Section 1: CKD Epidemiology

The Problem Chronic Kidney Disease is an epidemic worldwide Growth 6-8% per annum of dialysis patients Accumulating data re: possibility of delaying the progression of kidney disease, using multiple drug and behaviour intervention therapies. Under-recognition at earlier stages of kidney dysfunction persists Late referral Lost opportunities for improved patient outcomes  

RRT Modalities 36,542 DOD/0503-04

Age Specific Rate per Million Patients Accepted in the UK for Renal Replacement Therapy 50 100 150 200 250 300 80 81 82 83 84 85 86 87 88 90 91 92 93 94 95 96 97 98 99 2000 2001 Year Age Specific Rate per Million 0 - 44 45 - 64 65+ Diabetics Total

Cadaveric Kidney Donors & Transplants and End of Year Kidney Waiting List, UK, 1994-2003 DOD/0503-04

Prevalence of renal replacement therapy Take-on rates /pmp England 98 Wales 118 France 200 Italy 260 USA 315

Estimates of Prevalence of CKD in the US: NHANES III Stage Description GFR (ml/min/1.73 m2) Prevalence (000s) (%) 1 Kidney Damage with Normal or  GFR >90 5,900 3.3 2 Kidney Damage with Mild  GFR 60-89 5,300 3.0 3 Moderate  GFR 30-59 7,600 4.3 4 Severe  GFR 15-29 400 0.2 5 Kidney Failure <15 or (or dialysis) 300 0.1 Using their definition and classification of stages of chronic kidney disease the K/DOQI workgroup was able to provide rough estimates of the prevalence of each stage in adults aged 20 or over from the Third National Health and Nutrition Examination Survey (NHANES III) in the United States. In the United States, there is a rising incidence and prevalence of kidney failure. There is an even higher prevalence of earlier stages of CKD. Adapted from Am J Kidney Dis 2002; 39 (2, Suppl. 1): S17-S31

NICE: 2008 Classification of CKD waking up to the impact of proteinuria Stage 1: GFR>90 + abnormal urinalysis Stage 2: GFR 60-89 + abnormal urinalysis Stage 3A: GFR 45-59 Stage 3B: GFR 30-44 Stage 4: GFR 15-29 Stage 5: GFR <15 or dialysis dependent Suffix P denotes presence of proteinuria (ACR>30 or PCR>50)

National Disease Prevalence Survey (%)

CKD: A Typical GP Practice of 10000 5 6 15 4 60 Stage of Kidney Disease 30 (GFR) 380 3 60 2 460 90 1

Incident Rates by Primary Diagnosis (per million population, unadjusted) Diabetes is the most rapidly rising cause of ESRD, but hypertension and glomerulonephritis rates also continue to rise. USRDS, 2000

Obesity Trends: UK

Life expectancy: UK