Initiatives for Prevention of Chronic Kidney Disease

Gregorio T. Obrador, MD, MPH

Dean & Professor of MedicineUniversidad Panamericana School of Medicine

President, Board of Directors Mexican Kidney Foundation

Co-Chair Kidney Disease Prevention Network

CKD Prevention Initiatives

Epidemiology of ♦ Non-communicable diseases (NCDs)

♦ Chronic kidney disease (CKD)

● KEEP Mexico and Latin American CKD Clinical Practice Guidelines initiatives

● Conclusions

NCDs are the Most Common Cause of Death Worldwide

WHO 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Non-communicable Diseases

● 36 million deaths (63%) due to NCDs

● In low- and middle-income countries, 29% of the deaths due to NCDs occur in people younger than 60 years

● Projected 15% increase between 2010-2020.

Four Modifiable Risk Factors

Diabetes Prevalence in Mexico

23% don’t know

Diabetes Prevalence in Mexico

ENSANUT 2006

Diabetes Control

ENSANUT 2006

Diabetes is the Main Cause of Death in Men and Women

Diabetic Nephropathy is the Most Expensive Complication of Diabetes

Diabetes Care 27:104-109, 2004

Hypertension Prevalence in Mexico

43.2% of the Adult Population Has Hypertension in Mexico

ENSANUT 2006

Hypertension Prevalence is Increasing in Mexico

High Prevalence of Overweight and Obesity in Mexico

ENSANUT 2006

At least, 8.5% of the Adult Mexican Population Have CKD Stages 3-5

CKD 1 62.5% 626,034 pmp

CKD 2 29.0% 289,181 pmp

CKD 3 8.1% 80,788 pmp

CKD 4 0.3% 2,855 pmp

CKD 5 0.1% 1,142 pmp

Amato et al, Kidney Int 68:S11-S17, 2005

Number of Patients on Dialysis in Mexico

Peritoneal dialysis 45,639

Hemodialysis 19,097

ESRD without access 65,006

TOTAL 129,472

UNAM Study, 2010

Dialysis Costs in Mexico

Kidney Transplants in Mexico

CKD Prevention

1Normal Riskfactors

2 3 4 5KRT

DialysisTransplant

PrimaryPrevention

SecondaryPrevention

TertiaryPrevention

CKD

Prevent CKDdevelopment

Early detection & prevention of progression/complications

Treat advancedCKD

Levey et al. Am J Kidney Dis 53:522-35, 2009

KEEP

CKD Prevention Initiatives

Epidemiology of ♦ Non-communicable diseases (NCDs)♦ Chronic kidney disease (CKD)

KEEP Mexico and Latin American Clinical Practice Guidelines initiatives

● Conclusions

KEEP Mexico

● KEEP is a free kidney health screening program designed to raise awareness about kidney disease among high risk individuals, and provide free testing and educational information, so that kidney disease and its complications can be prevented or delayed

● Developed by the NKF more than 10 years ago and over 100,00 people have participated in KEEP US

● In 2008, KEEP was adapted for use in Mexico by the Mexican Kidney Foundation

● Pilot program began in 2008 in Mexico City and Guadalajara, Jalisco

KEEP Mexico

Methods

Questionnaire

● Age, gender, education, employment, insurance● Tobacco and ETOH use● Personal and family history of DM, HTN, or CKD● Past medical care

Physical exam● Height, weight, body mass index (BMI)● Blood pressure

Lab tests

● Albuminuria (Clinitek)● Scr (eGFR by MDRD)● Glucose (AccuCheck)● Hemoglobin (Hemocue)● Calcium, phosphorus, and iPTH (≥ CKD 3)

Am J Kidney Dis 57(3): 361-370, 2011

Kidney Int 70 (Suppl 116):S2-S8, 2010

Participants’ Characteristics

CKD Prevalence (N=4,970)

CKD Prevalence by Risk Factor

Awareness of CKD & Previous Medical Attention

CKD Prevalence in the Pilot ProgramKEEP Mx versus KEEP US

Jalisco’s Demonstration Project

● Consisted in adapting KEEP to do rapid and massive screening of diabetic patients attending clinics of the Jalisco State’s Secretariat of Health

● Sponsored by the Federal Government (Popular Insurance) and the Jalisco State’s Secretariat of Health

● Coordinated by the Mexican Kidney Foundation with support from the National Institute of Public Health

CKD Prevalence in 7,689 Diabetic Patients Screened in 8 Weeks

CKD Prevalence in 7,689 Diabetic Patients Screened in 8 Weeks

Latin American CKD 1-5 Clinical Practice Guidelines

Available in the following homepages

●Latin American Society of Nephrology (www.slanh.org)

●Mexican Kidney Foundation

(www.fundrenal.org.mx)

●Spanish Society of Nephrology

(www.sen.org)

●International Society of Nephrology

(www.isn.org)

CKD Prevention Model

1Normal Riskfactors

2 3 4 5KRTDialysisTransplant

CKD

Guidelines

Database

Care model

KEEP

Financing

Outcomes

LATIN AMERICAN CLINICAL PRACTICE GUIDELINES

IN PROGRESS

IN PROGRESS

IN PROGRESS

Conclusions

● NCDs are the main cause of death worldwide

● High prevalence of CKD and risk factors for CKD in Mexico

● KEEP Mexico is an effective CKD screening program

● CKD Clinical Practice Guidelines are being disseminated and implemmented in an effort to improve outcomes in the Latin American region

● Efforts should focus on effective preventive measures

Acknowledgements

● National Kidney Foundation▪ John Davies▪ Danielle Green▪ Allan Collins, MD▪ Lesley Stevens, MD▪ Giggi Politoski▪ Monica Gannon

● Chronic Disease Research Group▪ Nan Booth, MSW, MPH▪ Shane Nygaard, BA

● Mexican Kidney Foundation▪ Nadia Olvera, MRS▪ Evangelina Ferreira, RN▪ Daniela Ortiz de la Peña, RN▪ Verónica Gutiérrez, RD▪ Leopoldo Garvey, MBA

● Univ Panamericana Sch Med▪ Antonio Villa, MD, MSc▪ Margarita Virgen, MD▪ Ximena Rubilar, RN▪ Jorge Arizmendi, MD

● KEY Australia▪ Anne Shephard▪ Mark Shephard▪ Anne Wilson▪ Timothy Mathew

● Sponsors▪ Secretariat of Health▪ Instituto Carso de Salud▪ Laboratorios Polanco▪ Roche▪ Genzyme▪ Amgen▪ Abbott▪ Hemocue▪ Beckman Coulter▪ Bio-Rad