European Parliament Symposium

Transcription

1 European Parliament Symposium Chronic Kidney Disease and Hypertension Twin Challenges for 21st Century Europe European Parliament, 10th March 2009

2 European Kidney Health Alliance (EKHA) Alliance of not-for for-profit organizations who represent the key stakeholders in kidney health issues in Europe CEAPIR ERA-EDTA EDTA EDTNA/ERCA IFKF

3 EKHA unique alliance A single voice representing the combined views of the renal community

4 Kidney disease is more than kidney failure Around 250,000 people are being treated for kidney failure in the EU27 but Chronic kidney disease affects at least 10% of the population 40 million people

5 What is chronic kidney disease? CKD is the generic name for persistent kidney damage regardless of cause CKD is commonly caused by high blood pressure, diabetes or renal inflammation CKD is graded into five stages depending on the degree of kidney functional impairment CKD Stage 5 requires treatment with dialysis or kidney transplantation

6 CKD the silent epidemic Most patients with CKD feel entirely well but have greatly increased risk of - Progressive kidney failure Cardiovascular disease

7 CKD and Hypertension: silent partners Hypertension Progressive Kidney failure Heart attacks Strokes Chronic kidney disease

8 The need for greater awareness of CKD Lack of awareness: 73% of those being treated for hypertension were ignorant of their risk of developing CKD 47% had had their kidney function assessed 18% had discussed steps to help look after their kidneys with their doctor 11% are aware that there are no obvious symptoms of early-stage CKD Based on a survey of 286 individuals with cardiovascular disease in Europe TNS 2009

9 EKHA fundamental objectives Raising awareness of kidney disease Promoting uniform standards of care Supporting research and development Cooperating with EU organisations Facilitating exchange of information

10 EKHA Engaging the EU First year - Establishing links DG Research lobbied for research in CKD DG SANCO lobbied for renal programs EU Parliament -Amendment on CKD prevention in Resolution on Organ Donation and Transplantation Second year - Strengthening links EU Parliament -Public health programs to reduce the need for renal transplants as part of Action Plan and Directive on Organ Donation and Transplantation

11 EKHA

12 Chronic Kidney Disease and Hypertension -Twin challenges for 21st century Europe

13 Cardiovascular Cancer-lymphoma CKD World Health Organization A MUCH SILENT EPIDEMICS CKD still not mentioned among Chronic diseases by the WHO..

14 Mortality infectious diseases * epidemiologic transition The ascendancy of cardiovascular disease 50 Life duration 75 High LDL & low HDL Cholesterol Hypertriglyceridemia Fasting hyperglicemia and... Old age

15 XXth Century Risk Factors (Framingham Risk Factors) Trade off: Huge 2 nd epidemics wave CKD CKD % XX th XX Century I st epidemics wave Huge investments in prevention of CV diseases Cardiovascular Longer life expectancy of poeple with CV diseases 16.8% % NHANES III after 10 years NHANES IV

16 The Chronic Kidney Disease Epidemics by stages NHANES III survey & USRDS GFR Mild Millions 100 Moderate Severe ESRD dialysis % 7.6 millions 0.2% 0.5 million...florence...eindhoven...lyon 0.2% ~0.5 million

17 Billions 3.0 The figures of risk factors now and in the foreaseble future Billions Hypertriglyceridemia low HDL Cholesterol fasting hyperglycemia 0.5 Frank diabetes

18

19

20 The true risk of CKD is more heart disease than ESRD % % 24% Mortality 1% 1% ESRD / dialysis GFR (ml) 90 Dysfunction Mild Moderate DS Keith, JAMA 164: 659, 2004

21 The Chronic Kidney Disease Epidemics Groningen Holland residents yrs.

22 The Chronic Kidney Disease Epidemics NHANES III survey Mean age 45 years GFR % Moderate Severe Groningen Courtesy dr. P.De Jong mean age: 49 years ESRD % 4.9% 0.2% 0.1% 0.2% 0.1%

23 20 March males Moderate to Severe Renal Insufficiency (all ages) 15 females a strong message % should be delivered % to EU countries,, the WKD message.. CKD is common and harmful but also 10 11% Iceland 10 England Germany Belgium also 8% preventable and Germany treatable England Italy Italy Norway 6% Belgium 4% 5 Iceland Norway Zoccali C, Jager K, Kramer A. Eugloreh report 2009

24 S & C Because of the ageing world population and consequent increasing prevalence of hypertension and diabetes, CKD rates will continue to increase Focus on public awareness and screening programmes as well as programmes to educate both patients and physicians is fundamental. Screening for risk factors of CKD like hypertension and diabetes and combating obesity is fundamental for halting the CKD epidemics.

