu

mb

er

of

P

atie

nts

NNHeS 2003-2004 Renal Report Prevalence of CKD Stage 3-5

according to AGE

0

5

10

15

20

25

20-29 30-39 40-49 50-59 60-69 70+

Stage 3 Stage 4 Stage 5

0.3%0.3% 1.0%1.0%

5.0%5.0% 2.9%2.9%

7.5%7.5%

20.7%20.7%

MEAN AGE – 2004 PRDR DATA

ALL NEW DIALYSIS PTS 52 YEARS

ESRD - DM NEPHRO 58 YEARS

ESRD – HTN NEPHRO 57 YEARS

ESRD – CGN 38 YEARS

END STAGE RENAL IS A BAD DISEASE TO HAVE

Limited survivalExpensive

Retrospective cohort study of 327 patients from NKTI and SLMC diagnosed to have ESRD 2000-2001

OVERALL SURVIVAL

Kaplan-Meier survival estimate

analysis time365 730 1000

0.00

0.25

0.50

0.75

1.00

12 month estimated survival rate - 53% (95%CI: 47-12 month estimated survival rate - 53% (95%CI: 47-58)58)

24 month estimated survival rate - 36% (95%CI: 30-24 month estimated survival rate - 36% (95%CI: 30-42 42

Results

PATIENT GROUP

days 365 730 1000

0.00

0.25

0.50

0.75

1.00

Private

Service

Service – n=198 (60%) Private – n=129 (40%) Service – n=198 (60%) Private – n=129 (40%)

Log rank test: chi2 = 29.62, p<.001Log rank test: chi2 = 29.62, p<.001

National Statistics Office

Kidney disease is now no. 10 cause

of mortality in the Philippines

GROWING PROBLEM

OF CHRONIC KIDNEY

DISEASE

NNHes Population

Survey

Renal Disease

Registry ESRD

survival data

National mortality

data

Treatment is too expensive

Prevention is the key

Kung hindi tayo ang kikilos

Sino ang kikilos?

Kung hindi ngayon, kailan pa?

The Philippine College of Physicians wishes to acknowledge the following for their invaluable contribution in the preparation of this module

Philippine Society of Nephrology