ZUBAIR ASMALNephrologist, Pretoria

CKD and ESRD Prevalence of ESRD Predicted prevalence of ESRD Prevalence of HIV HIV and Kidney disease HIV in Transplantation

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

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)

Inaccurate Reflects only patients on dialysis and

transplanted Many patients not diagnosed ?80% of patients not accepted Huge difference between public and private

0 1000 2000 3000 4000 5000 6000 7000

2012

2013

2014

3182

3150

3280

5377

5690

6311

Private

Public

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

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

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%

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

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

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

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

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

64 712 pt should be on dialysis secondary to hypertension (32.4%)

+/- 200 000 pts in total have ESRD

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

130 000 to 200 000 possible ESRD 65 000 to 100 000 people require kidneys!!!

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

100000

219

Patients Needing Transplant Current Transplant

8177

219

Patients Needing Transplant Current Transplant

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

Initially, infections and sepsis (OI) HIVAN/HIVICK Drug related Chronic diseases

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?