25 European Parliament Symposium Public Health Strategies to address CKD and its associated diseases Tom Oostrom M.Sc. Vice President Dutch Kidney Foundation

26 European Parliament Symposium Dutch perspective

27 European Parliament Symposium 1. Positioning a health foundation 2. Example public health strategy: Kidney Check and Prevention Consult 3. Hurdles in the Dutch health care system 4. Input for public health strategies in Europe

28 European Parliament Symposium Patients Insurance companies/ government Professionals Positioning a health foundation

29 European Parliament Symposium Background Kidney check - 1 in 200 have kidney damage - Diabetes/hypertension: GP s s screen in only 10-40% of the cases on albuminuria

30 European Parliament Goals Kidney check Symposium - Detection kidney damage at an early stage - Create awareness among GP s about importance of early detection

31 European Parliament Results Kidney check Symposium million Kidney Checks requested (8,7% population 18+) kidney disease, albuminuria, 270 diabetes, hypertension. Total found 4.500

32 European Parliament Next steps? Symposium - We started a prevention program with Heart and Diabetes Foundations: Live a long and healthy life (LekkerLangLeven) one check - Contact with The Dutch College of General Practitioners (NHG) about collaboration on a health check used by GP s: Prevention Consult

33 Lessons European Parliament Symposium - Let health funds play the role of innovator and initiator in breaking down walls; in this case it had effect - Involve the GP s s in your plans, it helps acceptation and implementation - Don t t act alone as renal community

34 European Parliament Symposium A succesfull story? Still problems universal prevention selective indicative care related cure care

35 European Parliament Symposium A succesfull story? Still problems universal prevention selective indicative care related cure care Law on PH Laws on individual health care

36 European Parliament Symposium A succesfull story? Still problems universal prevention selective indicative care related cure care Law on PH Government Laws on individual health care Insurance companies

37 European Parliament Symposium A succesfull story? Still problems universal prevention selective indicative care related cure care Law on PH Government Laws on individual health care Insurance companies Early detection of the population at risk?

38 European Parliament Symposium Lobby needed to get early detection covered, but: 1. Public health is fragmented, members act apart 2. Relatively limited budget for public health research 3. Research is a condition for evidence based prevention interventions

39 European Parliament Work to do: Symposium Organize the public health community Lobby with one voice More impact on research agenda (PH oriented) More evidence based interventions condition for coverage by insurance companies (closing gap)

40 Recommendations: 1. Let health foundations enforce change Don t t act alone as renal community (WKD/WHD good example) 2. Don European Parliament Symposium 3. Organize the public health community locally and in Europe (public health is a shared concern) 4. Focus lobby on the research agenda 5. More PH means more manpower

41 European Parliament Symposium Impossible? Not if we go for it, together!

42 Valerie Twomey Cork, Ireland

43 Before Transplantation 2004: nephrologists confirmed ESRF - dialysis or transplantation essential Tired, pale skin, trouble concentrating, poor appetite, nauseated, swollen ankles & changes in urination Dialysis for two years to ensure optimum clearance achieved Home Dialysis Peritoneal Dialysis Hospital based Haemodialysis Massive impact on the whole of my life, not just on my physical condition Lifestyle (eg 4am slot) Dietary & fluid restrictions Body image Social implications Work Financial implications 2

44 The Phone Finally Rings 4.45am June 2006 We have a fantastic Kidney for you would you like to take it? Mixed emotions excitement, disbelief, fear, anxiety, sadness (deceased donor) Bag packed for two years - week before the call, decided to refresh my clothes 9.00am - arrived at Beaumont hospital: Physical examination to check that it was safe to proceed The cross-match a negative cross-match meant the operation could go ahead 2.30pm wheeled down to surgery 8.30pm back in the ward 3

45 Life After Transplantation Rejected after 10 days - back on dialysis & received intravenous steroids for 5 days Took a year to recover following transplantation Less medications Longer life expectancy Freedom from dialysis and no diet/fluid restrictions Far more energy a great quality of life Very determined advocate for Organ Donor Awareness, representing Ireland at the World Transplant Games August

46 5

47 6

48 The Way Forward Public health promotion healthy lifestyle & healthy diet Better integration of care between GP s & specialists Well disseminated treatment guidelines to all health professionals Research focused on understanding complications that accompany longer life span