NATIONAL KIDNEY AND TRANSPLANT INSTITUTE Romina A. Danguilan, MD, FPCP, FPSN Chair, Department of Adult Nephrology National Kidney And Transplant Institute

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<ul><li><p>NATIONAL KIDNEY AND TRANSPLANT INSTITUTERomina A. Danguilan, MD, FPCP, FPSNChair, Department of Adult NephrologyNational Kidney And Transplant InstituteQuezon City25 June 2009</p></li><li><p>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</p><p>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 missionsQuality assurance</p></li><li><p>Renal Disease Control Program (REDCOP)Flagship project: The Philippine Renal Disease Registry(A National Registry)</p><p>Registry started by the Philippine Society of Nephrology in the mid-1990s, but with </p></li><li><p>Renal Disease Control Program (REDCOP)Flagship project: The Philippine Renal Disease Registry(A National Registry)</p><p>It was linked to BHFS to make participation mandatory for licensing of dialysis and transplant facilities</p><p>It was linked to Philhealth to make participation mandatory for Philhealth accreditation</p><p>In 2009, it was absorbed by the DOH under the NEC, still to be administered by REDCOP </p></li><li><p>The Philippine Renal Disease Registry (PRDR)ESRD REGISTRYLooks at the acceptance rate into a renal replacement therapy program.Hemodialysis RegistryPeritoneal Dialysis RegistryKidney Transplant RegistryCHRONIC KIDNEY DISEASE REGISTRYCHRONIC KIDNEY DISEASE REGISTRYPathologic causes of renal disease. Kidney Biopsy Registry</p></li><li><p>PRDROBJECTIVE: To determine trends in the demographics of ESRD patients on dialysis and who received a kidney transplant from 2001-2008.</p><p>METHODOLOGYCollection 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. </p></li><li><p>PRDRMETHODOLOGY contStandard 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. </p></li><li><p>NUMBER OF DIALYSIS CENTERSACCORDING TO TYPE OF DIALYSISNumber of Centers</p></li><li><p>NEW PATIENTS ON DIALYSISNumber of Patients(7%)(7%)</p></li><li><p>INTERNATIONAL COMPARISONS% DISTRIBUTION OF DIALYSIS PATIENTS BY MODALITYUSRDS 2008 Annual Report</p></li><li><p>INTERNATIONAL COMPARISONS INCIDENCE OF ESRD, 2006 (PMP)PHILIPPINES: Acceptance Rate into RRT = 84 PMP in 2008 Up from 55 PMP in 2002, and 71 PMP in 2005USRDS 2008 Annual Report</p></li><li><p>NEW DIALYSIS PATIENTS NCR VS REGIONSNumber of Patients255 PMP59 PMP</p></li><li><p>INTERNATIONAL COMPARISONS PREVALENCE OF ESRD, 2006 (PMP)USRDS 2008 Annual Report</p></li><li><p>PREVALENCE AND NEW PATIENTS STARTING DIALYSIS</p></li><li><p>DISTRIBUTION OF TOP 3 CAUSES OF ESRD Number of Patients DM - Diabetes mellitus GN - Chronic glomerulonephritisHPN - Hypertensive nephrosclerosis(42%)</p></li><li><p>INTERNATIONAL COMPARISONS% OF INCIDENT DIALYSIS PXS WITH DIABETESUSRDS 2008 Annual Report</p></li><li><p>AGES OF NEW DIALYSIS PATIENTS in 2008Number of Patients</p></li><li><p>AGE AND GENDER OF NEW DIALYSIS PATIENTS, 2008</p><p>AGE (yrs)According to Primary Renal DiseaseDiabetic nephropathy60Hypertensive nephrosclerosis57Chronic pyelonephritis54Chronic glomerulonephritis35According to Type of DialysisHemodialysis53.8Peritoneal dialysis49.2GENDERM:F RATIO 1.44:1</p></li><li><p>CONCLUSIONSThe acceptance rate into RRT is only 84 PMP</p><p>Majority of patients are treated with hemodialysis (93%), a capital-intensive form of therapy vs peritoneal dialysis</p><p>Dialysis patients were mostly males (1.44:1) aged between 40-70 yrs</p><p>The most common cause of ESRD is diabetes (42%)</p></li><li><p>NUMBER OF NEW KIDNEY TRANSPLANTS 35%decreaseNumber of Patients</p></li><li><p>PRIMARY RENAL DISEASE OF NEW KIDNEY TRANSPLANTSNumber of Patients</p></li><li><p>LENGTH OF TIME ON DIALYSIS PRIOR TO KIDNEY TRANSPLANTNumber of Patients</p></li><li><p>AGE OF RECIPIENTSAGE OF DONORSNumber of PatientsNumber of Patients Mean age: 43 yrs Mean age: 30 yrs Range : 7-77 Range: 9-59</p></li><li><p>GENDER OF RECIPIENTS AND DONORSM:F 1.8:1M:F 3.7:1Number of Patients</p></li><li><p>DONOR SOURCENumber of Patients(5%)(67%)(28%)3.9%</p></li><li><p>REDCOPNational Advocacy Campaign for kidney transplantation from deceased donors: tri-media coverage, lay fora, seminarsLay communityGovt physicians</p><p>Despite the continuous advocacy campaign, the PRDR reports that living donors comprise 96% of donor kidneys from 1999-2001</p></li><li><p>REDCOPNational survey on knowledge, attitudes, perceptions of Filipinos on organ donation in 2001 and 2005</p><p>OBJECTIVE OF SURVEY 2001To determine the reasons for the small numbers of transplants from deceased donorsThe results led to a more intensive advocacy campaign addressing public concerns on organ donation</p><p>OBJECTIVE OF SURVEY 2005To determine if the improved advocacy campaign was effective in increasing KT from deceased donors</p></li><li><p>National survey on knowledge, attitudes, perceptions of Filipinos on organ donationOBJECTIVECompare KAP of Filipinos on organ donation based on the 2 surveys.To determine factors favoring organ donationTo determine whether the advocacy campaign was effective in increasing KT from deceased donors</p><p>METHODS2 surveys performed in 15 regions using multi-stage sampling2001: 2,000 respondents 2005: 2,140Structured questionnaire</p></li><li><p>Comparison of National Survey on knowledge, attitudes, perceptions of Filipinos on organ donation</p><p>20012005Knew about kidney donation82%77%Source of donors for transplantationLiving donors onlyDeceased donors onlyBOTH49%14%37%9%41%Willing to become living donors53%57%Willing to become deceased donors16%78%</p></li><li><p>Comparison of National Survey on knowledge, attitudes, perceptions of Filipinos on organ donationFactors that disadvantaged deceased organ donationPoor understanding of concept of brain deathOrgan donation is against ones religionFear of the operation/post-operative effects</p><p>Factors significantly correlated with consent for organ donation in 2001 surveySingle civil statusHigher educationHigher monthly income</p></li><li><p>Number of Transplant Recipients from Deceased DonorsNUMBER OF TRANSPLANT RECIPIENTS FROM DECEASED DONORS3.9%2.6%7%</p></li><li><p>Comparison of National Survey on knowledge, attitudes, perceptions of Filipinos on organ donationThere has been a steady increase in the numbers of KT from deceased donors through 2008, though the % remains low</p><p>Public information campaigns should be strengthened</p><p>Concept of brain death needs careful explanationOperative/post-operative effects should be clear</p><p>Procedures with the least effect on the donor physically, should be used (lap nephrectomy)</p><p>********************************</p></li></ul>