WHY WORLD KIDNEY DAY? WORLD KIDNEY DAY (1) PURPOSE: 1.World Kidney Day was established to increase awareness of the need for detection programs for CKD

WHY WHY WORLD WORLD KIDNEY KIDNEY

DAY?DAY?

WORLD KIDNEY DAY (1)WORLD KIDNEY DAY (1)PURPOSE:PURPOSE:

1.1.World Kidney Day was established to World Kidney Day was established to increase awareness of the need for detection increase awareness of the need for detection programs for CKD & to improve programs for CKD & to improve prevention & treatment of CKD. prevention & treatment of CKD. 2.The motto of World Kidney Day: 2.The motto of World Kidney Day:

Kidney Disease is Common, Kidney Disease is Common, Harmful and Treatable.Harmful and Treatable.

About 20 Million People With Chronic Kidney Disease (CKD) in

the United States and ~20 Million More at Risk

Estimates Suggest That About 10 Percent of Adult Patients Worldwide

May Have CKD

Dialysis Mortality: 20% General Population vs ESRD Dialysis Patients

RN Foley, PS Parfrey, and MJ Sarnak; Clinical epidemiology of cardiovascular disease in chronic renal disease AJKD, 1998 32(5):S112-S119

0.001

0.01

0.1

1

10

100

25-34 35-44 45-54 55-64 66-74 75-84 >85

GP Male

GP Female

GP Black

GP White

Dialysis Male

Dialysis Female

Dialysis Black

Dialysis White

Age (years)

An

nu

al C

VD

Mo

rtal

ity

(%)

Most People with CKD will Die Prematurely from their Increased

Risk of Cardiovascular and Cerebrovascular Disease Before they Develop End-Stage Kidney

Failure

Interconnections Between Obesity, Diabetes

Mellitus, High Blood Pressure, and Chronic Kidney Disease (CKD)

Diabetes Is the Most Common Primary Diagnosis in Patients With Kidney

Failure

ESRD = end-stage renal disease.USRDS 2005 Annual Data Report. The data reported here have been supplied by the USRDS. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government. Available at: www.usrds.org. Accessed December 6, 2005.

Hypertension

Glomerulonephritis

Other

20%

45% 27%

8%Diabetes

350

300

250

200

150

100

50

0

Incident Dialysis(2003: 100,499)

Year

Nu

mb

er o

f P

atie

nts

(t

ho

usa

nd

s)

350

300

250

200

150

100

50

0

Prevalent Dialysis (2003: 324,826)

Prevalent Transplant (2003: 128,131)

′88 ′90 ′92 ′94 ′96 ′98 ′00 ′02

Diabetes50%

Hypertension27%

Glomerulonephritis13%

Other10%

Primary Diagnoses for Patients Who Start Dialysis

United States Renal Data System (USRDS) 2005 Annual Data Report • WWW.USRDS.ORG

DEFINITION OF OBESITY

1. Overweight: BMI 25.0 -29.0 kg/m2

2. Obese: BMI ≥30 kg/m2

3. Morbidly Obese: ≥35kg/m2

4. Abdominal Obesity: Waist circumference ≥102 cm in men; ≥88 cm in women

Hill, Endocrine Reviews 2006;27:750-761

HSU et al. Ann Int Med 2006;144:21

OBESITY RISK FOR ADVANCED CKDBMI ≥ 25 at 20 years old OR for Incidence of Advanced CKD

Stratified by Comorbidity

No Diabetes 2.4( CI: 1.6-3.6)

No Hypertension 3.6 (1.8-7.1)

No Diabetes or Hypertension 3.0 (1.4-6.4)

Stratified by Type of CKD

Diabetic Nephropathy 5.2 (3.2-8.4)

Nephrosclerosis 3.0 (1.6-5.5)

Glomerulosclerosis 3.0 (1.8-4.9)

Other 2.1 (1.2-3.6)

Ejerblad et al JASN 2006;17:1695-1702

Iseki Contrib Nephrology 2006;42-56

Kelley et al, Int J Obesity 2008;32:1431-1437

Percentage of population that is overweight

Percentage of population that is obese (BMI≥30kg/m2

(BMI 25-29kg/m2)

Challenges of CKD Management problems, enormous Management problems, enormous everywhere, are particularly great, even everywhere, are particularly great, even overwhelming, in developing countries:overwhelming, in developing countries:1. Little awareness of CKD or its 1. Little awareness of CKD or its consequences consequences 2. Few financial resources for 2. Few financial resources for prevention, detection or treatment prevention, detection or treatment 3. Little expertise3. Little expertise4. High prevalence of CKD4. High prevalence of CKD

Today There are Many Safe and Effective Treatments That Prevent or Slow the Progression of Chronic Kidney Disease

Simple Methods for Detection of CKD

1. Urine Albumin, including Microalbumin (indicator of kidney disease especially of small blood vessels in kidney)

2. Serum Creatinine (indicator of kidney function)

3. Blood Pressure

What Can WKD Do (1)?

