Chronic kidney disease insert title here Insert name

Chronic kidney disease: [insert title here] Insert name, title, date here Insert acknowledgements here

CKD: Staging System and Prevalence Stage Description GFR (ml/min/1. 73 m 2) U. S Prevalence (1000 s) China Prevalence (1000 s) 1 Kidney Damage with 90 Normal or GFR 5, 600 62, 894 2 Kidney Damage with 60 -89 Mild GFR 5, 700 37, 516 3 Moderate GFR 30 -59 7, 400 17, 655 4 Severe GFR 15 -29 300 1103 5 Kidney Failure < 15 or Dialysis 391 331 NKF-K/DOQI, 2002; Zhang et al, Lancet 2012

Future definitions of CKD may also incorporate information on proteinuria GFR stage Composite ranking by adjusted relative risk Composite ranking by unadjusted absolute risk Albuminuria stage Description and range of proteinuria stages, ACR or dipstick A 1 A 2 A 3 Optimal and high-normal High Very high and nephrotic Description Range 1 High and optimal > 105 2 Mild 3 a Mild to moderate 45 -59 3 b Moderate to severe 30 -44 4 Severe 15 -29 5 Kidney failure < 15 Levey, Ann Intern Med 2011 (ml/min/ 1. 73 m 2) 90 -104 75 -89 60 -74 <10 mg/g 10 -29 mg/g 30 -299 mg/g 300 -1999 mg/g ≥ 2000 mg/g Range (ml/min/ 1. 73 m 2) > 90 60 -89 Normal Mild Heavy 10 -29 mg/g or negative 30 -300 mg/g or trace to 1+ >300 mg/g or ≥ 2+

CKD and ESRD are associated with exceedingly high mortality ESRD vs general population 60 Stage 3 -4 CKD vs general population (GP) Expected remaining life-years Mortality rate per 1000 pt-yr Europe US Whites 50 GP females Stage 3 females Stage 4 females General population 150 30 17. 6 13. 9 10. 6 20 0 GP males Stage 3 males Stage 4 males 200 40 10 250 Dialysis 100 7. 8 2. 5 20 25 30 35 40 45 50 55 60 65 70 75 80 Age (years) Jager, from ERA-EDTA and USRDS data Alberta Kidney Disease Network, unpublished data 50 0 20 -25 30 -35 40 -45 50 -55 60 -65 Age groups 70 -75 80 -85

Proteinuria by dipstick further increases N=920, 985 the risk of poor outcomes Hemmelgarn, JAMA 2010 mild: trace or 1+; heavy: ≥ 2+

What do people with CKD die from? Cardiovascular disease is a major cause ESRD, USA All other 33. 0% Malignancy 4% Withdrawal 9% USRDS, 2010 ADR National Vital Statistics Report, CDC 2010 General population, USA Cardiovascular disease 42. 0% All other 33. 1% Self-harm 1. 4% Alzheimers 3. 1% Infection 12% Cardiovascular disease 31. 0% Malignancy 23. 2% Infection 3. 6% Lung disease 5. 3%

Risk factors for CKD are similar to those for other NCDs • Diabetes • Age, minority status • Hypertension • UTI, nephrolithiasis • Relative with CKD • Acute renal failure • CV disease • UT obstruction • Chronic infections • Nephrotoxins • Smoking, obesity, dyslipidemia NKF-K/DOQI, 2002

CKD often coexists with other NCDs Hypertension Diabetes CKD Cardiovascular disease This suggests that addressing CKD will improve outcomes for other NCDs also

ESRD is increasingly common worldwide Frequency of ESRD 2, 500, 000 1, 490, 000 426, 000 1990 2000 2010 9 Lysaght, J Am Soc Nephrol, 2002

The global burden of CKD is greatest in developing countries and in the poor Territories are sized in proportion to the absolute number of people who die of CKD each year. Even within countries, burden of CKD is concentrated among the poorest. Renal replacement is available only to a wealthy few. White et al, WHO Bull 2008; Nugent et al, NCP 2011

Most people affected by CKD are unaware Individuals who were aware that they had CKD e. GFR (ml/min/1. 73 m 2) - NHANES 1988 -94 and 1999 -2000 surveys in the US general population (19, 589); Adults aged 20 years and older; - China National Survey of Chronic Kidney Disease; Adults aged 18 years and older; - Self-reported awareness of CKD - Awareness of CKD is even lower in developing countries Coresh et al, JASN 2005; Zhang et al. Lancet, 2012

Detecting CKD is cheap and efficient • Kidney function (e. GFR) estimated using simple equations applied to results of blood test (serum creatinine; $0. 75) • Albuminuria detected using semi-quantitative urine dipstick ($0. 02) or quantitative urine albumin: creatinine ratio ($2. 50) • Consistent presence of low e. GFR or abnormal albuminuria indicates presence of CKD NKF-K/DOQI, 2002

Inexpensive treatments for CKD improve CV and renal outcomes • • • Control of hypertension ACEI or ARB use Statin use Control of blood sugar (in diabetic patients) Smoking cessation Prevention of obesity Remuzzi, Lancet 2012

Summary • CKD is common, expensive, and associated with very poor outcomes • CKD often coexists with other NCDs • Many of the affected are unaware…but CKD is cheaply and easily detected using routine tests • Effective and cost-effective treatments for CKD are available • Detection and management of CKD should be integrated into national NCD programs