NATIONAL KIDNEY AND NATIONAL KIDNEY AND TRANSPLANT INSTITUTETRANSPLANT INSTITUTE

Romina A. Danguilan, MD, FPCP, FPSNChair, Department of Adult Nephrology

National Kidney And Transplant InstituteNational Kidney And Transplant Institute

Quezon CityQuezon City

25 June 200925 June 2009

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

• 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 missions Quality assurance

Renal Disease Control Program (REDCOP)

• Flagship project: The Philippine Renal Disease Registry

(A National Registry)

Registry started by the Philippine Society of Nephrology in the mid-1990s, but with <50% data capture since it was purely voluntary

In 2000, it became a partnership between PSN and the NKTI, to provide logistical and administrative back-up, and assigned to the REDCOP

Renal Disease Control Program (REDCOP)

• Flagship project: The Philippine Renal Disease Registry

(A National Registry)

It was linked to BHFS to make participation mandatory for licensing of dialysis and transplant facilities

It was linked to Philhealth to make participation mandatory for Philhealth accreditation

In 2009, it was absorbed by the DOH under the NEC, still to be administered by REDCOP

The Philippine Renal Disease Registry (PRDR)

ESRD REGISTRY

Looks at the acceptance

rate into a renal

replacement therapy

program.

Hemodialysis Registry

Peritoneal Dialysis Registry

Kidney Transplant Registry

CHRONIC KIDNEY DISEASE REGISTRY

CHRONIC KIDNEY DISEASE REGISTRY

Pathologic causes of renal disease.

Kidney Biopsy Registry

PRDR

• OBJECTIVE: To determine trends in the demographics of ESRD patients on dialysis and who received a kidney transplant from 2001-2008.

• METHODOLOGY Collection 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.

PRDR

• METHODOLOGY cont Standard 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.

NUMBER OF DIALYSIS CENTERSACCORDING TO TYPE OF DIALYSIS

0

50

100

150

200

250

300

350

400

450

2001 2002 2003 2004 2005 2006 2007 2008

TOTAL

HD

PD

Number of Centers

NEW PATIENTS ON DIALYSIS

0

1000

2000

3000

4000

5000

6000

7000

8000

2001 2002 2003 2004 2005 2006 2007 2008

TOTAL HD PDNumber of Patients

(7%)

(7%)

INTERNATIONAL COMPARISONS% DISTRIBUTION OF DIALYSIS PATIENTS

BY MODALITY

USRDS 2008 Annual Report

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 2005

USRDS 2008 Annual Report

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

REGIONS NCR NO DATA

NEW DIALYSIS PATIENTS NCR VS REGIONS

Number of Patients

255 PMP

59 PMP

INTERNATIONAL COMPARISONS PREVALENCE OF ESRD, 2006 (PMP)

USRDS 2008 Annual Report

PREVALENCE AND NEW PATIENTS STARTING DIALYSIS

0

2000

4000

6000

8000

10000

12000

2004 2005 2006 2007 2008

PREVALENCE OFDIALYSIS PATIENTS

NEW PATIENTSSTARTING DIALYSIS

DISTRIBUTION OF TOP 3 CAUSES OF ESRD

0

500

1000

1500

2000

2500

3000

3500

2002 2003 2004 2005 2006 2007 2008

DM

GN

HPN

Number of Patients

DM - Diabetes mellitus GN - Chronic glomerulonephritisHPN - Hypertensive nephrosclerosis

(42%)

INTERNATIONAL COMPARISONS% OF INCIDENT DIALYSIS PXS WITH DIABETES

USRDS 2008 Annual Report

AGES OF NEW DIALYSIS PATIENTS in 2008

0

200

400

600

800

1000

1200

1400

1600

1800

2000

1 to 10 11 to 20 21 to 30 31 to 40 41-50 51-60 61-70 71-80 81-90 >90

HD PDNumber of Patients

AGE AND GENDER OF NEW DIALYSIS PATIENTS, 2008

AGE (yrs)According to Primary Renal Disease

Diabetic nephropathy 60Hypertensive nephrosclerosis 57

Chronic pyelonephritis 54Chronic glomerulonephritis

35

According to Type of Dialysis

Hemodialysis 53.8

Peritoneal dialysis 49.2

GENDER M:F RATIO 1.44:1

CONCLUSIONS

• The acceptance rate into RRT is only 84 PMP

• Majority of patients are treated with hemodialysis (93%), a capital-intensive form of therapy vs peritoneal dialysis

