ESRD Differences in treatment - A worldwide overview Update 2004

Transcription

1 ESRD Differences in treatment - A worldwide overview Update 2004 [IRCT- Différences dans le traitement - une vue d'ensemble mondiale Mise à jour 2004] version for internet download Wolfgang Meichelboeck, Dipl.-Ing Ing. Munich-Pentenried - Germany SFAV & STN Tunis-Gammarth Tunisia May 27-29, 2004

2 ESRD treatment modalities (RRT) ESRD Death Kidney transplant (Tx) Dialysis Hemodialysis (HD) Peritonealdialysis (PD) Cont. access AV-Fistula Vasc Graft (Shunt) CV-Catheter Catheter

3 ESRD International data - validity International ESRD/RRT data Collect epidemiological data with incidence/prevalence rates status of the RRT understand data and publications from other countries compare with own treatment modalities and outcomes REGISTRIES: Mandatory (only some) Voluntary (many) No registry at all (most) response rates within the national registries vary inclusion criteria & reporting standards? Reporting time too long! (No data from the same year)

4 Examples for Renal Registries on the Internet website secure.cihi.ca/cihiweb/disppag e.jsp?cw_page=ar_5_e edta-reg.org niere.de/ ridt.org/sin-ridt/sin- ridt.org.htm Name IFFR SLANH ANZDATA USRDS CORR ERA-EDTA EDTA UK RR SIN RIDT Area or country International South & Latin America Australia & NewZealand USA Canada Europe / International Germany UK Italy Norway Malaysia

5 World wide trends in the underlying disease Diabetis (DM) Glumerolonephritis (GN)

6 ESRD - underlying disease The most common diseases in selected registries 1996 Diseases USRDS CORR ANZDATA ( % of ESRD pat in RRT) Incidence (USA) (Canada) (AUS / NZ) JSDT (Japan) Diabetes 42% 29% 19% 34% Hypertension 26% 10% 10% 7% Glomerulonephritis 11% 16% 35% 38% Point-Prevalence 1996 Diabetes 32% 23% 30% 22% Hypertension 25% 9% 12% 4% Glomerulonephritis 18% 20% 22% 54% Schena FP: Epidemiology of end-stage renal disease: International comparison of renal replacement therapy. Kidney International (2000); Vol.57 Suppl.74:S39-S45

7 ESRD - underlying disease - DM vs. GN /2002 Diseases USRDS (USA) CORR (Canada) ANZDATA (AUS / NZ) JSDT (Japan) Incidence 1996 (1) Diabetes (DM) 42% 29% 19% 34% Glomerulonephritis 11% 16% 35% 38% Incidence 2001/2002 (2) Diabetes (DM) 45% 32% 30% 38% Glomerulonephritis 8% 13% 30% 32% DM (1) Schena FP Kidney International (2000) (2) USRDS 2003, CORR 2001, ANZDATA 2002, JSDT 2003 GN

8 Incidence of DM and GN in JAPAN 1983 to % 15,6% 17,4% 19,6% 21,3% 22,1% 24,3% 26,5% 26,2% 27,8% 28,4% 29,9% 30,7% 31,9% 33,1% 33,9% 58,3% 56,3% 54,0% 54,8% 52,4% 49,9% 47,4% 46,1% 44,1% 42,2% 41,4% 40,5% 39,4% 38,9% 36,6% 26,1% 26,3% 26,4% 23,9% 25,5% 25,8% 26,1% 27,7% 28,1% 29,4% 28,7% 28,8% 28,7% 28,0% 29,5% 80% 60% 40% Others 20% 0% CGN DM Akiba T, Kidney International (2000) suppl.74 dialysis population only

9 Diabetic nephropathy (DN) as cause of ESRD in 2000 in Asia-Pacific Region 11% 34% 33% 30% 26% 22% 47% 44% 42% 41% 37% 36% 50% 40% 30% % of incident diaylsis pat. with DN 20% 10% 0% Singapore Malaysia Brunei South Korea Japan New Zealand HongKong Taiwan Thailand Phillipines Australia China Lee G, Seminars in Nephrology (2003)

10 Trends in worldwide incidence rates

11 Trends in worldwide incidence rates (per ( million population - pmp) selected countries from the USRDS-2003 report chapter increasing increasing incidence incidence rates rates Canada Czech Republic Denmark Germany Italy Japan* Malaysia Norway Philippines Qatar Taiwan Turkey United States * Japan dialysis patients only Australia

