Dialysis in Russia, key issues Prevalence of 2HPT in Russian dialysis population Dr. Valeriy Shilo Mоscow, Russia Russian Zemplar® Advisory Board Meeting Moscow 2009

General information about Russia and Healthcare Dialysis in Russia Prevalence and current management of HPT in Russian Dialysis Population Zemplar

Macroeconomic snapshot of Russia Area sq.km. Population –

Russia: economic state Per capita GDP in international dollars, 2004 GDP = gross domestic product 52 Russia15,922 IMF 2008Russia World Bank Russia14,743 World Bank 2007Russia

Healthcare structure/personnel Hospitals5 285 Hospitals Policlinics2 350 Policlinics Dispansers1 152 Dispansers MDs 43,3 per MDs 43,3 per Nurses 94,3 per Nurses 94,3 per MD : nurse ratio 1:2,2MD : nurse ratio 1:2,2 12, 4 Hospital beds per 1000

GDP 2,6% 3,7% 3,5%

Data from Russian Registry of Renal Replacement Therapy Dialysis in Russia: key issues Data from Russian Registry of Renal Replacement Therapy

HD units distribution (number per на 100k km 2 ) by the end 2005

RRT centers ( ) Число отделений (Δ 47%) (Δ 36%) ( Δ 258%)

Dialysis Units (Types) Type Proportion (%) Patients # (%) Federal Academic Institution <5 5 Private Academic Institution 0 0 Federal Hospitals 1 0,1 Municipal Hospitals Other public (Military, Railway ets) 5 <5 Private hospitals 0 0 Private ambulatoric 5 20 dialysis clinics

Prevalence of patients on RRT in Russia in yrs (increase 13,6% ) Число больных ГД ПД Tx ,7% 6,8% 21.5% 19483

Access to RRT in Moscow(2006 г), whole Russia (2006 г.) in comparison to other countries (2005 г.) (International comparison. USRDS 2006) Обеспеченность на млн. населения

Comparison in RRT prevalence in Federal Parts of Russia ,5 2006

Incidence rates in yrs HD PD Per million pop. 2,1 15,6 16,9 19,2 20,2 24,3 29, Summary grouth 135%

Incidence rates HD + PD per Million Population in Moscow, whole Russia, Austria, USA Число больных, впервые приятых на лечение ГД и ПД за год, на млн. населеня 132, ,7 39, ,

Age of RRT Pts ( ) PrevalentIncident Children on RRT 451 pts (18,8 PMCP )

Prevalence of HPT an other disturbances in mineral metabolism in Russian dialysis population

Исследование распространенности ВГПТ в РФ фаза I – II HPT Russian Study Vaves I-II центра РФ –10 Москва –3 Санкт – Петербург –Екатеринбург –Краснодар –Нижний Новгород –Петрозаводск –Самара –Липецк –Новосибирск –Кемерово –Волгоград Всего включено 1569 пациентов на ГД

PTH Comparison

PTH Distribution

Phosphate distribution

Фосфор сыворотки – сравнение с международными данными

Total pts Russia pts 2009 Q1

Corrected Ca distribution

Corrected Ca comparison

Са х РО4 Product

Available options for HPT Management in Russia Active Vitamin D sterols –Calcitriol –Alfacalcidol –Paricalcitol - not reimbursed Calcimimetics –Mimpara - not reimbursed Phosphate binders (cont)

Available phosphate binders in Russia Calcium carbonate Aluminum gel salts Sevelamer HCl (Renagel) – not reimbursed Calcium acetate Lantanum carbonate Not Available

Vit D Usage

Conclusion (I) RTT in Russia is still unacceptable poor comparable to industrial countries, though some improvement are obviousRTT in Russia is still unacceptable poor comparable to industrial countries, though some improvement are obvious No central (Federal) reimbursement for HD and PD creates unequal access to dialysis throughout the countryNo central (Federal) reimbursement for HD and PD creates unequal access to dialysis throughout the country From 2005 EPO and iron become available due to federal reimbursement programFrom 2005 EPO and iron become available due to federal reimbursement program Rapidly grown economy promise further improvement in health care systemRapidly grown economy promise further improvement in health care system