ESRD Rates Continue to Rise USRDS, 2004 Rully Roesli, 2009. ESRD Costs are High (in $billions for 2002) Kidney Failure Accounts for 6% of Medicare Payments Lost Income for Patients is $24 Billion / Yr.
ESRD Rates Continue to Rise USRDS, 2004 Rully Roesli, 2009. ESRD Costs are High (in $billions for 2002) Kidney Failure Accounts for 6% of Medicare Payments Lost Income for Patients is $24 Billion / Yr.
ESRD Rates Continue to Rise USRDS, 2004 Rully Roesli, 2009. ESRD Costs are High (in $billions for 2002) Kidney Failure Accounts for 6% of Medicare Payments Lost Income for Patients is $24 Billion / Yr.
Rully Roesli , 2009 Rully Roesli , 2009 Prevalence of GFR Category Rully Roesli , 2009 ESRD Rates Continue to Rise USRDS, 2004 Rully Roesli , 2009 Kidney Failure Compared to Cancer Deaths in the U.S. in 2000 (in Thousands)
Lung Cancer Kidney Failure Colorectal Cancer Breast Cancer Prostate Cancer 57 100 41 30 160 Rully Roesli , 2009 Costs of Kidney Failure are High (in $billions for 2002)
Kidney Failure Care Total NIH Budget 25.2 23.2 Kidney Failure Accounts for 6% of Medicare Payments
Lost Income for Patients is $2- 4 Billion/Yr USRDS, 2004 Rully Roesli , 2009 Rully Roesli , 2009 Rully Roesli , 2009 Rully Roesli , 2009 Rully Roesli , 2009 Incidence & Prevalence of CKD Incidence Prevalence Rully Roesli , 2009 Etiologi penyebab Gagal Ginjal di Malasia 14th Report of the Malaysian Dialysis and Transplant Registry, 2006, Rully Roesli , 2009 Etiologi penyebab Gagal Ginjal di Singapura 3rd Report of the Singapore Renal Registry, 1999/2000 Rully Roesli , 2009 The bad companions... Rully Roesli , 2009 Diabetes: The Most Common Cause of ESRD Primary Diagnosis for Patients Who Start Dialysis Diabetes 50.1% Hypertension 27% Glomerulonephritis 13% Other 10% United States Renal Data System. Annual data report. 2000. No. of Patients Projection 95% CI 1984 1988 1992 1996 2000 2004 2008 0 100 200 300 400 500 600 700 r 2 = 99.8% 243,524 281,355 520,240 No. of Dialysis Patients (Thousands) DIABETES HYPERTENSION - ESRD Rully Roesli , 2009 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 Rully Roesli , 2009 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 2 Diabetes in Hypertension: 2.43 Hypertension (n=3.804) 29,1 * Hypertension: A Significant Risk Factor for Type 2 Diabetes Rully Roesli , 2009 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 Rully Roesli , 2009 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 A g e - S t a n d a r d i z e d
R a t e
o f
C a r d i o v a s c u l a r
E v e n t s
( p e r
1 0 0
p e r s o n - y r )
Estimated GFR (mL/min/1.73 m2) Rully Roesli , 2009 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
Rully Roesli , 2009 Who to Test for Chronic Kidney Disease Regular testing of people at risk Diabetes Hypertension Relative with kidney failure Cardiovascular disease Rully Roesli , 2009 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 prediction equation
*24 hour urine collections are NOT needed. Diabetics should be tested once a year. Others at risk testing less frequently as long as normal. Rully Roesli , 2009 Who Should be Treated for Chronic Kidney Disease With diabetes: With urine albumin/creatinine ratios more than 30mg albumin/1 gram creatinine Without diabetes: With urine albumin/creatinine ratios more than 300mg albumin/1 gram creatinine corresponding to about 1+ on standard dipstick Or Any patient: With estimated GFR less than 60 mL/min/1.73 m 2
