Malaysian Society of NephrologyMinistry of Health Malaysia

Retardation Of Renal Disease Progression

Introduction

WHY DO WE BOTHER

PREVENTING RENAL FAILURE ?

The Burden of ESRD:

Economic dialysis is a costly treatment incidence of ESRD is still increasing especially

in the older age groups

Medical

Socialquality of life, work rehabilitation

End Stage Renal Disease

Global maintenance dialysis population from 1990 to 2010

Access and Equity More Than 80% Of Dialysis Patients Are

From USA, Europe And Japan

The Developing World With 80% Of The World’s Population Has Less Than 20% Of Its Dialysis Patients

The Capability To Provide Dialysis Treatment Is Directly Related To The Wealth Of The Country.

End Stage Renal Disease

Developing countries cannot provide RRT for all patients

Prevention of ESRD may reduce the burden to the healthcare system.

Prevention Of ESRD

Renal Replacement Therapy in Malaysia Prevalence Rate 1980 - 2003

The Economic Burden Of Chronic Renal Failure

Prevention of ESRD may prevent other co-morbid conditions from developing

In particular, there is a high prevalence of Cardiovascular diseases in patients with Chronic kidney disease

The Medical Burden Of Chronic Renal Failure

Cardiovascular mortality in dialysis patients is 10 – 20 times higher than in the general population (GP)

INCREASED BURDEN

OF DIABETES

NATIONAL HEALTH AND MORBIDITY SURVEYMALAYSIA 1996

Prevalence of Diabetes Mellitus – 7%

Prevalence of impaired GTT - 5%

Indians had the highest prevalence of DM followed by Chinese, Malays and other indigenous groups

( Lim TO et al, Med J Malaysia 2000)

Epidemic of Diabetes Mellitus

Year 2000 2001 2002 2003

New Dialysis Patient 1811 2036 2223 1992

% unknown cause 30 31 31 30

% diabetic nephropathy 45 46 50 51

% glomerulonephritis 9 7 6 5

% SLE 2 2 1 1

% polycystic kidney disease 1 2 1 1

% obstuctive nephropathy 3 4 3 3

% toxic nephropathy 0 1 0 0

% miscellaneous 9 8 7 8

RENAL REPLACEMENT PROGRAM-MALAYSIAPrimary Renal Disease 2000 – 2003

ESRD due to diabetes is frequently accompanied by other organ complications of diabetes

The Medical Burden Of Chronic Renal Failure

Increasing age in patients accepted

for dialysis

Increased Co-morbidity

The Medical Burden Of Chronic Renal Failure

Dialysis Treatment Rate by Age Group 1980 - 2003

WHY DO WE BOTHER

PREVENTING RENAL FAILURE ?

Retarding The Progression Of Renal Failure

The need to retard the progression of renal failure is obvious.

Who should take the lead and be the driving force?

Prevention Of Renal Failure

Who should take the lead?

The primary care physician and the

nephrologists

PRIMARY CARE PHYSICIAN

Screening

Diagnosis

Treatment

NEPHROLOGISTS

Diagnosis

Management

Pre Dialysis care

Prevention Of Renal Failure

RENAL DISEASE

CHRONIC RENAL FAILURE

DIALYSIS OR Tx

COMPLICATIONS OF RRT, MORBIDITY/MORTALITY

RENOPROTECTION

Will it work?

Recent studies have shown that certain

strategies in the management of diabetic

nephropathy and the non diabetic proteinuric

renal disease can lead to decreased rate of

progression of renal failure.

Prevention Of Renal Failure

-60%

-50%

-40%

-30%

-20%

-10%

0%

rela

tive

ris

k (%

)

REIN(n=352)

CAPTOPRIL(n=409)

RENAAL(n=1513)

IDNT(n=1715)

Less Need Of Dialysis For Non Diabetic And Diabetic Renal Disease With Renin – Angitensin Blockade

Management of ESRD poses an immense challenge to healthcare systems all over the world

Incidence continue to increase and nearly half of the patients are diabetic

Patients with ESRD have many other medical complications especially CVD

Retarding the progression renal failure in patients with CKD may reduce the burden of ESRD

Conclusion

Good doctor relieve disease

Better doctor cure disease

Superior doctor prevent disease

Old Chinese saying…….