1. NATIONAL KIDNEY AND TRANSPLANT INSTITUTE
Romina A. Danguilan, MD, FPCP, FPSN
Chair, Department of Adult Nephrology
National Kidney And Transplant Institute
Quezon City
25 June 2009

2. National Kidney and Transplant Institute (NKTI)
The largest tertiary referral center of the DOH for the prevention, diagnosis and management of diseases involving the kidneys and urinary tract, and for the treatment of end-organ damage through organ transplantation
The Renal Disease Control Program (REDCOP) is the public health arm of the DOH for renal disease and organ donation and transplantation, through the NKTI
Comprehensive public education program, and advocacy for the maintenance of renal health and the prevention of kidney disease.
Research on renal diseases
Patient services through medical missions
Quality assurance

3. Renal Disease Control Program (REDCOP)
Flagship project:
The Philippine Renal Disease Registry
(A National Registry)
Registry started by the Philippine Society of Nephrology in the mid-1990s, but with <50% data capture since it was purely voluntary
In 2000, it became a partnership between PSN and the NKTI, to provide logistical and administrative back-up, and assigned to the REDCOP

4. Renal Disease Control Program (REDCOP)
Flagship project:
The Philippine Renal Disease Registry
(A National Registry)
It was linked to BHFS to make participation mandatory for licensing of dialysis and transplant facilities
It was linked to Philhealth to make participation mandatory for Philhealth accreditation
In 2009, it was absorbed by the DOH under the NEC, still to be administered by REDCOP

5. The Philippine Renal Disease Registry (PRDR)
CHRONIC KIDNEY DISEASE REGISTRY
ESRD REGISTRY
CHRONIC KIDNEY DISEASE REGISTRY
Looks at the acceptance rate
into a renal replacement
therapy program.
Pathologic causes
of renal disease.
Hemodialysis Registry
Peritoneal Dialysis Registry
Kidney Biopsy Registry
Kidney Transplant Registry

6. PRDR
OBJECTIVE: To determine trends in the demographics of ESRD patients on dialysis and who received a kidney transplant from
METHODOLOGY
Collection of data on a quarterly basis from 397 dialysis units and 24 transplant centers with 98% data capture.
Submission of data is mandated by the Bureau of Health Services of DOH, as a requirement for licensing.
Dialysis and Transplant Centers are oriented as to the data collection methods.

7. PRDR
METHODOLOGY cont
Standard PRDR forms are completed by dialysis and transplant center personnel and collected by
PRDR Central Office based at REDCOP for the National Capital Region (NCR),
and by DOH Regional Coordinators for centers outside NCR, who then send the forms to the Central Office by mail.
All the data are reviewed, checked for completion and internal consistency.
Any inconsistencies are clarified by calling on the dialysis or transplant facility.
Reports are generated looking at frequencies, averages and percentages.
Annual Report is generated.

8. NUMBER OF DIALYSIS CENTERS ACCORDING TO TYPE OF DIALYSIS
Number of Centers

9. NEW PATIENTS ON DIALYSIS
Number of Patients
(7%)
(7%)

10. INTERNATIONAL COMPARISONS % DISTRIBUTION OF DIALYSIS PATIENTS BY MODALITY
USRDS 2008 Annual Report

11. INTERNATIONAL COMPARISONS INCIDENCE OF ESRD, 2006 (PMP)
PHILIPPINES: Acceptance Rate into RRT = 84 PMP in 2008
Up from 55 PMP in 2002, and 71 PMP in 2005
USRDS 2008 Annual Report

12. NEW DIALYSIS PATIENTS NCR VS REGIONS
Number of Patients
59 PMP
255 PMP

13. INTERNATIONAL COMPARISONS PREVALENCE OF ESRD, 2006 (PMP)
USRDS 2008 Annual Report

14. PREVALENCE AND NEW PATIENTS STARTING DIALYSIS

15. DISTRIBUTION OF TOP 3 CAUSES OF ESRD
Number of Patients
(42%)
DM - Diabetes mellitus
GN - Chronic glomerulonephritis
HPN - Hypertensive nephrosclerosis