12 Europe ERA-EDTA EDTA Register 31 registries: RED: 15 countries - data in the ERA database ORANGE: 16 countries with own database - sending data to ERA

13 RRT in the 5 major countries in Western Europe Country year pop Mill. ESRD incid. pmp ESRD prev pmp HD % PD % Tx % Germany (1) % 4% 25% France (2) % 3% 44% Italy (3) % 8% 20% Spain (4) (78%) % 5% 43% UK (5) % 15% 46% (1) German Report 2002 www-quasi.niere.de (2) Project R.E.I.N preliminary data, Oct 2003 (3) SIN-RIDT Report 2001 (4) Amenabar JJ, et al. Nefrologia 2002 (5) UK Renal Registry Report 2003 (prelim.) 293,1 Mill. Population Prev: : 829 pmp ESRD patients 80% RRT in the EU

14 ESRD in Northern, Southern & Central & Eastern Europe Central Northern Southern Eastern & Balkan prevalence pmp Germany France (2) Austria Netherlands UK (5) Sweden Denmark Norway Finland Iceland Portugal Spain (4) Greece Italy (3) Tunisia Croatia Czech Rep. Serbia-Monten. Slovakia* Poland Latvia Russia 0 ERA-EDTA Register Report 2002 & National data

15 RRT in Northern, Southern & Central & Eastern Europe 100% HD % PD% Tx % central northern southern Eastern & Balkan 1% 25% 44% 50% 52% 46% 52% 38% 60% 54% 32% 43% 18% 20% 17% 38% 12% 34% 47% 24% 73% 80% 60% 40% 20% 0% Germany France (2) Austria Netherlands UK (5) Sweden Denmark Norway Finland Iceland Portugal Spain (4) Greece Italy (3) Tunisia Croatia Czech Rep. Serbia-Monten. Poland Latvia Russia ERA-EDTA Register Report 2002 (2) Project R.E.I.N preliminary data, Oct 2003 (3) SIN-RIDT Report 2001 (4) Amenabar JJ, et al. Nefrologia 2002 (5) UK Renal Registry Report 2003 (prelim.)

16 ESRD in North America

17 RRT in North America Country Pop Mill. ESRD incid. [pmp] ESRD prev [pmp] RRT [n] HD % PD % USA ,1% 5,9% USA Tx % 29% Canada Canada For comparison: ,4% 45,4% 13% 41,5% Tunisia ,1% 2,2% 0,7% France % 3% 44% USRDS 2003 Report CORR Prelim Report Million population pmp patients on RRT

18 ESRD in South & Latin America

19 ESRD in Latin America ESRD prevalence [pmp [ pmp] URUGUAY CHILE ARGENTINA(98) BRASIL MEXICO (98) VENEZUELA COLOMBIA COSTA RICA CUBA PANAMA(98) ECUADOR (98) PERÚ PARAGUAY(94) R. DOMINICANA EL SALVADOR(95) HONDURAS (97) GUATEMALA (93) BOLIVIA(92) SLANH Report 2001 *Year in ( ) if other then 1999 PUERTO RICO

20 ESRD - RRT in Latin America % 15% 13% 8% 8% 8% 5% 5% 3% 2% 0% 35% 33% 55% 47% 46% 46% 64% HONDURAS (97) ECUADOR (98) EL SALVADOR(95) GUATEMALA (93) BOLIVIA(92) COLOMBIA PUERTO RICO 100% 80% 60% 40% 20% 0% HD % PD % Tx % 33% - 64% on PD PANAMA(98) CUBA PERÚ COSTA RICA BRASIL URUGUAY VENEZUELA ARGENTINA(98) CHILE PARAGUAY(94) SLANH Report 2001 *Year in ( ) if other then 1999 MEXICO (98)

21 ESRD in Latin America 1999 (n patients on RRT) Patients on RRT in 1999 ESRD Total n BRASIL MEXICO ARGENTINA(98) CHILE COLOMBIA VENEZUELA PUERTO RICO PERÚ URUGUAY CUBA ECUADOR (98) COSTA RICA R. DOMINICANA PARAGUAY(94) PANAMA(98) EL SALVADOR(95) GUATEMALA (93) HONDURAS (97) BOLIVIA(92) SLANH Report 2001

