CKD in Iran Presented by: SM Gatmiri, MD, Nephrologist Imam
Khomeini Hospital, TUMSNRC In The Name of God
Slide 2
CKD -A worldwide problem. -Rising incidence &
prevalence.
Slide 3
CKD Definition 1 -Kidney damage 3months, -Structural
(pathological) or -Functional (composition of blood or urine) or
-Imaging abnormalities -With or without decreased GFR. OR
Slide 4
CKD Definition 2 -Presence of GFR
Slide 5
Stage 1: NL GFR (>90 mL/min/1.73 m2) & persistent
albuminuria (1.8% of the total US adult population). Stage 2: GFR
60 to 89 mL/min/1.73 m2 & persistent albuminuria (3.2%). Stage
3: GFR 30 & 59 mL/min/1.73 m2 (7.7%). Stage 4: GFR 15 & 29
mL/min/1.73 m2 (0.35%). Stage 5: GFR of
Slide 6
The number of ESRD in US has increased from -10,000 in 1973 to
-86,354 in 1983, & to -527,283 as of December 31, 2007.
Slide 7
In 2007 alone, 111,000 patients entered the US ESRD program.
(Incidence: 440 PMP)
Slide 8
Patients with ESRD consume a disproportionate share of health
care resources.
Slide 9
Total Medicare DM CHF Dialysis/Tx CKD Numbers 5.8% 1.1%
20.7%25.1% 41.3%48.1% 19% 7.8% CKD, CHF & DM; Number of
patients & costs; USA 2002 Costs Collins AJ; USRDS
database
Slide 10
The total cost of the ESRD program in the US was approximately
$35.32 billion in 2007.
Slide 11
However CKD in the US, is under- diagnosed &
under-treated.
Slide 12
Iran Area: 1.648 million Sq Km Population : 68,017,860 Median
Age : 24.23,Life Expectancy : 69.96 Total Health Expenditure of GDP
: 6%
Slide 13
ESRD in Iran 12% Prevalence : 357 PMP Incidence :66 PMP CKD
epidemiology in Iran Mitra Mahdavi-Mazdeh- Assessment of HD
patients , Iran ;NDT (2007)
Slide 14
Mean age difference in ESRD patients during last 10 years in
Iran
Slide 15
Sex difference in ESRD patients during last 10 years
Slide 16
Causes of ESRD in the last 10 years in Iran
Slide 17
Sex difference in ESRD patients during last 10 years in Iran
male to female ratio is 1.33.
Slide 18
Diabetes as the cause of ESRD in the last 10years
Slide 19
HTN & DM as the causes of ESRD in the last 10 years in
Iran
Slide 20
The number Of ESRD will be doubled in next 10 years
Slide 21
Annual RRT Cost with total health expenditure of GDP of 6%
-Dialysis sessions: 800Billion R for 13000 Pts (>60,000,000
R/Pts) -R Tx drugs =500 B R -for 12000 Pts (>40,000,000
R/Pts)
Slide 22
RRT program so far? Kidney Transplant CAPD HD centers
Slide 23
Time to change our approach: decrease ESRD number or its
postponing
Slide 24
Mahdavi-Mazdeh :IJKD.vol:4,no:4, 2010 Population-Based
Screening CKD in Iran:
Slide 25
What is Solution? We Should push for a CKD education To take
serious high NL Cr To take serious HTN &Diabetes management CKD
should be viewed as the third part of the deadly triangle with DM
and CVD affecting the health & welfare of the general
population
Slide 26
What is Our Common Task As -Nephrologists -Internist -GPs
-Health Authorities?
Slide 27
Education 1. Primordial Prevention : Healthy Diet, Changes in
Social, Cultural and Personal Habits 2. Early Detection, Referral
and Control of HTN & DM Public Education Professional (Health
Care Personnel) Education
Slide 28
CKD Patients receiving ACE-Is/ARBs NHANES III 19881994 &
NHANES 19992002 patients age 60 & older; patients with eGFRs of
less than 15 ml/min/1.73 m 2 are excluded. *Sample size less than
30, or coefficient of variation is not less than 30 percent.
Slide 29
Vascular Access: New Medical Evidence Form 2728 Data, May
2005-Dec 2006 82% of patients are using a catheter as their first
outpatient access!!!! Only 13% of incident HD patients used a
fistula as their first access. Assessment of HD patients , Iran
;NDT (2007)
Slide 30
AVF use in Canadian prevalent (53%) and incident (26%)patients.
In Europe [prevalent(74%), incident(50%) AVF is the advocated
access route in Iran [prevalent (91%), incident(37.5%)in Tehran].
Assessment of HD patients , Iran ;NDT (2007) Vascular Access
Slide 31
Message: -CKD & ESRD is increased & highly prevalent -A
strong CVD risk factor.
Slide 32
Message -We can detect CKD with simple tests & there are
treatments for CKD.
Slide 33
Message: -ESRD is increasing, more than increases in number of
HD facility & Tx.
Slide 34
Message -We should consider CKD prevention & place initial
focus on strategies that slow disease progression to postpone
RRT.