16. INTERNATIONAL COMPARISONS % OF INCIDENT DIALYSIS PXS WITH DIABETES
USRDS 2008 Annual Report

17. AGES OF NEW DIALYSIS PATIENTS in 2008
Number of Patients

18. AGE AND GENDER OF NEW DIALYSIS PATIENTS, 2008
AGE (yrs)
According to Primary Renal Disease
Diabetic nephropathy 60
Hypertensive nephrosclerosis 57
Chronic pyelonephritis 54
Chronic glomerulonephritis 35
According to Type of Dialysis
Hemodialysis
53.8
Peritoneal dialysis
49.2
GENDER
M:F RATIO :1

19. CONCLUSIONS The acceptance rate into RRT is only 84 PMP
Majority of patients are treated with hemodialysis (93%), a capital-intensive form of therapy vs peritoneal dialysis
Dialysis patients were mostly males (1.44:1) aged between yrs
The most common cause of ESRD is diabetes (42%)

20. NUMBER OF NEW KIDNEY TRANSPLANTS
Number of Patients
35%
decrease

21. PRIMARY RENAL DISEASE OF NEW KIDNEY TRANSPLANTS
Number of Patients

22. LENGTH OF TIME ON DIALYSIS PRIOR TO KIDNEY TRANSPLANT
Number of Patients

23. AGE OF RECIPIENTS AGE OF DONORS Mean age: 43 yrs Mean age: 30 yrs
Number of Patients
Number of Patients
Mean age: 43 yrs Mean age: 30 yrs
Range : Range: 9-59

24. GENDER OF RECIPIENTS AND DONORS
Number of Patients
M:F 3.7:1
M:F 1.8:1

25. DONOR SOURCE
Number of Patients
(67%)
3.9%
(28%)
(5%)

26. REDCOP
National Advocacy Campaign for kidney transplantation from deceased donors: tri-media coverage, lay fora, seminars
Lay community
Govt physicians
Despite the continuous advocacy campaign, the PRDR reports that living donors comprise 96% of donor kidneys from

27. REDCOP
National survey on knowledge, attitudes, perceptions of Filipinos on organ donation in 2001 and 2005
OBJECTIVE OF SURVEY 2001
To determine the reasons for the small numbers of transplants from deceased donors
The results led to a more intensive advocacy campaign addressing public concerns on organ donation
OBJECTIVE OF SURVEY 2005
To determine if the improved advocacy campaign was effective in increasing KT from deceased donors

28. National survey on knowledge, attitudes, perceptions of Filipinos on organ donation
OBJECTIVE
Compare KAP of Filipinos on organ donation based on the 2 surveys.
To determine factors favoring organ donation
To determine whether the advocacy campaign was effective in increasing KT from deceased donors
METHODS
2 surveys performed in 15 regions using multi-stage sampling
2001: 2,000 respondents : 2,140
Structured questionnaire

29. Comparison of National Survey on knowledge, attitudes, perceptions of Filipinos on organ donation
2001
2005
Knew about kidney donation
82%
77%
Source of donors for transplantation
Living donors only
Deceased donors only
BOTH
49%
14%
37% 9%
41%
Willing to become living donors
53%
57%
Willing to become deceased donors
16%
78%

30. Factors that disadvantaged deceased organ donation
Comparison of National Survey on knowledge, attitudes, perceptions of Filipinos on organ donation
Factors that disadvantaged deceased organ donation
Poor understanding of concept of “brain death”
Organ donation is against one’s religion
Fear of the operation/post-operative effects
Factors significantly correlated with consent for organ donation in 2001 survey
Single civil status
Higher education
Higher monthly income

31. NUMBER OF TRANSPLANT RECIPIENTS FROM DECEASED DONORS7%
2.6%
3.9%

32. Public information campaigns should be strengthened
Comparison of National Survey on knowledge, attitudes, perceptions of Filipinos on organ donation
There has been a steady increase in the numbers of KT from deceased donors through 2008, though the % remains low
Public information campaigns should be strengthened
Concept of “brain death” needs careful explanation
Operative/post-operative effects should be clear
Procedures with the least effect on the donor physically, should be used (lap nephrectomy)