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Epidemiology

Rully Roesl i , 2009

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definition


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Staging of CKD


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Staging of CKD


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Prevalence of GFR Category


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ESRD Rates Continue to Rise

USRDS, 2004Rully Roesl i , 2009

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Kidney Failure Compared to

Cancer Deaths in the U.S. in 2000

(in Thousands)

Lung Cancer Kidney

Failure

Colorectal

CancerBreast

Cancer

Prostate

Cancer

57

100

41

30

160


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Costs of Kidney Failure are High

(in billions for 2002)

KidneyFailure

Care Total NIH

Budget

25.2

23.2Kidn ey Fai lure Acc oun ts for

6% of Medicare Payments

Lost Income for Pat ients is $2-4 Bil l ion/Yr

USRDS, 2004Rully Roesl i , 2009

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Prevalence

of CKD

In

Different

Countries


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CKD Hypertension


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CKD Proteinuria


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Incidence Prevalence of CKD

Incidence Prevalence


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Etiologi peny ebab Gagal Ginjal di Malasia

14th Report of the Malaysian Dialysis and Transplant Registry, 2006,


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Etiologi penyebab Gagal Ginjal di Singapura

3rd Report of the Singapore Renal Registry, 1999/2000


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The bad companions...


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Diabetes: The Most Common Cause of ESRD

Primary Diagnosis for Patients Who Start Dialysis

Diabetes50.1%

Hypertension27%

Glomerulonephritis

13%

Other

10%

United States Renal Data System. Annual data report. 2000.

No. of PatientsProjection

95% CI

1984 1988 1992 1996 2000 2004 20080

100

200

300

400

500

600

700

r2= 99.8%243,524

281,355520,240

No. of

Dialysis

Patients(Thousands)

DIABETES HYPERTENSION - ESRD


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Hypertension Is Prevalent

Among Diabetic Adults

Geiss LS et al. Am J Prev Med. 2002;22:42-8.

NHANES III = Third US National Health and Nutrition Examination Survey (19881994).

29%

71%

Diabetes + HTN*

Diabetes alone

* Hypertension defined according to JNC-6: BP 130/85 mm Hg


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Gress et al .N.Engl.J.Med. 2000;342: 905

6 Year Follow-up of the Atherosclerosis Risk in Communities (ARIC-Study)

0

10

20

30

Incidence of Diabetes(Cases per 1000 Person Years)

No Hypertension(n=8.746)

12,0

All Subjects(n=12.550)

16,6

*RR for Development of Type 2Diabetes in Hypertension: 2.43

Hypertension(n=3.804)

29,1

*

Hypertension: A Significant Risk Factor

for Type 2 Diabetes

Rul l Roes li 2009

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Parallels Between Hypertension

in 1972 and Kidney Disease in 2005 Recent documentation of effective therapy

Treatment of a silent disease to reduce risk

for a disastrous outcome

Simple screening

Advantages for patients, physicians, industry


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CKD Predicts CVD

2.11

3.65

11.29

21.8

36.6

0

5

10

15

20

25

30

35

40

60 45-59 30-44 15-29 < 15

Go , et al., 2004

Age-S

tan

dar

dize

dRa

teo

fCar

diovascu

lar

Even

ts(per1

00person-yr

)

Estim ated GFR (mL /min/1.73 m2)


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CKD is Not Being

Recognized or Treated

Most practices screen fewer than 20% of their Medicare

patients with diabetes*

Patients are referred late to a nephrologist, especially

African-American men

Less than 1/3 of people with identified CKD get an ACE

Inhibitor

Kinchen, et al., 2002;McClellan et al.,1997

*Data provided by the USRDS based on 5 percent Medicare enrollment and claims data


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Who to Test for Chronic

Kidney Disease

Regular testing of people at risk

Diabetes

Hypertension

Relative with kidney failure

Cardiovascular disease


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How to Test for Chronic

Kidney Disease*In individuals with diabetes:

Spot urine albumin to creatinine ratio

In others at risk:

Spot urine albumin to creatinine ratio OR standard dipstick(Bouleware, et al., 2003)

Estimate GFR from serum creatinine using the MDRD predictionequation

*24 hour urine collections are NOT needed. Diabetics should betested once a year. Others at risk testing less frequently as long asnormal.


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Who Should be Treated for

Chronic Kidney Disease

With diabetes:

With urine albumin/creatinine ratios more than 30mgalbumin/1 gram creatinine

Without diabetes: With urine albumin/creatinine ratios more than 300mg

albumin/1 gram creatinine corresponding to about 1+ onstandard dipstick

OrAny patient:

With estimated GFR less than 60 mL/min/1.73 m2


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How to Treat for Chronic

Kidney Disease

Maintain blood pressure less than

130/80 mmHg

Use an ACE Inhibitor or ARB

More than one drug is usually required and a diureticshould be part of the regimen

Continue best possible glycemic control in individuals

with diabetes


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How to Treat for Chronic

Kidney Disease(continued)

Refer to dietician for a reduced protein diet

Consult a nephrologist early

Team with the nephrologist for care if GFR is less than30 mL/min/1.73 m2

Monitor hemoglobin and phosphorous with treatment as

needed

Treat cardiovascular risk, especially smoking and

hypercholesterolemia


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Early Treatment Makes

a Difference

Brenn er, et al., 2001Rully Roesl i , 2009

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CHRONIC KIDNEY DISEASE

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DATA WHO


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DAERAH TAHUN PREVALENSI

JAKARTA

MAKASAR

BALI

SINGAPARNA

1982

1993

20011981

1998

2005

2004

1995

1,7 %

5,7 %

14,7 %1,5 %

2, 9 %

12,5 %

3,9 7,2 %

1,1 %

NASIONAL

(data PERSI)

