1. Chronic Kidney Disease in the Community - Indian Scenario by Dr. Vidya N. Acharya; MD; FAMS; Hon. Secretary - National Kidney Foundation - India Director - Professor; Post Graduate Studies in Nephrology; Muljibhai Patel Society for Research in Nephro - Urology and Hospital - Nadiad - South Gujarat - India

2. India - The Hard Economic Facts. Population=1000 million and growing Per capital Income=Rs.12989/year One US $= Rs. 46 - 47 Earning > Rs.50,000=2.2% of population No. of poor=36% of population Cost of a renal Tx.=Rs. 2,50,000 June, 2003

4. Chronic Kidney Disease in India - Hospital Based Data Comparison of data on C.R.F. from Chennai and Chandigarh Compared [hospital data] Channai - %Chandigarh - % [Mani M.K.][Sakuja - Sud] *Chronic Glomerulonephritis 17.44 37.0 *Diabetic Nephropathy 27.60 24.0 *Chronic Interstitial Nephritis 20.39 14.0 *Nephrosclerosis 11.0 13.0 Ref. Kidney Intl. Sup. No. 83; Feb., 2003 Community based data may be in variance with selective hospital based data June, 2003

5. Male adultsFemale adultsChildren Chronic Kidney Disease in the Community Mumbai 2002 - Age and Sex Distribution of the screened population- n = 3218 June, 2003

6. HinduMuslimChristianSikhOthers Demographic Data - Mumbai 2002 Distribution by Religion - n = 3218 June, 2003

7. 1= Hypertensive nephrosclerosis 2= Diabetic renal disease 3=Stone disease 4=Miscellaneous (GN 3.5%, UTI 3.4%, others 0.5%) Chronic Kidney Disease Detected in the community: Mumbai 2002 n=3218 CKD=34.7%

8. Chronic Kidney Disease in the Community Mumbai Data - 2002 [H] High Risk Group [H] n = 748 Diabetics12216%Adults98.7% Children1.3% below 18 yrs. Non Diabetic62684% Hypertensives21028% Non. Hypertnvs.53872% Combined Diabetics with Hypertensives n = 80/122=66% June, 2003.

9. Positive Negative ProteinuriaHematuriaPyuria June, 2003

10. Demographic Data of the High Risk Group -Mumbai 2002 - Weight distribution [in Kgs.] - n = 748 Entire group63.6 + 13 (4-110) Diabetic65.0 + 13 (4-92) Non Diabetic64.2 + 9 (15-110) Difference in weight not statistically significant June, 2003

11. Non-DM 84% DM 16% Adults 15.7% Children 0.3% June, 2003

12. Chronic Kidney Disease in the Community [H] Mumbai Data - 2002 [contd] Duration of Diabetes Mean in years4.28 ± 5.18 Range1 year to 23 years Diabetes/Age Mean52.4 ± 13.5 yrs. Range2 years - 85 years Diabetes and Therapy [OHA and/or Insulin] Not on treatment = 30/122 = 25% On treatment = 92/122 = 75% June, 2003.

13. Chronic Kidney Disease in the Community [H] Mumbai Study - Blood Pressure values - n=748 Diabetics/Non Diabetics. MeanRange DiabeticsSystolic B.P. 132 ± 23mmHg 100 - 180mmHg Diastolic B.P. 82.6 ± 9.9mmHg 60 - 100 mmHg Non Systolic B.P. 132.4 ± 21.10mmHg 100 - 201mmHg DiabeticsDiastolic B.P. 87 ± 15mmHg 50 - 140 mmHg June, 2003.

14. +++ Proteinuria % % % June, 2003

15. +++ Proteinuria % % % June, 2003

16. Chronic Kidney Disease in the Community [H] Mumbai - 2002 [H] - Hypertensives - n = 748. Known Hypertensives=210[28%] Not known Hypertensives=538[72%] Duration of Hypertension in yrs. Mean 1.4 ± 3.24 B.P. levelsSystolic 133.8 ± 24mmHg Range 120 - 190 mmHg Diastolic 84.3 ± 12.5mmHg Range 70 - 105mmHg Not known Hypertensive B.P. levelsSystolic 131 ± 21mmHg Range 100 - 210mmGh. Diastolic 86 ± 15mmHg Range 50 - 90mmHg Differences in B.P. levels between known and not known hypertensives - not significant. June, 2003.

