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 – 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

The prevalence of CKD Stage 3-5 is 2.6% 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 years and above in 2005 was 46,627,172 A prevalence of 2.6% means that 1,212,306 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 20.7% 7.5% 5.0% 2.9% 0.3% 1.0%

Mean level of GFR by age group: Philippine vs. US data in Years NNHeS 2003 Philippines NHANES III U.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 Number of Patients 2005: TOTAL INCREASE BY 7% HD = 87%; INCREASE BY 8% PD = 13%; INCREASE BY 1% 2004: TOTAL INCREASE BY 10% HD = 87%; INCREASE BY 15% PD = 13%; DECREASE BY 14%

NEW PATIENTS ON DIALYSIS: 2001-2005 ACCORDING TO DIALYSIS MODALITY Number of Patients 2005: TOTAL INCREASE BY 7% HD = 87%; INCREASE BY 8% PD = 13%; INCREASE BY 1% 2004: TOTAL INCREASE BY 10% HD = 87%; INCREASE BY 15% PD = 13%; DECREASE BY 14%

ACCEPTANCE RATE TO RRT PROGRAMS (PMP) Data from International Federation of Renal Registries website and the Philippine Renal Disease Registry 71 PMP 55 PMP 63 PMP 68 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 71 PMP 55 PMP 63 PMP 68 PMP Patients per million population

PRIMARY RENAL DISEASE OF ALL NEW DIALYSIS PATIENTS 20% 26% 38%

DISTRIBUTION OF TOP 3 CAUSES OF ESRD Number of Patients

NNHeS 2003-2004 Renal Report Prevalence of CKD Stage 3-5 according to AGE 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 20.7% 7.5% 5.0% 2.9% 0.3% 1.0%

END STAGE RENAL IS A BAD DISEASE TO HAVE Limited survival Expensive

Retrospective cohort study of 327 patients from NKTI and SLMC diagnosed to have ESRD 2000-2001 OVERALL SURVIVAL 12 month estimated survival rate - 53% (95%CI: 47-58) 24 month estimated survival rate - 36% (95%CI: 30-42

Results PATIENT GROUP Service – n=198 (60%) Private – n=129 (40%) Log 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 GROWING PROBLEM OF CHRONIC KIDNEY DISEASE

Treatment is too expensive Prevention is the key

Kung hindi tayo ang kikilos Sino ang kikilos? Kung hindi ngayon, kailan pa?

Philippine Society of Nephrology The Philippine College of Physicians wishes to acknowledge the following for their invaluable contribution in the preparation of this module Philippine Society of Nephrology