2006 1,5 2,3 %

PREVALENSI DIABETES DI INDONESIA

Data : Perhimpunan Rumah Sakit Seluruh Indonesia (PERSI)


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NEFROPATI DIABETES SEBAGAI PENYEBAB

GAGAL GINJALYANG MEMERLUKAN

CUCI DARAH DI INDONESIA

1980 1993 1998

Data : Pusat Registrasi Nasional untuk Hemodialisis

Tahun


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TAHUN PREVALENSI (%)

SKRT 1995 8,3

MONICA

(Jakarta)

1988

1993

2000

L=13,6 W=16

L=16,5 W=17

L=12.1 W=12,2

Boedhi

Darmojo

(Semarang)

1977

1985

1,8

3,3

PREVALENSI HIPERTENSI DI INDONESIA

DATA TIDAK AKURAT DAN TIDAK ADA DATA NASIONAL


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TAHUN PREVALENSI (%)

MENKES 2007 URBAN RURAL

( 17 21 % )

FKMUI/SKRT

(Zamhir S)

2004 Pulau Jawa 41.9 %

Perkotaan 39,9 %

Pedesaan 44,1 %

FKUNSRI

(Zukhair Ali)

Sum Sel

( 6,3 9,17 % )

PREVALENSI HIPERTENSI DI INDONESIA


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PERHIMPUNAN HIPERTENSI INDONESIARESUME RAPAT PLENO

Jakarta, 8 November 2008

CARA PENGUKURAN YANG BENAR DAN SERAGAM( ROADSHOW : KURSUS HIPERTENSI)

CARA PENCATATAN DAN PELAPORANYANG BENAR DAN SERAGAM

(diusulkan dihubungkan dengan SKP IDI)


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Fasilitas Hemodialisis di

Indonesia vs Singapura

0.34

6.8

2

3

4

5

6

7

Fasilitas HD

Indonesia

Singapura

Pusat Registrasi Nasional untuk Hemodialisis , 1992-1993

Rull y Roesli , 2009

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Fasilitas Hemodialisis di Indonesia

Berdasarkan Daerah

2.2

0.23 0.35

0.25

0.5

0.32 0.42 0.36 0.31

0

0

0.5

1

1.5

2

2.5

Propinsi

Jakarta

Jawa Barat

Jawa Tengah

Jawa Timur

Sumatera Utara

Sumatera Selatan

Kalimantan

Jambi

Riau

Propinsi lain



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Prevalence Rate (PR) penderita cuci darah

di Indonesia pada tahun 1993

0

100

200

300

400500

600

700

Indonesia Belanda Perancis Itali Jerman Jepang Singapura



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KOTA TAHUN JUMLAH

TINDAKAN

TAHUN JUMLAH

TINDAKAN

JAKARTA 1980 389 X 1986 4487 X

BANDUNG 1984 115 X 1989 7223 X

MEDAN 1982 100 1990 1100 X

PENINGKATAN JUMLAH TIDAKAN DIALISIS DI INDONESIA


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0

2000

4000

6000

8000

10000

12000

1989 1992 1995 1998 2005

TAHUN

JUMLAH KASUS DIALISIS PT ASKES

481

10.452

2770

ProgramProgramJAMKESMASJAMKESMAS

9241

krisiskrisis

monetermoneter

1327

2131

Jumlah kasus dialisis yang dibiayai oleh PT ASKES

pada tahun 1988-2006


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0100

200

300

400

500

600

700

800

DKI Jakarta Jawa Barat Jawa Tengah DI Yogya Jawa Timur

1995 1996 1997 1998 1999

TH.1997

KRISIS

EKONOMI

Penurunan jumlah kasus dialisis pada saat krisis ekonomi (1998-1999)

pada beberapa daerah


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Etiologi pasien Gagal Ginjal yang menjalani dialisis

(Pusat Registrasi Nasional, PERNEFRI 1992)

392

190

156

53 20 17 17

Glomerulonefritis Diabetes Polikistik

Hipertensi Pielonefritis Batu

Urat

46,4 %46,4 %

22,5 %22,5 %

18,5 %18,5 %

6,3 %6,3 %


DIABETES


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25 %25 %

23 %23 %

20 %20 %

10 %10 %

DIABETES


Data Etiologi Pasien Hemodialisis Di-IndonesiaThn.2007-2008

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1461

1647

86

1802

125 124

687

540

465

302

Sumber Data IRR:

RU-02 (Data Pasien HD Baru ) Thn.2007-2008 (Agt'08).Terdiri dari: 8064 pasien, 74 Renal Unit

yang telah mengirimkan datanya.Rully Roesl i , 2009

LAJU FILTRASI GLOMERULUS LAKI LAKI DAN PEREMPUAN

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Gambar 1. Laju filtrasi glomerulus

LAJU FILTRASI GLOMERULUS LAKI-LAKI DAN PEREMPUAN

40

60

80

100

1820222426283032343638 40 42 44 46 4850525456586062646668707274767880

UMUR

LFG

laki-laki

perempuan

Data kreatinin serum yang didapat selama tahun 2006 dan 2007 adalah :

Total : 31244 buah dengan 22047 laki-laki dan 9197 perempuan

Umur : 18 81 tahun


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KESIMPULAN :

[] INSIDENSI PGK (CKD) MENINGKAT SECARA

GLOBAL

[] INSIDENSI PGK BERHUBUNGAN ERAT DENGAN

DIABETES DAN HIPERTENSI

[] DI INDONESIA, BELUM ADA PERENCANAANYANG MATANG UNTUK MENGHADAPI

LONJAKAN KASUS DIABETES ,

HIPERTENSI, DAN PENYAKITGINJAL KRONIS

Rully Roes li , 2009

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epid pgk 2009

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