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Epidemiology of chronic kidney disease 2

Chronic kidney disease (CKD) is a worldwide public health problem 3

Chronic kidney disease is a major worldwide public health hazard. Its global prevalence is rapidly and steadily increasing, particularly in developing countries 4

Chronic kidney disease (CKD) is a major public health threat with a rapid increase in its global incidence and prevalence, particularly in developing countries, leading to end-stage renal disease (ESRD), and resulting in premature mortality, poor quality of life, and large burden for the health care systems 5

The incidence of major risk factors of chronic kidney disease (CKD) in the world is on the rise, and it is expected that this incidence and prevalence, particularly in developing countries, will continue to increase 6

The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF- K/DOQI) workgroup has defined CKD as the following, which has been accepted internationally The presence of markers of kidney damage for three or more months, as defined by structural or functional abnormalities of the kidney, with or without decreased glomerular filtration rate (GFR), that can lead to decreased GFR, manifest by either pathological abnormalities or other markers of kidney damage, including abnormalities in the composition of blood or urine, or abnormalities in imaging tests The presence of GFR <60 mL/min per 1.73 m2 for three or more months with or without other signs of kidney damage, as described above. 7

studies have estimated the prevalence of CKD in the general population through measurement of markers of kidney damage such as elevated serum creatinine concentration, decreased estimated GFR (eGFR), and presence of albuminuria 8

10% of the population worldwide is affected by chronic kidney disease (CKD), and millions die each year because they do not have access to affordable treatment 9

Chronic kidney disease is defined as a reduced glomerular filtration rate, increased urinary albumin excretion, or both, and is an increasing public health issue. Prevalence is estimated to be 8-16% worldwide. 10

In people aged 65 through 74 worldwide, it is estimated that one in five men and one in four women have CKD 11

more than 10% of adults in the United States—more than 20 million people— may have CKD, chances of having CKD increase with age; it increases after age 50 years and is most common among adults older than 70 years 12

Adults with diabetes or high blood pressure, or both have a higher risk of developing CKD than those without these diseases. Approximately 1 of 3 adults with diabetes and 1 of 5 adults with high blood pressure has CKD 13

Other risk factors for CKD include cardiovascular disease, obesity, high cholesterol, lupus, and a family history of CKD 14

It is estimated that by 2030, over 70% of patients with ESRD will be inhabitants of developing countries, probably related to the fast rising trend of obesity and diabetes in these countries 15

the estimated prevalence within the United States of each stage in 1999 to 2004 ● Stage 1 disease is defined by a normal GFR (>90 mL/min per 1.73 m2) and persistent albuminuria (1.8 percent of the total United States adult population). ●Stage 2 disease is a GFR between 60 to 89 mL/min per 1.73 m2 and persistent albuminuria (3.2 percent). ●Stage 3 disease is a GFR between 30 and 59 mL/min per 1.73 m2 (7.7 percent). ●Stage 4 disease is a GFR between 15 and 29 mL/min per 1.73 m2 (0.35 percent). ●Stage 5 disease is a GFR of <15 mL/min per 1.73 m2 or end-stage renal disease (ESRD) (2.4 percent)

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Prevalence in other countries cross-country comparisons are difficult because of variations in study design, differences in definitions used, lack of standardization of laboratory calibrations, and lack of knowledge of significant factors such as age and comorbidity. CKD, most commonly defined as an elevated serum creatinine level or decreased eGFR or moderately increased albuminuria, reportedly ranges from approximately 1 to 30 percent 19

As examples: ● In a population-based study in Korea, the prevalence of moderately increased albuminuria was 2.8 percent among normotensive, normoglycemic individuals and 10 and 16 percent among hypertensives and diabetics, respectively ●Among adults in Iceland, the prevalence of an eGFR <60 mL/min per 1.73 m 2 and proteinuria was 5 and 2 percent among men, respectively, and 12 and 1 percent among women, respectively. ●In a report from Taiwan, the prevalence of an eGFR <60 mL/min per 1.73 m 2 was 7 percent. ●In one study, the overall prevalence of CKD in Norway, was 10.2 percent, which is similar to that reported in the United States ●In a population-based study from Malaysia, the prevalence of CKD was 9 percent 20

Incidence of CKD ● The Framingham Offspring study consisted of 1223 men and 1362 women who were initially free of preexisting kidney disease. After a mean follow-up of 18.5 years, 244 participants (9.4 percent) had developed kidney.The development of CKD was associated with increased age, diabetes, hypertension, smoking, obesity, and a lower baseline GFR. ●In a retrospective cohort study over a 5.5-year period of follow-up, the estimated annual incidence of CKD was 1700 per million population 21

