Section 1 CKD Epidemiology The Problem Chronic Kidney

Section 1: CKD Epidemiology

The Problem Chronic Kidney Disease is an epidemic worldwide – Growth 6 -8% per annum of dialysis patients Accumulating data re: possibility of delaying the progression of kidney disease, using multiple drug and behaviour intervention therapies. Under-recognition at earlier stages of kidney dysfunction persists – Late referral – Lost opportunities for improved patient outcomes

RRT Modalities 36, 542 DOD/0503 -04

Patients Accepted in the UK for Renal Replacement Therapy 250 0 - 44 200 150 45 - 64 65+ Diabetics Total 100 Year 97 98 99 2000 2001 0 85 86 87 88 90 91 92 93 94 95 96 50 80 81 82 83 84 Age Specific Rate per Million 300

Cadaveric Kidney Donors & Transplants and End of Year Kidney Waiting List, UK, 1994 -2003 DOD/0503 -04

Prevalence of renal replacement therapy Take-on rates /pmp England 98 Wales 118 France 200 Italy 260 USA 315

Estimates of Prevalence of CKD in the US: NHANES III Stage Description GFR (ml/min/1. 73 m 2 ) 1 Kidney Damage with Normal or GFR >90 5, 900 3. 3 2 Kidney Damage with Mild GFR 60 -89 5, 300 3. 0 3 Moderate GFR 30 -59 7, 600 4. 3 4 Severe GFR 15 -29 400 0. 2 5 Kidney Failure <15 or (or dialysis) 300 0. 1 Adapted from Am J Kidney Dis 2002; 39 (2, Suppl. 1): S 17 -S 31 Prevalence (000 s) Prevalence (%)

NICE: 2008 Classification of CKD waking up to the impact of proteinuria • • • Stage 1: Stage 2: Stage 3 A: Stage 3 B: Stage 4: Stage 5: GFR>90 + abnormal urinalysis GFR 60 -89 + abnormal urinalysis GFR 45 -59 GFR 30 -44 GFR 15 -29 GFR <15 or dialysis dependent Suffix P denotes presence of proteinuria (ACR>30 or PCR>50)

National Disease Prevalence Survey (%)

15 5 6 4 60 3 380 30 (GFR) Stage of Kidney Disease CKD: A Typical GP Practice of 10000 60 2 90 1 460

Incident Rates by Primary Diagnosis (per million population, unadjusted) USRDS, 2000

Obesity Trends: UK

Life expectancy: UK