• Dialysis patients were mostly males (1.44:1) aged between 40-70 yrs

• The most common cause of ESRD is diabetes (42%)

NUMBER OF NEW KIDNEY TRANSPLANTS

124157

186 208

276 263306

420470

630690

1046

679

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

35%decrease

Number of Patients

PRIMARY RENAL DISEASE OF NEW KIDNEY TRANSPLANTS

0

100

200

300

400

500

600

2004 2005 2006 2007 2008

CGN

DM

HPN

Number of Patients

LENGTH OF TIME ON DIALYSIS PRIOR TO KIDNEY TRANSPLANT

0

50

100

150

200

250

300

350

2004 2005 2006 2007 2008

0.1- 0.5

0.6 - 1

1.1 - 1.5

1.6 - 2

2.1 - 2.5

2.6 - 3

> 3

No Data

Number of Patients

AGE OF RECIPIENTS

0

20

40

60

80

100

120

140

160

180

1 TO 10 11 TO 20 21-30 31-40 41-50 51-60 71-80 NO DATA 0

50

100

150

200

250

300

350

400

450

1 to10

11 to20

21-30 31-40 41-50 51-60 61-70 71-80 NODATA

AGE OF DONORS

Number of Patients Number of Patients

Mean age: 43 yrs Mean age: 30 yrs Range : 7-77 Range: 9-59

GENDER OF RECIPIENTS AND DONORS

0

100

200

300

400

500

600

Recipients Donors

Males

Females

M:F 1.8:1M:F 3.7:1

Number of Patients

DONOR SOURCE

0

100

200

300

400

500

600

700

800

900

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

NON-RELATED

RELATED

DECEASED

Number of Patients

(5%)

(67%)

(28%)

3.9%

REDCOP

• National Advocacy Campaign for kidney transplantation from deceased donors: tri-media coverage, lay fora, seminars Lay community Govt physicians

• Despite the continuous advocacy campaign, the PRDR reports that living donors comprise 96% of donor kidneys from 1999-2001

REDCOP

• National survey on knowledge, attitudes, perceptions of Filipinos on organ donation in 2001 and 2005

OBJECTIVE OF SURVEY 2001 To determine the reasons for the small numbers of

transplants from deceased donors The results led to a more intensive advocacy campaign

addressing public concerns on organ donation

OBJECTIVE OF SURVEY 2005 To determine if the improved advocacy campaign was

effective in increasing KT from deceased donors

National survey on knowledge, attitudes, perceptions of Filipinos on organ donation

• OBJECTIVE Compare KAP of Filipinos on organ donation based

on the 2 surveys. To determine factors favoring organ donation To determine whether the advocacy campaign was

effective in increasing KT from deceased donors

• METHODS 2 surveys performed in 15 regions using multi-

stage sampling 2001: 2,000 respondents 2005: 2,140 Structured questionnaire

Comparison of National Survey on knowledge, attitudes, perceptions of Filipinos on organ donation

2001 2005

Knew about kidney donation 82% 77%

Source of donors for transplantationLiving donors only

Deceased donors onlyBOTH

49%14%37%

9%41%

Willing to become living donors 53% 57%

Willing to become deceased donors 16% 78%

Comparison of National Survey on knowledge, attitudes, perceptions of Filipinos on organ donation

• Factors that disadvantaged deceased organ donation Poor understanding of concept of “brain death” Organ donation is against one’s religion Fear of the operation/post-operative effects

• Factors significantly correlated with consent for organ donation in 2001 survey Single civil status Higher education Higher monthly income

Number of Transplant Recipients from Deceased Donors

NUMBER OF TRANSPLANT RECIPIENTS FROM DECEASED DONORS

6

17

6

107

1513

36

29 30

0

5

10

15

20

25

30

35

40

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

3.9%2.6%

7%

Comparison of National Survey on knowledge, attitudes, perceptions of Filipinos on organ donation

• There has been a steady increase in the numbers of KT from deceased donors through 2008, though the % remains low

• Public information campaigns should be strengthened

Concept of “brain death” needs careful explanation Operative/post-operative effects should be clear

Procedures with the least effect on the donor physically, should be used (lap nephrectomy)