1. The Databases: Successes and Shortcomings in Renal Replacement Therapy Since 1989 European Renal Association and European Dialysis and Transplant Association (ERA-EDTA) Carmine Zoccali

2. CKD as public health priority CKD not mentioned

3. CKD%181614 NHANES III 1988-94 NHANES IV 1999-2004 40 million 14.5% 45 million 16.8% after 10 years  prevalence of diabetes and hypertension

4. RR (95% CI) 2.001.80//1.401.301.201.101.00 Overlapping of risk factors for the CV and CKD epidemics Age 5 years BMI1kg/m2  BP Stage 2 Diabetes CKD Stage 1 Smoking HDL  10 mg/dl Uric a.  2 mg/dl 17375 apparently healthy volunteers of the general Viennese population 2008

5. 177570 subjects that voluntereed for health checkups betwen 1964 and 1973 (Northern California kaiser Permanente)RR2.52.0//1.601.401.201.00 Cr S 1.6-1.9 mg/dl Proteinuria (+) Stage 1 hypertensionOverweight Glicosuria dark vs none Arch Intern Med. 2009;169:342-350

6. >85 years 20-44 years 0-19 years 8007006005004003002001000 PM P 1996199820002002 20042006 Incidence of RRT 1996-2006 MALES8007006005004003002001000 PM P 45-64 years 65-74 years 75-84 years annual ∆=20 % annual ∆=8.7 % annual ∆=6 % annual ∆=2.4 %

7. >85 years 20-44 years 0-19 years 8007006005004003002001000 PM P 1996199820002002 20042006 Incidence of RRT 1996-2006 FEMALES8007006005004003002001000 PM P 45-64 years 65-74 years 75-84 years

8. Survival % adjusted for age and gender & renal disease 100908070605040 0 1 2 3 4 5 1997-2001 2002-2006 Risk Reduction  10%

9. 300250200150100500 5 15 20 25 30 5 15 20 25 30 Incidence of RRT pmp Whole Time Equivalent Nephrologists (pmp) Germany England 14121086420 Geographical access Dialysis Units PMP Redrawn from Caskey FJ AJKD 2006; 47:445 the capacity of the system to capture and accomodate into RRT programs the ESRD population depends on human resources invested

10. Italy Catalonia -Spain Scotland Denmark SwedenNetherlandNorwayAustria UK Belgium Finland Valencia- Spain 95 /100.000 /year 164 /100.000 /year 250200150100500 800 850 900 950 1000 1050 1100 1150 1200 800 850 900 950 1000 1050 1100 1150 1200 Deaths/10 5 pts/year (general population) Deaths/10 5 pts year (RRT population) 1996-2000 r 2 =0.35..only  35% is explained by background mortality Van Dijk P. Kidney International (2007) 71, 53–59

11. The incidence rate of RRT in Europe is stable or decreasing in younger cohorts and tends to stabilize in older, diabetic and hypertensive cohorts Variations in incidence rates of RRT and in survival exist in western Europe. These differences are only in limited part explained by medical factors The ERA EDTA Registry has started an initiative (QUEST) aimed at promoting and facilitating Quality improvement programs, education in epidemiology for nephrologists and studies looking at factors implicated in the variation in RRT rates and outcomes across countries. S & C