PREVALENCE OF END-STAGE RENAL DISEASE (ESRD) The prevalence of ESRD is increasing. The number of patients enrolled in the ESRD Medicare-funded program has increased from approximately 10,000 in 1973 to 615,899 as of December 31,

RACIAL VARIATIONS IN PREVALENCE OF ESRD AND CKD There are striking racial and ethnic differences in the incidence and prevalence rates of end-stage renal disease (ESRD) In 2005, the incidence rates for ESRD in the United States were 268 per million population in Caucasians; 991 in African Americans; 355 in Asian Americans, native Hawaiians, and other Pacific Islanders; and 516 in American Indians and Alaska Natives Similarly, the incidence of ESRD in South-Asian and African- Caribbean immigrants in the United Kingdom is three- to fourfold higher than in the general population 23

These disparities raise the possibility that differential access to health care, and, thus, management of CKD and probably faster progression to ESRD, may be a cause for concern in minority groups, particularly among African Americans 24

IMPACT OF CKD AND ESRD ON GENERAL MORBIDITY Both early stages of chronic kidney disease (CKD) and end-stage renal disease (ESRD) are associated with high morbidity and increased healthcare utilization. Approximately 50 percent of dialysis patients have three or more comorbid conditions ; 25

IMPACT OF CKD AND ESRD ON MORTALITY Patients with chronic kidney disease (CKD) and particularly end-stage renal disease (ESRD) are at increased risk of mortality, particularly from cardiovascular disease (CVD). Survival probabilities for dialysis patients at one, two, and five years are approximately 81, 65, and 34 percent, respectively 26

Risk of dying Premature death from all causes and from cardiovascular disease is higher in adults with CKD than in adults without CKD 27

the incidence of end-stage renal disease (ESRD) is dramatically increasing worldwide Most patients with kidney problems visit their physicians in the late stages of the disease 28

According the 2010 Global Burden of Disease study, chronic kidney disease was ranked 27th in the list of causes of total number of deaths worldwide in 1990, but rose to 18th in

In the US, treatment of chronic kidney disease is likely to exceed $48 billion per year. Treatment for kidney failure consumes 6.7% of the total Medicare budget to care for less than 1% of the covered population In China, the economy will lose US$558 billion over the next decade due to effects on death and disability attributable to heart disease and kidney disease In Uruguay, the annual cost of dialysis is close to $ US 23 million, representing 30% of the budget of the National Resources Fund for specialized therapies In England, according to a recent report published by NHS Kidney Care, chronic kidney disease costs more than breast, lung, colon and skin cancer combined In Australia, treatment for all current and new cases of kidney failure through 2020 will cost an estimated $12 billion 30

The prevalence of CKD is high in Iran and its contributing risk factors are older age, female sex, hypertension, diabetes, high waist circumference, dyslipidemia and high body mass index 31

CKD and its main risk factors are common and represent a definite health threat in Iran 32

Chronic kidney disease (CKD), with a prevalence of 10% to 15% Iran J Kidney Dis May;9(3): A multilevel model for services provided to patients with chronic kidney disease. 33

The prevalence of CKD in patients with diabetes mellitus and hypertension was 21.5% Iran J Kidney Dis Nov;8(6): Chronic kidney disease management program in Shahreza, Iran. 34

A total of 800 subjects aged more than 35 years admitted from 2011 to 2013 were enrolled in the study CKD was seen in 14.8% patients with MetS and 8.3% individuals without MetS in Boroujerd J Res Med Sci May; 20(5): 465–469. Metabolic syndrome and its components associated with chronic kidney disease 35

prevalence was 18.9% among people aged over 20 years, in Tehran, Iran in A study during 2002 to 2005 reported that the CKD prevalence (stags 1 to 5) was 12.6% in Iranian people. Another study conducted in 1557 Iranian samples showed 19.5% prevalence for CKD (stages 1 and 2, 10.6%; stages 3 to 5, 8.9%). 36

In a large study reported that prevalence of CKD among individuals over14-years old in different parts of the country was 6%to 17% Safarinejad MR ( 2009 ) The epidemiology of adult chronic kidney disease in a population-based study in Iran: prevalence and associated risk factors. J Nephrol 22: 99–10 37

this study shows considerable disparities among counties of Iran. Early intervention strategies to reduce the burden of CKD are essential. 38

In the past decade, 1.1 trillion dollars have been spent for dialysis worldwide Early diagnosis and treatment of mild to moderate CKD may prevent or delay progression of the disease to severer stages 39

Diagnosis and treatment of CKD in early stages and prevent of risk factors of CKD specially obesity can be an important public health issue, particularly in the developing countries with high rates of CKD 40

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