chronic kidney disease: the philippine situation
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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