A classroom presentation

1. Chronic Kidney Diseases and Its
Causes, Trends and Corrective
Actions Needed to Take in the
Developing World
Presented by-
Dr. Jheelam Biswas
Dept of NCD
BUHS

2. Outlines
 Introduction
 Background
 Causes of CKD
 Global trends of CKD over years
 CKD: Bangladesh context
 Corrective actions to be taken
 Conclusion

3. Introduction
• Chronic kidney disease (CKD) is now recognized
as a public health priority worldwide, with a high
economical cost to health system of developing
countries.
• It is an independent risk factor for
cardiovascular diseases, therefore premature
deaths and decreased quality of life.

4. Background
• Chronic kidney diseases can be defined by the
indicators of renal insufficiency like proteinuria,
changes in kidney structure detected by imaging
or increased serum creatinine.
• Worldwide, estimated 200 million people suffer
from CKD, and the estimated prevalence of
stages 1 to 5 was 13.4% among which 10.6% are
in stages 3 to 5. (1)
• Lozano R, Naghavi M, Foreman K et al. Global and regional mortality from 235 causes of death for 20 age
groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013;
380: 2095–2128

5. Background (cont..)
• Globally, more than 100 countries have no
provisions for chronic maintenance dialysis or
kidney transplantation and thus, more than 1
million people die annually from ESRD.
• The health expenditure of CKD in USA was 6.3%
and in Bangladesh the was 3.7% of gross
domestic product (GDP). (2)
• (2) Roy S. Determinants of healthcare expenditure on human capital and economic growth in Bangladesh: a
longitudinal data analysis from 1995–2010. Asian J Pharm Res Health Care 2014; 6: 6–10

6. Background (cont..)
• It affects all age groups, but in young and
middle aged population, development of CKD
causes loss of income, and increased social and
economic burden.
• It is a big concern for developing countries
because of the increasing prevalence, high
health expenditure, and low socioeconomic
condition.

7. Causes of CKD
CGN, 25.50%
Diabeties, 41%
Hypertension,
33%
others, 0.90%
Source: Bangladesh Renal journal 2004

8. Global trend of CKD over years:
• Like all other NCD, CKD is now becoming one of
the global health challenges.
• 2002–03, the third Australian Diabetes, Obesity
and Lifestyle (AusDiab) study showed a high
prevalence of CKD in the USA and Australia, 16
and 14%, respectively.

9. Global trend (cont…)
• In the same year European countries and China
the prevalence rate was around 10%.
• But after 2003, in USA, incidence rates of ESRD
have been stable, and five years later the
annual incidence rate almost fell to zero for the
first time. (3)
• Weinhandl E, Constantini E, Everson S, Gilbertson D, Li S, Solid C, et al. Peer kidney care initiative 2014 report:
dialysis care and outcomes in the United States. Am J Kidney Dis. 2015;65 Suppl 1:S1–140.

10. Global trend (cont…)
• But in the developing countries the picture was
exactly opposite.
• In 2015, India had a prevalence rate of 6.3%, in
stage 3 of CKD.
• In Srilanka the CKD prevalence was 34.3%, and in
Pakistan (according to Pakistan renal registry
2013) 7260 patients are on dialysis currently.

12. CKD: Bangladesh Context
• No reliable prior data exists on prevalence of
CKD in Bangladesh.
• In 1994, a small scale study reveals that, 24% of
the patients presented with diabetic
nephropathy, in 1998, 31% (an increase of 7%)
and in 2013, 41% (a further increase of 10%
compared with 1998). (4)
• (4) Abraham G. The challenges of renal replacement therapy in Asia. Nat Clin Pract Nephrol 2008;
4: 643

13. CKD: Bangladesh Context
• According to NKF, CKD prevalence of 16- 18% in
Bangladesh; of them, 11% belong to stage-III
and above in 2014.
• According to renal registry 2010, prevalence of
ESRD in Bangladesh was 30-35 thousand per
year. In 2013, 7007 patients could access renal
replacement therapy.

14. CKD: Bangladesh Context
• Almost 80% RRT centers in Bangladesh are profit
based.
• Cost of single dialysis ranges from 3500-5000
taka per dialysis (US$ 44-62.00) .
• In 2013, more than 80% patients could not
access RRT, and therefore died.

15. Prevalence of Hemodialysis from 1998 to 2014 (NKF yearbook 2016)

16. Corrective actions to be taken
• To control the increasing burden of CKD in the
developing countries and decrease the disparity
between rich and poor in access to RRT both
governmental and international partnership is
needed.
• But as always, prevention is better than cure.

17. Corrective actions (cont…)
• Primary prevention:
 Screening and raising awareness
 Prevention of LBW
 Early detection and control of diabetes and
hypertension
 Stopping the use of OTC and herbal drugs
 Lifestyle modification.

18. Corrective actions (cont…)
• Secondary prevention:
 Early detection and treatment
 Achieving good glycemic control and control of
hypertension with appropriate drugs in the
patients with early stage of CKD.
 Reducing disparity in access to RRT

19. Corrective actions (cont…)
• National and Local health planning:
 Improving medical materials, methods and
processes used in screening, treatment and
monitoring of CKD
 Financial management
 Training of local health providers
 Building international partnership

20. Conclusion:
• The increased burden of CKD in developing
countries is due to globalization, low
socioeconomic status, and poor access to health
care and health care disparities.
• By early detection, treatment increasing
community outreach, and access to preventive
medicine for high risk population, can decrease
the rising burden of CKD.