Chronic Kidney Disease in the Community -Indian Scenario

by

Dr. Vidya N. Acharya; MD; FAMS;Hon. Secretary - National Kidney Foundation - India

Director - Professor; Post Graduate Studies inNephrology; Muljibhai Patel Society for Research

in Nephro - Urology and Hospital - Nadiad - South Gujarat - India

India - The Hard Economic Facts.

Population = 1000 million and growing

Per capital Income = Rs.12989/year

One US $ = Rs. 46 - 47

Earning > Rs.50,000 = 2.2% of population

No. of poor = 36% of population

Cost of a renal Tx. = Rs. 2,50,000

June, 2003

June, 2003

Chronic Kidney Disease in India - Hospital Based Data

Comparison of data on C.R.F. from Chennai and ChandigarhCompared [hospital data]

Channai - % Chandigarh - %[Mani M.K.] [Sakuja - Sud]

*Chronic Glomerulonephritis 17.44 37.0*Diabetic Nephropathy 27.60 24.0*Chronic Interstitial Nephritis 20.39 14.0*Nephrosclerosis 11.0 13.0

Ref. Kidney Intl. Sup. No. 83; Feb., 2003Community based data may be in variance with selective hospitalbased data June, 2003

Demographics

0

10

20

30

40

50

60

1 2 3

%

Male adults Female adults Children

Chronic Kidney Disease in the Community Mumbai 2002 - Age and

Sex Distribution of the screened population- n =

3218

June, 2003

0

10

20

30

40

50

60

70

80

90

1 2 3 4 5Hindu Muslim Christian Sikh Others

Demographic Data - Mumbai 2002Distribution by Religion - n = 3218

June, 2003

11.210.6

5.3

7.4

0

2

4

6

8

10

12

1 2 3 4

1= Hypertensive nephrosclerosis2= Diabetic renal disease3=Stone disease4=Miscellaneous (GN 3.5%, UTI 3.4%, others 0.5%)

Chronic Kidney Disease Detected in the community:Mumbai 2002

n=3218

CKD=34.7%

Chronic Kidney Disease in the Community Mumbai Data - 2002 [H]

High Risk Group [H] n = 748 Diabetics 122 16% Adults 98.7%

Children 1.3%below 18 yrs.

Non Diabetic 626 84% Hypertensives 210 28% Non. Hypertnvs. 538 72% Combined Diabetics with Hypertensives n = 80/122 = 66%

June, 2003.

Urinary abnormalities in the high risk group - Mumbai 2002 - n = 748

94

87

97

6

13

3

80

85

90

95

100

105

1 2 3

Series2

Series1

Positive

Negative

Proteinuria Hematuria Pyuria

June, 2003

Demographic Data of the High Risk Group -Mumbai 2002 -

Weight distribution [in Kgs.] - n = 748

Entire group 63.6 + 13 (4-110)Diabetic 65.0 + 13 (4-92) Non Diabetic64.2 + 9 (15-110)

Difference in weight not statistically significant

June, 2003

Chronic Kidney Disease: High Risk Group - n = 748

Non-DM 84%

DM16%

Adults 15.7%

Children 0.3%

June, 2003

Chronic Kidney Disease in the Community [H]Mumbai Data - 2002 [contd]

Duration of DiabetesMean in years 4.28 ± 5.18 Range 1 year to 23 yearsDiabetes/AgeMean 52.4 ± 13.5 yrs. Range 2 years - 85 yearsDiabetes and Therapy [OHA and/or Insulin]Not on treatment = 30/122 = 25%On treatment = 92/122 = 75%

June, 2003.

Chronic Kidney Disease in the Community [H] Mumbai Study - Blood Pressure values - n=748

Diabetics/Non Diabetics.

Mean RangeDiabetics Systolic B.P. 132 ± 23mmHg 100 - 180mmHg

Diastolic B.P. 82.6 ± 9.9mmHg 60 - 100 mmHg

Non Systolic B.P. 132.4 ± 21.10mmHg 100 - 201mmHgDiabetics Diastolic B.P. 87 ± 15mmHg 50 - 140 mmHg

June, 2003.

Urinary abnormalities in Diabetics - Mumbai 2002 n=121

5

2.5

0.5

0

1

2

3

4

5

6

1 2 3+ + +Proteinuria

%

%

%

June, 2003

Urinary abnormalities in Diabetics Mumbai - 2002 - n=121

5

2.5

0.5

0

1

2

3

4

5

6

1 2 3+ + +Proteinuria

%

%

%

June, 2003

Chronic Kidney Disease in the Community [H]Mumbai - 2002 [H] - Hypertensives - n = 748.

Known Hypertensives = 210 [28%]Not known Hypertensives = 538 [72%]Duration of Hypertension in yrs.Mean 1.4 ± 3.24B.P. levels Systolic 133.8 ± 24mmHg Range 120 - 190 mmHg

Diastolic 84.3 ± 12.5mmHg Range 70 - 105mmHgNot knownHypertensiveB.P. levels Systolic 131 ± 21mmHg Range 100 - 210mmGh.