1. Advertise/Educate i. The public-at –large ii. National, regional and local

governments, insurers and other health related organizations (eg, the pharmaceutical industry)

iii. Health care professionals (There is abundant evidence that medical care is suboptimal nationally, even when financial resources are not a limiting factor).

What Can WKD Do (2)? 2. Advocate

i. With National, State and Local Governments for Better Kidney Disease:

- Education

- Prevention

- Detection

- Treatment

ii. With Other Major Organizations; e.g., Insurance Agencies, Large Health Care Providers, Universities, etc.

What Can Be Done (2)?

2. Conduct Detection and Treatment Programs i. Particularly for high risk groups. ii. Employ inexpensive methods of detection and

treatment (Experience of Dr. Manis from Chennai, consider using non-physicians where possible).

iii. Collaboration with other like-minded organizations will increase efficiency and effectiveness – especially for a nation as populous and with as many volunteer health organizations as India.


4. Ultimately, the costs of prevention, detection and treatment programs nationally will require resources that can only be provided by such national or regional organizations as governments or other third party insurers – But this is for the future.

WORLD KIDNEY DAY WORLD KIDNEY DAY

A SUCCESS STORY:A SUCCESS STORY:

There has been an overwhelming There has been an overwhelming response around the world to response around the world to World Kidney Day.World Kidney Day.

WKD Successes (1)• Outstanding response from around the

world:

– 45 participating countries - 2006

– 63 participating countries - 2007

– 90 participating countries & territories – 2008

– Over 100 participating countries & territories -2009

WKD Successes (2)Participating Countries

– from Albania to Zimbabwe– In many countries, activities in many different

places– Participating organizations included:

societies, foundations, universities, colleges, hospitals associations, trusts and individuals

– Local activities focused on raising awareness across all key audiences:

– Public-at -large, Government ministers and Health Officials, Physicians and Allied Health Professionals

World Kidney Day Los Angeles World Kidney Day Los Angeles 2010 (2)2010 (2)

Many Southern California Organizations joined together for this event (continued)

March, 2010

4. Kidney Disease Lectures at Scheduled Hospital Conferences, Universities - Academic Nephrologists


Many Southern California Organizations joined together for this event

March 7, 2010

1. Polycystic Kidney Disease / KidneyWise Walk

March 11, 2010

2. Minority community education program and focus groups – Drew Postgraduate Medical School, Community Organizations

3. KEEP Dectetion Program– National Kidney Foundation



March 13, 2009

5. CKD Management Training for MD’s, RN’s, General Internists, Family Practitioners, Nurse Practitioners and Specialists, Case Managers – Kaiser Permanente Health Care System and Foundation, Los Angeles County Department of Health Services



March, 2008, 2009 And 2010

6. Innumerable planning meetings and individual activities – By representatives of all of the above organizations and entities

7. In Washington and elsewhere, meeting with government officials, editorials, the media and many many other activities

March 11, 2010

WorldKidney

Day

Interconnections Between Obesity, Diabetes Mellitus (DM), High Blood

Pressure, and Chronic Kidney Disease (CKD)

Relationships between Obesity, Diabetes & CKD: i. Obesity predisposes to both Diabetes & CKD ii. Diabetes is the most common cause of end-stage CKD that requires chronic dialysis treatments or renal transplantation iii. Roughly one-third of people with Diabetes will develop CKD

Interconnections Between Obesity, Diabetes Mellitus, High Blood Pressure,

and Chronic Kidney Disease (CKD)

Relationships between Obesity, Diabetes & CKD:(continued)

iv. Diabetes is easy to detect, can be prevented in most cases, and can usually be treated effectively in most cases.

Interconnections Between Obesity, Diabetes Mellitus, High Blood Pressure


Relationships between Obesity, Diabetes & CKD : v. Tight glucose control in DM appears to reduce the risk for CKD. vi. Blood pressure control reduces the harmful complications of DM. vii. DM is easy to detect, and in most cases, it can be prevented and usually treated effectively.

