1. Section 1: CKD Epidemiology

2. 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

3. RRT Modalities 36,542 DOD/0503-04

4. Patients Accepted in the UK for Renal Replacement Therapy

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

6. Prevalence of renal replacement therapy Take-on rates /pmp England98 Wales118 France200 Italy260 USA315

7. Estimates of Prevalence of CKD in the US: NHANES III StageDescription GFR (ml/min/1.73 m 2 ) Prevalence (000s) Prevalence (%) 1 Kidney Damage with Normal or  GFR >905,9003.3 2 Kidney Damage with Mild  GFR 60-895,3003.0 3 Moderate  GFR 30-597,6004.3 4 Severe  GFR 15-294000.2 5 Kidney Failure <15 or (or dialysis) 3000.1 Adapted from Am J Kidney Dis 2002; 39 (2, Suppl. 1): S17-S31

8. 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)

9. National Disease Prevalence Survey (%)

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

11. Incident Rates by Primary Diagnosis (per million population, unadjusted ) USRDS, 2000

14. Obesity Trends: UK

15. Life expectancy: UK