ZUBAIR ASMAL Nephrologist, Pretoria · Meta-analysis of 90 studies Study quality was low (20%...
Transcript of ZUBAIR ASMAL Nephrologist, Pretoria · Meta-analysis of 90 studies Study quality was low (20%...
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ZUBAIR ASMALNephrologist, Pretoria
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CKD and ESRD Prevalence of ESRD Predicted prevalence of ESRD Prevalence of HIV HIV and Kidney disease HIV in Transplantation
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Difference between CKD and ESRD Proteinuria and eGFR Differences between definition and
methodology Few studies done Studies that have been done are biased in
some way
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Meta-analysis of 90 studies Study quality was low (20% medium, 3%
high) 93% studies were urban No difference between urban and rural Prevalence of CKD was 13.9% (about 7
million)
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Inaccurate Reflects only patients on dialysis and
transplanted Many patients not diagnosed ?80% of patients not accepted Huge difference between public and private
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0 1000 2000 3000 4000 5000 6000 7000
2012
2013
2014
3182
3150
3280
5377
5690
6311
Private
Public
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0
100
200
300
400
500
600
700
800
1994 2012 2013 2014
073 71.3 72.6
0
620 648.1716.3
70
164 167 178
Public
Private
Overall
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71.8
13.514.7
2014
Haemodialysis
Peritoneal
Transplant
71.2
1414.8
2013
Haemodialysis
Peritoneal
Transplant
67.114.1
18.8
2012
Haemodialysis
Peritoneal
Transplant
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Hypertension 32.4% Diabetes 13.3% (public 11.2%, private 47.2%) Glomerulonephritis 33.7% HIV 6% Uncertain or not stated 12.8% Miscellaneous 7.8%
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32.531.7 32.4
12.4 11.813.3
9.5
36.533.7
36.1
12.8 12.8
3.3 3.1
7.8
0
5
10
15
20
25
30
35
40
2012 2013 2014
Hypertension
Diabetes
Glomerulonephritis
Uncertain
Miscellaneous
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78% of people over age of 50 (Int. J. Epidem, feb,2014)
30.4% of adult population (CVJ Africa, nov2014)
15-20% of patients with hypertension develop kidney disease
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0
10
20
30
40
50
60
70
80
15-24 25-34 35-44 45-54 55-64 65+
410
22
39
52
60
11
20
42
60
70
78
1.65 36.3 9 10.5 11.7
1998
2008
CKD
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20.1
17.6
12.4
9.4
6.2 5.3
0
5
10
15
20
25
15-24 25-34 35-44 45-54 55-64 65+
2011
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Age Population Hypertension CKD ESRD15-24 10 378 019 1 141 582 228 316 5 70725-34 9 088 327 1 817 665 363 533 9 08835-44 6 416 386 2 694 882 538 976 13 47445-54 4 838 572 2 903 143 580 628 14 51555-64 3 183 176 2 228 223 445 644 11 14165+ 2 765 990 2 157 472 431 494 10 787
36 670 470 12 942 967 2 588 591 64 712
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64 712 pt should be on dialysis secondary to hypertension (32.4%)
+/- 200 000 pts in total have ESRD
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2.28 million people with diabetes 20-40% develop CKD 456 000 patients with CKD +/- 0.75% of total diabetics develop ESRD 17 100 of diabetics in ESRD 130 000
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130 000 to 200 000 possible ESRD 65 000 to 100 000 people require kidneys!!!
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0
1000
2000
3000
4000
5000
6000
7000
8000
9000
2012 2013 2014
248 246 219
1607 1307 1414
69527533
8177
New Transplant
Transplant
Dialysis
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100000
219
Patients Needing Transplant Current Transplant
8177
219
Patients Needing Transplant Current Transplant
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7 million people 19.2% adult HIV prevalence 380 000 new HIV infections 30% develop ckd 48% on HAART 4,9 million can potentially donate
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Initially, infections and sepsis (OI) HIVAN/HIVICK Drug related Chronic diseases
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Rising prevalence of ESRD Many are still undiagnosed High prevalence of HIV Low transplant rate secondary to organ
shortage Should we be using HIV organs?