DEVELOPMENT OF STRATEGIES FOR PREVENTION OF CHRONIC KIDNEY DISEASE RELEVENT TO

DIFFERENT REGIONS AND COUNTRIES

ROBERT C ATKINS

BELLAGIO, MARCH 2004

USA: 283,000

Latin Am: 82,000

Eur: 317,000

India: 20.000

China: 30,000

AUS/NZL: 11,000

Japan: 167,000

Schena, Kidney Int (Suppl 74), 2000

World-ESRD (1996)PrevalenceIncidence

1,000,000 220,000

DIALYSIS PATIENTS WORLD-WIDE (1996)

Incidence of Diabetes in E.S.R.FIncidence of Diabetes in E.S.R.FAustralia 1980 - 2000Australia 1980 - 2000

Year of Entry

Number of Diabetics Number of New Patients

0

100

200

300

400

500

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00

0

300

600

900

1200

1500

1800Type 2 (Ins Requiring)Type 2 (Non Insulin)Type 1Total New Patients

Diabetes and hypertension are the main causes for ESRD in the USA

The proportion of ESRD patients with diabetic nephropathy is higher in the USA than in Europe. However, diabetic nephropathy is the most rapidly growing cause of ESRD in European countries

CAUSES OF ESRD IN THE USACAUSES OF ESRD IN THE USA

1990 1992 1994 1996 19980

20

40

60

80

100

120

140 Diabetes

Hypertension

Glomerulonephritis

Cystic kidney

Inci

den

ce r

ates

(x

mil l

ion

po

pu

lat i

on

)

USRDS, 2000

AUSDIAB RESULTS

• 7.2% with diabetes

(3.6% known and 3.6% newly diagnosed)

• 16.1% with impaired glucose metabolism

• 60% overweight or obese

• 61.3% with high cholesterol (7.3% on treatment)

• 29% with high blood pressure (14% on treatment)

PREVALENCE OF RENAL ABNORMALITIES

1. Haematuria>10x106/L 4.6%

2. Proteinuria 2.4%UP:UC>0.2 mg/mg

3. Renal Impairment 11.2%calculated GFR <60 mls/min

No abnormality 82%At least one abnormality 18%Multiple abnormalities 2%

PREVALENCE OF TYPE 2 DIABETES IN ASIA AND PREVALENCE OF TYPE 2 DIABETES IN ASIA AND PACIFICPACIFIC

Age-standardised to Segi’s world population 35-64 years except: * ³40 **30-59 ‡ 30-69 #20-64 § 40-69

0 10 20 30 40

Nauru

Urban PNG - Koki

Aboriginal Australian

Singapore

Urban Western Samoa

Pakistan

India

J apan

Indonesia

Malaysia

White USA

Taiwan

China

PNG Highlands

Prevalence diabetes (%)

#

*

**

§

World

20002025

154 m300 m

55 m72 m

Developed Count. Developing Count.

99 m228 m

16.724.5

39.3

18.2

38.430.7

21.8

9.1

57.2

22.8

37.5

18.6

0.4 0.7

2000

2025

* In million subjects

47%

116%

25%

140%

150%

102%

64%

THE GLOBAL BURDEN OF DIABETES (2000-2025)