Rully Roesli , 2009 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 diuretic should be part of the regimen Continue best possible glycemic control in individuals with diabetes Rully Roesli , 2009 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 than 30 mL/min/1.73 m 2 Monitor hemoglobin and phosphorous with treatment as needed Treat cardiovascular risk, especially smoking and hypercholesterolemia Rully Roesli , 2009 Early Treatment Makes a Difference Brenner, et al., 2001 Rully Roesli , 2009 Rully Roesli , 2009 Rully Roesli , 2009 DATA WHO Rully Roesli , 2009 DAERAH TAHUN PREVALENSI JAKARTA
MAKASAR
BALI SINGAPARNA 1982 1993 2001 1981 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) Rully Roesli , 2009 NEFROPATI DIABETES SEBAGAI PENYEBAB GAGAL GINJALYANG MEMERLUKAN CUCI DARAH DI INDONESIA 1980 1993 1998 Data : Pusat Registrasi Nasional untuk Hemodialisis Tahun Rully Roesli , 2009 Rully Roesli , 2009 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 Rully Roesli , 2009 TAHUN PREVALENSI (%) MENKES 2007 URBAN RURAL ( 17 21 % ) FKM UI/SKRT (Zamhir S) 2004 Pulau Jawa 41.9 % Perkotaan 39,9 % Pedesaan 44,1 % FK UNSRI (Zukhair Ali) Sum Sel ( 6,3 9,17 % ) PREVALENSI HIPERTENSI DI INDONESIA Rully Roesli , 2009 PERHIMPUNAN HIPERTENSI INDONESIA RESUME RAPAT PLENO Jakarta, 8 November 2008 CARA PENGUKURAN YANG BENAR DAN SERAGAM ( ROADSHOW : KURSUS HIPERTENSI) CARA PENCATATAN DAN PELAPORAN YANG BENAR DAN SERAGAM (diusulkan dihubungkan dengan SKP IDI)
Rully Roesli , 2009 Rully Roesli , 2009 Rully Roesli , 2009 Rully Roesli , 2009 Fasilitas Hemodialisis di Indonesia vs Singapura 0.34 6.8 0 1 2 3 4 5 6 7 Fasilitas HD Indonesia Singapura Pusat Registrasi Nasional untuk Hemodialisis , 1992-1993 Rully Roesli , 2009 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 Pusat Registrasi Nasional untuk Hemodialisis , 1992-1993 Rully Roesli , 2009 Prevalence Rate (PR) penderita cuci darah di Indonesia pada tahun 1993 0 100 200 300 400 500 600 700 Indonesia Belanda Perancis Itali Jerman Jepang Singapura Pusat Registrasi Nasional untuk Hemodialisis , 1992-1993 Rully Roesli , 2009 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 Rully Roesli , 2009 0 2000 4000 6000 8000 10000 12000 1989 1992 1995 1998 2005 TAHUN JUMLAH KASUS DIALISIS PT ASKES 481 10.452 2770 Program Program JAMKESMAS JAMKESMAS 9241 krisis krisis moneter moneter 1327 2131 Jumlah kasus dialisis yang dibiayai oleh PT ASKES pada tahun 1988-2006 Rully Roesli , 2009 0 100 200 300 400 500 600 700 800 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 Rully Roesli , 2009 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 % Pusat Registrasi Nasional untuk Hemodialisis , 1992-1993 DIABETES Rully Roesli , 2009 25 % 25 % 23 % 23 % 20 % 20 % 10 % 10 % DIABETES Rully Roesli , 2009 1461 1647 86 1802 125 124 687 540 465 302 Data Etiologi Pasien Hemodialisis Di-IndonesiaThn.2007-2008 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 Roesli , 2009 Gambar 1. Laju filtrasi glomerulus LAJU FILTRASI GLOMERULUS LAKI-LAKI DAN PEREMPUAN 40 60 80 100 1 8 2 0 2 2 2 4 2 6 2 8 3 0 3 2 3 4 3 6 3 8 4 0 4 2 4 4 4 6 4 8 5 0 5 2 5 4 5 6 5 8 6 0 6 2 6 4 6 6 6 8 7 0 7 2 7 4 7 6 7 8 8 0 UMUR L F G 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 Rully Roesli , 2009 KESIMPULAN :
[] INSIDENSI PGK (CKD) MENINGKAT SECARA GLOBAL
[] INSIDENSI PGK BERHUBUNGAN ERAT DENGAN DIABETES DAN HIPERTENSI
[] DI INDONESIA, BELUM ADA PERENCANAAN YANG MATANG UNTUK MENGHADAPI LONJAKAN KASUS DIABETES , HIPERTENSI, DAN PENYAKITGINJAL KRONIS