Diastolic 86 ± 15mmHg Range 50 - 90mmHg

Differences in B.P. levels between known and not knownhypertensives - not significant.

June, 2003.

4.7

1.4

5

2

0

1

2

3

4

5

6

1 2 3 41+ 2+ 3+ 4+

Mumbai 2002 Data [H]Hematuria in Hypertensives (%)

June, 2003

Chronic Kidney Disease in the CommunityMumbai - 2002 [O + N + H] n = 3218

Renal Diseases Detected 34.7%

Hypertensive Nephrosclerosis = 11.2%Diabetic Renal Disease = 10.6%Stone Disease = 5.3%Miscellaneous Renal Diseases = 7.4%

These include Urinary Tract Infeciton [3.4%]GMN [3.5%] ADPKD: Genito-Urinary Tuberculosis +Urinary Obstruction + Benign Prostatic enlargement[0.5%]

June, 2003.

150(65.0%)

MALE

FEMALE

81(35.0%)

Demography - Bharuch Data -SEX DISTRIBUTION

June, 2003

GROUP <=10 11-20 21-40 41-60 >60 TOTAL

Overall 22 20 93 64 32 231 (%) (9.5) (8.7) (40.3) (27.7) (13.9) Males 13 12 58 43 24 150 (%) (8.7) (8.0) (38.7) (28.7) (16.0)

Females 9 8 35 21 8 81(%) (11.1) (9.9) (43.2) (25.9) (9.9).

Demography - Bharuch Data -Distribution - Age in Years

*

June, 2003

GROUP NORMAL ABNORMAL TOTAL

BHARUCH 139 (61.2%) 92 (39.8%) 231

Chronic Kidney Disease inthe Community - Bharuch Data

June, 2003

URINARY PROTEINURIA (92)

0

10

20

30

40

50

60

Trace '+1 '+2 '+3 '+4

58(63.0%)

20(15.2%)

9(6.5%) 3

(3.3%)

11(12.0%)

Chronic Kidney Disease inthe Community - Bharuch Data

June, 2003

PROTEINURIA IN DIABETES (62)

0

5

10

15

20

25

30

35

Trace '+1 '+2 '+3 '+4

33(53.2%)

12(19.4%)

5(8.1%)

3(4.8%)

9(14.5%)

Chronic Kidney Disease inthe Community - Bharuch Data

June, 2003

PROTEINURIA IN HYPERTENSIVES

0

2

4

6

8

10

12

14

16

Trace '+1 '+2 '+3 '+4

16(55.2%)

6(20.7%)

1(3.4%)

2(6.9%)

4(13.8%)

Chronic Kidney Disease inthe Community - Bharuch Data

June, 2003

CREATININE STATUS

0

50

100

150

200

250

<=1.5 1.5-3.0 3.0-5.0 >5.0

218(94.5%)

6(2.6%)

3(1.1%)

4(1.6%)

Chronic Kidney Disease inthe Community - Bharuch Data

June, 2003

Chronic Kidney Disease in the Community [Data on Bharuch Camp] n = 231

Types of Diseases Detected

* Diabetic Renal Disease = 26.8%* Renal Stone Disease = 17.3%* Hypertensive nephrosclerosis = 16.88%* Urinary Tract Infection = 16.5%* Chronic Renal Failure = 5.6%* Glomerulonephritis with nephrotic syndrome = 3.5%* Benign prostatic hypertrophy = 1.3%

June, 2003.

Chronic Kidney Disease in theCommunity - Mumbai, Udaipur &Bharuch

Disease state Mumbai Udaipur BharuchHypertensive neph. 11.2 30.4 16.88Diabetic renal dis. 10.6 12.6 **26.8Stone Disease 5.3 **34.4 * 17.3Miscellaneous 7.4 12.4 10.8

* p < 0.05** p < 0.001

Miscellaneous group includes GMN, ADPKD, UTI, UrinaruObstruction, Genitourinary TB, Benign Prostate enlargement

June, 2003

Nephrologists as programme developers for the community* Need shift in perspective and use of different sets of analytical skills.* Evaluation of individual community health needs* Measures to counter renal problems as seen in individual communities.

June, 2003

There is a continuing cry for preventive aspects of nephrological disorders, which demands :

* Commitment* Honesty* Accountability* Integrity* Responsibility

June, 2003

Our Grateful Thanks to

* Giants International - Mumbai* Lions Clubs - Mumbai* Rotary Clubs of Mumbai, Udaipur,

Kanpur* Bharuch Junior Chamber

with Dr. Hiren Shah /JC Umesh Shah

June, 2003

[Contd.]

* Prempuri Ashram - Mumbai* Dr. Mukesh Barjathia - Udaipur* Dr. Dilip Sinha - Kanpur* Drs. Niranjan Kulkarni, Dr. Hemal Shah,

and others from Muljibhai Patel UrologicalHospital - Nadiad - South Gujarat

* Drs. Vasanti Balvalli.* Dr. Vishwanath Billa * Dr. Jyotsna Zope

June, 2003

THANK YOU