CKD in Iran Presented by: SM Gatmiri, MD, Nephrologist Imam
Khomeini Hospital, TUMSNRC In The Name of God
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CKD -A worldwide problem. -Rising incidence &
prevalence.
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CKD Definition 1 -Kidney damage 3months, -Structural
(pathological) or -Functional (composition of blood or urine) or
-Imaging abnormalities -With or without decreased GFR. OR
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CKD Definition 2 -Presence of GFR
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Stage 1: NL GFR (>90 mL/min/1.73 m2) & persistent
albuminuria (1.8% of the total US adult population). Stage 2: GFR
60 to 89 mL/min/1.73 m2 & persistent albuminuria (3.2%). Stage
3: GFR 30 & 59 mL/min/1.73 m2 (7.7%). Stage 4: GFR 15 & 29
mL/min/1.73 m2 (0.35%). Stage 5: GFR of
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The number of ESRD in US has increased from -10,000 in 1973 to
-86,354 in 1983, & to -527,283 as of December 31, 2007.
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In 2007 alone, 111,000 patients entered the US ESRD program.
(Incidence: 440 PMP)
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Patients with ESRD consume a disproportionate share of health
care resources.
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Total Medicare DM CHF Dialysis/Tx CKD Numbers 5.8% 1.1%
20.7%25.1% 41.3%48.1% 19% 7.8% CKD, CHF & DM; Number of
patients & costs; USA 2002 Costs Collins AJ; USRDS
database
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The total cost of the ESRD program in the US was approximately
$35.32 billion in 2007.
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However CKD in the US, is under- diagnosed &
under-treated.
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Iran Area: 1.648 million Sq Km Population : 68,017,860 Median
Age : 24.23,Life Expectancy : 69.96 Total Health Expenditure of GDP
: 6%
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ESRD in Iran 12% Prevalence : 357 PMP Incidence :66 PMP CKD
epidemiology in Iran Mitra Mahdavi-Mazdeh- Assessment of HD
patients , Iran ;NDT (2007)
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Mean age difference in ESRD patients during last 10 years in
Iran
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Sex difference in ESRD patients during last 10 years
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Causes of ESRD in the last 10 years in Iran
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Sex difference in ESRD patients during last 10 years in Iran
male to female ratio is 1.33.
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Diabetes as the cause of ESRD in the last 10years
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HTN & DM as the causes of ESRD in the last 10 years in
Iran
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The number Of ESRD will be doubled in next 10 years
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Annual RRT Cost with total health expenditure of GDP of 6%
-Dialysis sessions: 800Billion R for 13000 Pts (>60,000,000
R/Pts) -R Tx drugs =500 B R -for 12000 Pts (>40,000,000
R/Pts)
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RRT program so far? Kidney Transplant CAPD HD centers
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Time to change our approach: decrease ESRD number or its
postponing
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Mahdavi-Mazdeh :IJKD.vol:4,no:4, 2010 Population-Based
Screening CKD in Iran:
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What is Solution? We Should push for a CKD education To take
serious high NL Cr To take serious HTN &Diabetes management CKD
should be viewed as the third part of the deadly triangle with DM
and CVD affecting the health & welfare of the general
population
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What is Our Common Task As -Nephrologists -Internist -GPs
-Health Authorities?
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Education 1. Primordial Prevention : Healthy Diet, Changes in
Social, Cultural and Personal Habits 2. Early Detection, Referral
and Control of HTN & DM Public Education Professional (Health
Care Personnel) Education
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CKD Patients receiving ACE-Is/ARBs NHANES III 19881994 &
NHANES 19992002 patients age 60 & older; patients with eGFRs of
less than 15 ml/min/1.73 m 2 are excluded. *Sample size less than
30, or coefficient of variation is not less than 30 percent.
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Vascular Access: New Medical Evidence Form 2728 Data, May
2005-Dec 2006 82% of patients are using a catheter as their first
outpatient access!!!! Only 13% of incident HD patients used a
fistula as their first access. Assessment of HD patients , Iran
;NDT (2007)
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AVF use in Canadian prevalent (53%) and incident (26%)patients.
In Europe [prevalent(74%), incident(50%) AVF is the advocated
access route in Iran [prevalent (91%), incident(37.5%)in Tehran].
Assessment of HD patients , Iran ;NDT (2007) Vascular Access
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Message: -CKD & ESRD is increased & highly prevalent -A
strong CVD risk factor.
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Message -We can detect CKD with simple tests & there are
treatments for CKD.
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Message: -ESRD is increasing, more than increases in number of
HD facility & Tx.
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Message -We should consider CKD prevention & place initial
focus on strategies that slow disease progression to postpone
RRT.