17. 1+ 2+3+4+ Mumbai 2002 Data [H] Hematuria in Hypertensives (%) June, 2003

18. Chronic Kidney Disease in the Community Mumbai - 2002 [O + N + H] n = 3218 Renal Diseases Detected34.7% Hypertensive Nephrosclerosis=11.2% Diabetic Renal Disease=10.6% Stone Disease= 5.3% Miscellaneous Renal Diseases= 7.4% These include Urinary Tract Infeciton [3.4%] GMN [3.5%] ADPKD: Genito-Urinary Tuberculosis + Urinary Obstruction + Benign Prostatic enlargement [0.5%] June, 2003.

19. 150 (65.0%) MALE FEMALE 81 (35.0%) Demography - Bharuch Data - SEX DISTRIBUTION June, 2003

20. GROUP 60 TOTAL Overall 22 20 93 64 32 231 (%) (9.5) (8.7) (40.3) (27.7) (13.9) Males 13 12 58 43 24 150 (%) (8.7) (8.0) (38.7) (28.7) (16.0) Females 9 8 35 21 8 81 (%) (11.1) (9.9) (43.2) (25.9) (9.9). Demography - Bharuch Data - Distribution - Age in Years * June, 2003

21. GROUP NORMAL ABNORMAL TOTAL BHARUCH 139 (61.2%) 92 (39.8%) 231 Chronic Kidney Disease in the Community - Bharuch Data June, 2003

22. URINARY PROTEINURIA (92 ) 58 (63.0%) 20 (15.2%) 9 (6.5%) 3 (3.3%) 11 (12.0%) * Chronic Kidney Disease in the Community - Bharuch Data June, 2003

23. PROTEINURIA IN DIABETES (62) 33 (53.2%) 12 (19.4%) 5 (8.1%) 3 (4.8%) 9 (14.5%) * Chronic Kidney Disease in the Community - Bharuch Data June, 2003

24. PROTEINURIA IN HYPERTENSIVES 16 (55.2%) 6 (20.7%) 1 (3.4%) 2 (6.9%) 4 (13.8%) * Chronic Kidney Disease in the Community - Bharuch Data June, 2003

25. CREATININE STATUS 218 (94.5%) 6 (2.6%) 3 (1.1%) 4 (1.6%) * Chronic Kidney Disease in the Community - Bharuch Data June, 2003

26. Chronic Kidney Disease in the Community [Data on Bharuch Camp] n = 231 Types of Diseases Detected * Diabetic Renal Disease=26.8% * Renal Stone Disease=17.3% * Hypertensive nephrosclerosis=16.88% * Urinary Tract Infection=16.5% * Chronic Renal Failure=5.6% * Glomerulonephritis with nephrotic syndrome=3.5% * Benign prostatic hypertrophy=1.3% June, 2003.

27. Chronic Kidney Disease in the Community - Mumbai, Udaipur & Bharuch Disease state Mumbai UdaipurBharuch Hypertensive neph.11.2 30.416.88 Diabetic renal dis.10.6 12.6 **26.8 Stone Disease 5.3 **34.4 * 17.3 Miscellaneous 7.4 12.4 10.8 *p < 0.05 **p < 0.001 Miscellaneous group includes GMN, ADPKD, UTI, Urinaru Obstruction, Genitourinary TB, Benign Prostate enlargement June, 2003

28. Nephrologists as programme developers for the community * Need shift in perspective and use of different sets of analytical skills. * Evaluation of individual community health needs * Measures to counter renal problems as seen in individual communities. June, 2003

29. There is a continuing cry for preventive aspects of nephrological disorders, which demands : * Commitment * Honesty * Accountability * Integrity * Responsibility June, 2003

30. Our Grateful Thanks to *Giants International - Mumbai *Lions Clubs - Mumbai *Rotary Clubs of Mumbai, Udaipur, Kanpur *Bharuch Junior Chamber with Dr. Hiren Shah /JC Umesh Shah June, 2003

31. [Contd.] *Prempuri Ashram - Mumbai *Dr. Mukesh Barjathia - Udaipur *Dr. Dilip Sinha - Kanpur *Drs. Niranjan Kulkarni, Dr. Hemal Shah, and others from Muljibhai Patel Urological Hospital - Nadiad - South Gujarat *Drs. Vasanti Balvalli. *Dr. Vishwanath Billa *Dr. Jyotsna Zope June, 2003

32. THANK YOU