CHRONIC KIDNEY DISEASE The Philippine Situation

National Nutrition and Health Survey Philippine Renal Disease Registry

Mortality statistics
Survival data from a cohort study

NATIONAL NUTRITION SURVEY

Resulted from the mandate of the Food and Research Institute (FNRI) of the Dept. of Science and Technology (DOST)

Objective: To assess the Philippine food situation and nutritional status of the population Conducted every 5 years since 1978

NNHeS 2003-2004

Objectives
To assess the prevalence of lifestyle and nutrition-related risk factors and diseases among Filipinos 2 years and above

To aid in the development of health policies an programs for the prevention and control of lifestyle and nutrition-related diseases

NNHeS 2003-2004 Renal Report

Chronic Kidney Disease Stages

Stage GFR 1 2 3 4 5 >=90 60-89 30-59 15-29 <15 Normal or increased GFR Mildly decreased GFR Moderately decreased GFR Severely decreased GFR Kidney failure

Based on guidelines of the Dialysis Outcomes Quality Initiative US

NNHeS 2003-2004 Renal Report

Renal function
Abbreviated MDRD formula
Predicted GFR = 186.3 * (serum creatinine) 1.154 * age 0.203 * (0.742 for women) * (1.21 if African American)

Cockcroft & Gault formula

Ccr (mL/min) = (140 age)/sCr * weight/72 * 1.73/BSA, where age is in years, sCr is in mg/dL, weight is in kilograms, and BSA is body surface area using the formula: BSA = 0.20247 [height (m)]0.725 [weight (kg)]0.425

NNHeS 2003-2004 Renal Report

Prevalence of CKD in adults

using predicted GFR from MDRD equation

Stages of GFR
1 2 3 4 5 >=90 60-89 30-59 15-29 <15 72.8% 24.6% 2.2% 0.2% 0.2%

The prevalence of CKD Stage 3-5 is 2.6%

NNHeS 2003-2004 Renal Report

Prevalence of CKD in adults

The population of Filipinos aged 20 years and above in 2005 was 46,627,172

A prevalence of 2.6% means that 1,212,306 adult Filipinos have CKD.

NNHeS 2003-2004 Renal Report

Macroalbuminuria
at least +1 proteinuria using the
Multiple Reagent Strip for Urinalysis (Bayer Corporation)

The prevalence of macroalbuminuria was 4.2%

NNHeS 2003-2004 Renal Report

Microalbuminuria
The prevalence of microalbuminuria was 18.5%
This is equivalent to 8,626,027 Adult Filipinos

NNHeS 2003-2004 Renal Report

Prevalence of CKD Stage 3-5 according to AGE

Stage 3 25 20 15 10 5 0 20-29 30-39 40-49 50-59 60-69 70+
0.3% 1.0% 5.0% 2.9% 7.5%

Stage 4

Stage 5
20.7%

Mean level of GFR by age group: Philippine vs. US data

Age Group in Years

NNHeS 2003 Philippines

NHANES III U.S.A.

20-29
30-39 40-49 50-59 60-69 70+

119
109 103 100 86 77

116
107 99 93 85 75

PHILIPPINE RENAL DISEASE REGISTRY

Originated by the PSN in 1996 and later became a joint project with REDCOP Collects data on ESRD patients who start hemodialysis, peritoneal dialysis and undergo kidney transplantation

NEW PATIENTS ON DIALYSIS 2001-2005

Number of Patients

7000 6000 5070 5000 4000 3000 2000 4363 4409 5597

5997

2001

2002

2003

2004

2005

NEW PATIENTS ON DIALYSIS: 2001-2005

ACCORDING TO DIALYSIS MODALITY

Number of Patients
7000 6000 5000 4000 3000 2000 1000 0
PD HD

5597 5070 4363 4409

5997

TOTAL

2001

2002

2003

2004

2005

ACCEPTANCE RATE TO RRT PROGRAMS (PMP)

Data from International Federation of Renal Registries website and the Philippine Renal Disease Registry
PHIL 2003 PHIL 2004 PHIL 2005 INDONESIA CHINA MALAYSIA AUSTRALIA KOREA INDIA SPAIN CANADA MEXICO US

71 PMP 55 PMP 63 PMP 68 PMP

50

100

150

200

250

300

Patients per million population

ACCEPTANCE RATE TO RRT PROGRAMS (PMP)

Data from International Federation of Renal Registries website and the Philippine Renal Disease Registry
71 PMP 55 PMP 63 PMP 68 PMP

PHIL 2003 PHIL 2004 PHIL 2005 INDONESIA CHINA MALAYSIA AUSTRALIA KOREA INDIA SPAIN CANADA MEXICO US

50

100

150

200

250

300

Patients per million population

PRIMARY RENAL DISEASE OF ALL NEW DIALYSIS PATIENTS

N = 5,997
HD
OTHERS APKD GOUT OBSTR UNK CPN HPN GN DM

PD

20% 26% 38%

0 500 1000 1500 2000 2500

DISTRIBUTION OF TOP 3 CAUSES OF ESRD

2002 2003 2004 2005

2500
Number of Patients

2000 1500 1000 500 0

DM

GN

HPN

NNHeS 2003-2004 Renal Report

Prevalence of CKD Stage 3-5 according to AGE

MEAN AGE 2004 PRDR DATA
ALL NEW DIALYSIS PTS

Stage 3

Stage 4

52 YEARS

Stage 5
20.7%

25 20 15 10 5 0

ESRD - DM NEPHRO ESRD HTN NEPHRO ESRD CGN

58 YEARS 57 YEARS 38 YEARS

7.5% 5.0% 0.3% 1.0% 2.9%

20-29

30-39

40-49

50-59

60-69

70+

END STAGE RENAL IS A BAD DISEASE TO HAVE

Limited survival Expensive

Retrospective cohort study of 327 patients from NKTI and SLMC diagnosed to have ESRD 2000-2001

OVERALL SURVIVAL
Kaplan-Meier survival estimate 1.00

0.75

0.50

0.25

0.00 365 analysis time 730 1000

12 month estimated survival rate - 53% (95%CI: 47-58) 24 month estimated survival rate - 36% (95%CI: 30-42

Results

PATIENT GROUP
Service n=198 (60%)
1.00

Private n=129 (40%)

0.75 Private 0.50

0.25 Service 0.00 365 days 730 1000

Log rank test: chi2 = 29.62, p<.001

National Statistics Office

Kidney disease is now no. 10 cause of mortality in the Philippines

Renal Disease Registry NNHes Population Survey

GROWING PROBLEM OF CHRONIC KIDNEY DISEASE

ESRD survival data

National mortality data

Treatment is too expensive

Prevention is the key

Kung hindi tayo ang kikilos Sino ang kikilos?

Kung hindi ngayon, kailan pa?

The Philippine College of Physicians wishes to acknowledge the following for their invaluable contribution in the preparation of this module

Philippine Society of Nephrology