diabetes and kidney disease the health and economic impact
TRANSCRIPT
![Page 1: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/1.jpg)
Diabetes and Kidney Disease
The health and economic impact
Kelvin LynnMedical Director
Kidney Health New Zealand
![Page 2: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/2.jpg)
Kidney disease and diabetesA marriage made in hell!
No kidney disease or diabetes
Diabetes alone
Kidney disease alone
Diabetes and kidney disease
Health risks/costs
+
++
+++
++++
![Page 3: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/3.jpg)
How does the kidney work?
And where are they?
![Page 4: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/4.jpg)
Where are my kidneys?
![Page 5: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/5.jpg)
Where are your kidneys and what do they do?
• Most people have two kidneys ~10 cm long
• They are found in the back of the body just below the ribs
• The healthy kidney is a filter
• Each kidney has about a million filtering units called nephrons
![Page 6: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/6.jpg)
What do your kidneys do?
• Act as a filter system • Get rid of waste products • Balance the body's salt & water content • Make hormones that control blood pressure • Make erythropoietin to produce red blood cells• Activate vitamin D to maintain healthy bones
![Page 7: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/7.jpg)
Kidney disease
Health
Chronic kidney disease
Death
Dialysis
Transplant
What can happen with kidney disease?
= death from heart disease
Diabetes
![Page 8: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/8.jpg)
Chronic kidney disease
![Page 9: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/9.jpg)
What is chronic kidney disease (CKD)?
• Any structural or working abnormality of the kidneys for longer than 3 months
• Most people with CKD unaware they are affected
• People with CKD commonly have high blood pressure or diabetes
![Page 10: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/10.jpg)
CKD - an international problem “Kidney disease is common, harmful and treatable”
• Kidney disease now recognised as a global public health problem
• Over 1.5 million people worldwide are on dialysis or have had a kidney transplant
• Kidney disease is a “disease multiplier”– It causes death in many with diabetes
& hypertension & predicts heart disease
11 March 2010
![Page 11: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/11.jpg)
The best way to pick up CKD
Three simple tests that your doctor can do
Measure your blood pressure
Check your urine for protein
Do a blood test to measure the blood creatinine level (enables percent kidney function to be calculated)
![Page 12: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/12.jpg)
People at most risk of CKD
• People with:– diabetes – high blood pressure – family history of kidney disease
• Older people• Smokers• Maori and Pacific people
![Page 13: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/13.jpg)
Extent of CKD in New Zealand
• Australian and US studies suggest that 1 in 10 adults has CKD
• Good data available for NZ dialysis and transplant patients
• No reliable NZ data for less severe CKD • NZ has a unique population
– we need to know our own figures for CKD
![Page 14: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/14.jpg)
192,700
3.9 m
4,200
8,500
180,000
Probable number in NZ with CKD(adapted from various sources)
39,000
![Page 15: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/15.jpg)
Equals numberwith important kidney diseaseIn NZ
![Page 16: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/16.jpg)
Chronic kidney disease in NZ Census report December 2008
• 2,099 people on dialysis
• 1,351 alive with a transplant
• 492 patients (226 with diabetes) started dialysis
• No sign of number on dialysis stabilising
![Page 17: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/17.jpg)
Chronic kidney disease in NZ Census report December 2008
• 122 kidney transplants (57 % living donor)
• About 1,000 with marginal kidney function
• 1 in 10 adults likely to have a critical sign of CKD e.g. high blood pressure, proteinuria
• 70% with CKD have high blood pressure and/or diabetes
![Page 18: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/18.jpg)
New patients
![Page 19: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/19.jpg)
0
5,000
10,000
15,000
20,000
0
1,000
2,000
3,000
4,000
1990199
11992199319941995199
619971998199
9200020012002200
32004200520062007
199019911992199319941995199
619971998199920002001200220032004200520062007
Australia New Zealand
Dialysis Graft
Nu
mb
er
Prevalent Modality at Year End
Treatment of kidney failure in Australia and New Zealand 1990 - 2007
All patients
![Page 20: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/20.jpg)
Diabetes and CKD
![Page 21: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/21.jpg)
Estimated Number of People Aged 20–79 with Diabetes, By WHO Region, 2003 and 2025
Source: Disease Control Priorities in Developing Countries, second edition, 2006
Number of People (millions)
Prevalence (percent)
Region 2003 2025 2003 2025
Developing countries 141 264 4.5 5.9
Developed countries 53 68 7.8 9.2
World 194 333 5.1 6.3
![Page 22: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/22.jpg)
CKD and diabetes
• Maori and Pacific people are more prone to Type 2 diabetes and kidney disease
• Aging population or ethnicity contributes only 1/3 of growth in patients with kidney failure
• 50% of growth is due to diabetes
![Page 23: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/23.jpg)
Diabetes facts – Type 1
• 3-5% more new cases each year
• Diabetic kidney disease – Kidney disease is preventable – Finland – kidney disease now an uncommon
cause of death in Type 1 diabetes– In New Zealand 10-15 people with Type 1
diabetes starting dialysis each year
![Page 24: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/24.jpg)
Diabetes facts – Type 2
• New cases & total number increasing but people with Type 2 living longer
• Up to 195,000 people affected in NZ (MOH)
• Who doesn’t know they have diabetes?– 1 of 3 Europeans– 1 of 4 Maori– 1 of 6 Pacific Islanders
![Page 25: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/25.jpg)
Diabetes facts – Type 2
• Number developing kidney damage and failure probably unchanged
• Kidney disease risk compared to European– Maori 10 -15 x more likely– Pacific Islander 7 – 11 x more likely– Asian 3 x more likely
• 50% of new dialysis patients with diabetic kidney disease are Maori
![Page 26: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/26.jpg)
Finding new cases of kidney disease in people with diabetes
Australian study
10,000 GP visits for people with diabetes
Half with Type 2 diabetics had CKD!
