national kidney and transplant institute romina a. danguilan, md, fpcp, fpsn chair, department of...
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NATIONAL KIDNEY AND NATIONAL KIDNEY AND TRANSPLANT INSTITUTETRANSPLANT INSTITUTE
Romina A. Danguilan, MD, FPCP, FPSNChair, Department of Adult Nephrology
National Kidney And Transplant InstituteNational Kidney And Transplant Institute
Quezon CityQuezon City
25 June 200925 June 2009
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
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
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
The Philippine Renal Disease Registry (PRDR)
ESRD REGISTRY
Looks at the acceptance
rate into a renal
replacement therapy
program.
Hemodialysis Registry
Peritoneal Dialysis Registry
Kidney Transplant Registry
CHRONIC KIDNEY DISEASE REGISTRY
CHRONIC KIDNEY DISEASE REGISTRY
Pathologic causes of renal disease.
Kidney Biopsy Registry
PRDR
• OBJECTIVE: To determine trends in the demographics of ESRD patients on dialysis and who received a kidney transplant from 2001-2008.
• 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.
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.
NUMBER OF DIALYSIS CENTERSACCORDING TO TYPE OF DIALYSIS
0
50
100
150
200
250
300
350
400
450
2001 2002 2003 2004 2005 2006 2007 2008
TOTAL
HD
PD
Number of Centers
NEW PATIENTS ON DIALYSIS
0
1000
2000
3000
4000
5000
6000
7000
8000
2001 2002 2003 2004 2005 2006 2007 2008
TOTAL HD PDNumber of Patients
(7%)
(7%)
INTERNATIONAL COMPARISONS% DISTRIBUTION OF DIALYSIS PATIENTS
BY MODALITY
USRDS 2008 Annual Report
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
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
REGIONS NCR NO DATA
NEW DIALYSIS PATIENTS NCR VS REGIONS
Number of Patients
255 PMP
59 PMP
INTERNATIONAL COMPARISONS PREVALENCE OF ESRD, 2006 (PMP)
USRDS 2008 Annual Report
PREVALENCE AND NEW PATIENTS STARTING DIALYSIS
0
2000
4000
6000
8000
10000
12000
2004 2005 2006 2007 2008
PREVALENCE OFDIALYSIS PATIENTS
NEW PATIENTSSTARTING DIALYSIS
DISTRIBUTION OF TOP 3 CAUSES OF ESRD
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008
DM
GN
HPN
Number of Patients
DM - Diabetes mellitus GN - Chronic glomerulonephritisHPN - Hypertensive nephrosclerosis
(42%)
INTERNATIONAL COMPARISONS% OF INCIDENT DIALYSIS PXS WITH DIABETES
USRDS 2008 Annual Report
AGES OF NEW DIALYSIS PATIENTS in 2008
0
200
400
600
800
1000
1200
1400
1600
1800
2000
1 to 10 11 to 20 21 to 30 31 to 40 41-50 51-60 61-70 71-80 81-90 >90
HD PDNumber of Patients
AGE AND GENDER OF NEW DIALYSIS PATIENTS, 2008
AGE (yrs)According to Primary Renal Disease
Diabetic nephropathy 60Hypertensive nephrosclerosis 57
Chronic pyelonephritis 54Chronic glomerulonephritis
35
According to Type of Dialysis
Hemodialysis 53.8
Peritoneal dialysis 49.2
GENDER M:F RATIO 1.44:1
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 40-70 yrs
• The most common cause of ESRD is diabetes (42%)
NUMBER OF NEW KIDNEY TRANSPLANTS
124157
186 208
276 263306
420470
630690
1046
679
0
200
400
600
800
1000
1200
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
35%decrease
Number of Patients
PRIMARY RENAL DISEASE OF NEW KIDNEY TRANSPLANTS
0
100
200
300
400
500
600
2004 2005 2006 2007 2008
CGN
DM
HPN
Number of Patients
LENGTH OF TIME ON DIALYSIS PRIOR TO KIDNEY TRANSPLANT
0
50
100
150
200
250
300
350
2004 2005 2006 2007 2008
0.1- 0.5
0.6 - 1
1.1 - 1.5
1.6 - 2
2.1 - 2.5
2.6 - 3
> 3
No Data
Number of Patients
AGE OF RECIPIENTS
0
20
40
60
80
100
120
140
160
180
1 TO 10 11 TO 20 21-30 31-40 41-50 51-60 71-80 NO DATA 0
50
100
150
200
250
300
350
400
450
1 to10
11 to20
21-30 31-40 41-50 51-60 61-70 71-80 NODATA
AGE OF DONORS
Number of Patients Number of Patients
Mean age: 43 yrs Mean age: 30 yrs Range : 7-77 Range: 9-59
GENDER OF RECIPIENTS AND DONORS
0
100
200
300
400
500
600
Recipients Donors
Males
Females
M:F 1.8:1M:F 3.7:1
Number of Patients
DONOR SOURCE
0
100
200
300
400
500
600
700
800
900
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
NON-RELATED
RELATED
DECEASED
Number of Patients
(5%)
(67%)
(28%)
3.9%
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 1999-2001
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
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 2005: 2,140 Structured questionnaire
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 transplantationLiving donors only
Deceased donors onlyBOTH
49%14%37%
9%41%
Willing to become living donors 53% 57%
Willing to become deceased donors 16% 78%
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
Number of Transplant Recipients from Deceased Donors
NUMBER OF TRANSPLANT RECIPIENTS FROM DECEASED DONORS
6
17
6
107
1513
36
29 30
0
5
10
15
20
25
30
35
40
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
3.9%2.6%
7%
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)
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