Interconnections Between Obesity, Diabetes Mellitus, High Blood Pressure, and Chronic

Kidney Disease (CKD)

Relationships between CKD & high blood pressure: i. High blood pressure, like chronic kidney disease (CKD), is often silent and dangerous. ii. High blood pressure causes CKD. iii. CKD causes High blood pressure. iv. Both CKD and Hogh blood pressure are common and treatable.



Relationships between Obesity, Diabetes, CKD, High blood pressure versus Vascular Disease: 1. Each of the above four conditions increase the risk for Cardiovascular and Cerebrovascular Disease. 2. This risk is often markedly increased. 3. Together these 4 diseases (Obesity, Diabetes, CKD and high blood pressure) cause a large percentage of the illnesses and deaths in the Developed and the Developing World.



What can We do to Prevent and Treat these Related Diseases and Their

Harmful Effects?

Diabetes: Tight Glucose & Blood Pressure Control and CV Outcomes

StrokeAny Diabetic

EndpointDM

DeathsMicrovascularComplications

-50

-40

-30

-20

-10

0

% R

ed

ucti

on

In

Rela

tive R

isk

Tight Glucose Control (Goal <6.0 mmol/l or 108 mg/dL)

Tight BP Control (Average 144/82 mmHg)

32%

37%

10%

32%

12%

24%

5%

44%

*

*

*

**P <0.05 compared to tight glucose control

Bakris GL, et al. Am J Kidney Dis. 2000;36(3):646-661.

Suggested Goals for CKD Patients esp. with Diabetes and High Blood Pressure

• Lifestyle modifications (no obesity, regular exercise)

• BP 130/80 mmHg or lower, esp in diabetes or proteinuria)

• Maximal reduction of proteinuria (<1 g/d)

• Multiple BP lowering meds(3-4 meds or more, if needed)

• ACEIs, ARBs, Diuretics, Beta-Blockers, Non-Dihydropyridine-CCBs

• HbA1c at <7% (in diabetics)

• Dietary protein restriction (0.6 - 0.8 kg/d)

• Dietary sodium restriction (<2-3 g/d sodium)

• Lipid-lowering therapy (diet, statins)


3. New Direction:

We are beginning to join with other disease focused groups and world health days that relate to kidney disease (for example, World Hypertension Day, possibly in the future, World Diabetes Day).

World Kidney Day-Plans For 2009(2)

2. Collaboration with World Hypertension Day.

i. Share messages on websites, in printed messages?

ii. Place links on respective websites?

iii. Inaugurate combined programs in selected circumstances(2009 WKD will add a HTN focus).

3. Basic Principal: A message has the greatest impact when it is repeated many times and in different ways or by different groups.

World Kidney Day-Plans For 2009(3)

i. It follows that we might all come closer to achieving our respective goals if Heart, Diabetes and Stroke join in this linkage effort with WHD and WKD.

4. Role for the Vascular Alliance?

i. Coordinate such linkage efforts?

ii. Facilitate the liaison between Vascular Alliance and target audiences (eg, Nurses, family practitioners, general internists, pharmacists, government ministries, etc.).

World Kidney Day – Future Plans

1. Increase Public Health Message 2. Bring all Kidney Disease Organizations

together for a Unified Effort and Message (kidney foundations, societies of nephrology, patient organizations, community activists, medical schools, teaching hospitals, insurers)

3. Each community to use WKD as time to announce goals and timelines for targeted improvements in prevention and health care for people with or at risk for kidney disease. WKD is also used to announce the status and successes of these efforts.

Potential Evolution in Goals for Potential Evolution in Goals for World Kidney Day World Kidney Day

The goal is to use World Kidney Day as a The goal is to use World Kidney Day as a mechanism to stimulate people to work together mechanism to stimulate people to work together to improve the health care system as it affects to improve the health care system as it affects public health, preventative medicine and acute public health, preventative medicine and acute and chronic medical care in their locality with and chronic medical care in their locality with regard to acute and chronic kidney disease .regard to acute and chronic kidney disease .

We want to have volunteers from kidney We want to have volunteers from kidney foundations, kidney patient organizations, foundations, kidney patient organizations, societies of nephrology, other interested societies of nephrology, other interested organizations and the public-at-large join organizations and the public-at-large join together to attain these goals in their locality.together to attain these goals in their locality.

Documents

WHY WORLD KIDNEY DAY? WORLD KIDNEY DAY (1) PURPOSE: 1.World Kidney Day was established to increase awareness of the need for detection programs for CKD