![Page 27: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/27.jpg)
Hospital expenditure on treating complications of diabetes and the potential for deferring complications
in Canterbury, New ZealandIan Sheerin
NZMJ, 2009, Vol 122 No 1288
• In 2005/2006, $10.1 million of costs and 9,511 bed days were spent by the CDHB on hospital admissions for complications of diabetes
• $456,000 associated with kidney complications
• Expenditure was considerably greater than the amount spent on attempting to manage diabetes in the community
![Page 28: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/28.jpg)
Cost of dialysis and transplantation
![Page 29: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/29.jpg)
Impact on the health care system of kidney failure
• Proportion of total health spend on kidney failure care– US 1.2% – Japan 4.5%– Taiwan 8.5%
– In New Zealand ????? –But at least 1% for 0.08% of total population! About $100 million!
![Page 30: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/30.jpg)
Cost of CKD in NZEndre, Beaven & Buttimore NZMJ 2006
• Annual cost of treating kidney failure conservatively estimated at NZ$90 million annually (based on 2003 figures)
• Diabetic kidney disease is responsible for at least $36 million in direct annual healthcare costs
![Page 31: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/31.jpg)
Costs of treating kidney failure
Costs Average 3 yr Variance from costs per patient
transplant
Renal transplant $ 83,736Incentre dialysis $192,954 230%Satellite haemodialysis $144,516 72%Home haemodialysis $100,755 20%Peritoneal dialysis $109,842 31%
Auckland Regional Renal Report 2005
![Page 32: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/32.jpg)
Other risks for people with CKD
All markedly increased if diabetes also present!
![Page 33: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/33.jpg)
CKD results in increased risk of:
• Heart disease• Hospital admission for any cause• Death
![Page 34: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/34.jpg)
Heart disease in severe CKD
General US population
CKD patients
![Page 35: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/35.jpg)
Relative risk for events in CKD
![Page 36: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/36.jpg)
What can we do to prevent or retard the progression of CKD?
![Page 37: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/37.jpg)
What do we know works?
• Diabetes
– Good blood sugar control reduces complications
– Good blood pressure control reduces complications – may need 3 or 4 drugs
– Certain BP drugs called ACE inhibitors slow down diabetic kidney disease
![Page 38: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/38.jpg)
What do we know works?
• Blood pressure– Good blood pressure control prevents kidney
damage– Good blood pressure control slows
progression of kidney disease – particularly when caused by diabetes
Not everyone gets BP down enough
![Page 39: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/39.jpg)
Better ways of dealing with CKD and diabetes
• Early detection in the community• Early treatment in primary care supported
by specialists and treatment guidelines• Co-ordination of care with that of other
chronic diseases – “one stop shop”• Community education
![Page 40: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/40.jpg)
Prevention, support & research
• Partnership with Government to ensure that kidney checks are part of disease screening in high risk groups
• Support for education in schools, communities and health services
• Support for kidney transplantation
• Support for research into the causes and treatment of chronic kidney disease
![Page 41: Diabetes and Kidney Disease The health and economic impact](https://reader030.vdocuments.site/reader030/viewer/2022032420/55a4f9e71a28aba16e8b4790/html5/thumbnails/41.jpg)