22 ESRD in Africa

23 RRT in North Africa Country Pop Mill. ESRD incid. [pmp] ESRD prev [pmp] RRT [n] HD % PD % Tx % Algeria (1) (1) (137) (4.000)5 98% 1% 1% Egypt (2) Libya (1)-1993 Tunisia (3) 63.8 (2) ,5% 0,5% ~ 17% ? %? 60%? 9.7 (3) ,1% 2,2% 0,7% Morocco (1,4) (1,4) (84) (2.300)5 91% 3% 6% (1) Barsoum R.S., Kidney International, 2003 suppl. 83 (2) Afifi A. IFFR Conference 2001, San Francisco (3) ERA EDTA Registry Report 2002 (4) Bourquia A, Nephrolgie 1999 (5) Maiz HB, Congres AV, SFAV & STN Tunis-G Million population pmp resp patients on RRT

24 RRT (Dialysisonly( Dialysisonly) ) in Africa 2000 (excl. North Africa) Dialysis population Million population (listed countries only) ONLY ~ patients on dialysis ESRD & RRT? S Africa 500 Mauritius Sudan 350 Nigeria Kenya Cote D Ivoire - Bamgboye EL, Kidney Int 2003 suppl Fogazzi GB, Kidney Int 2003 suppl Naicker S, Kidney Int 2003 suppl Zimbabwe Mauritania Congo DRep. 50 Benin 40 Gabon 35 Ghana 30 Cameroon 30 Senegal Mali Burkina Faso 18 5 Ethiopia

25 ESRD in the Middle East

26 RRT in Middle East (selected countries) Country pop Mill. ESRD incid. [pmp] ESRD prev [pmp] RRT [n] HD % PD % Tx % Iran (1) (1) ,7% 0,5% 45,5% Egypt (2) Qatar (3) Israel (4) 63.8 (2) (3) (4) nd ,5% 0,5% ~ 17% ,4% 1% 31,6% nd % 17% 6% Saudi Arabia (5) 22.8 nd 330* 7.526* 93%* 7%* nd (1) Haghighi A.N., NDT 2002 (2) Afifi A. IFFR Conference 2001, San Francisco (3) USRDS 2003 Report (4) USRDS 2000 Report (5) *Saudi Arabia: dialysis only nd = no data

27 ESRD in Asia, Japan and AUS/NZ

28 ESRD in Asia / South East Asia & AUS/NZ ESRD prevalence pmp Japan Taiwan Singapore Brunei New Zealand HongKong Australia South Korea Malaysia Thailand China India Pakistan Phillipines Indonesia Vietnam Cambodia Myanmar -Sitprija V, Kidney Int 2003 suppl. 83 -ANZDATA Report 2003 ANDUSRDS Report 2003

29 ESRD - RRT in Asia / South East Asia & AUS/NZ % HD % PD% Tx % 80% 21% 33% 37% 43% 45% 44% 28% 41% 31% 64% HKG HKG 64% on PD 60% 40% 20% 0% Taiwan Japan Indonesia Vietnam Malaysia Brunei Phillipines Thailand Pakistan Myanmar Singapore South Korea India China Australia New Zealand HongKong - Sitprija V, Kidney Int 2003 suppl. 83, ANZDATA Report 2003, USRDS 2003

30 RRT in Baltic countries & Reunion

31 RRT in Baltic countries (1999) & Reunion (1996) Country Lithuania (1) ESRD ESRD Pop RRT HD PD incid. prev Mill. [pmp] [pmp] [n] % % % 4% Estonia (1) % 20% 51% Latvia (1) 2, % 9% 46% Reunion (2) For comparison: (1) 100 (2) % 2,6% 14,3% Tunisia ,1% 2,2% 0,7% France % 3% 44% Tx % 36% (1) Locatelli F, Nephrol Dial Transplant (2001) (2) Albitar S, Nephrol Dial Transplant (1998) (3) Tuppin P, Nephrologie (2004) French Overseas Territories (FOT) ESRD prev of in 2000 (3)

32 ESRD world wide distribution per region in 2001 Fresenius Medical Care Survey in 120 countries 5.7 Billion population 90% of the world population (99% of the ESRD population) Moeller S, Gioberge S, Brown G. ESRD patients in 2001: global overview of patients, treatment modalities and development trends Nephrol Dial Transplant (2002) 17:

33 ESRD world wide distribution per region in 2001 (Moeller S, et al NDT 2002) Region Population [Mill] ESRD prevalence [pmp] ESRD Patients [n] North America Total Europe European Union only Japan Asia (excl. Japan) Latin America Africa Middle East Global Moeller S, et al. Nephrol Dial Transplant (2002)

34 ESRD population around the world 2001 (questionnaire in 120 countries) North America (311Mill.) pmp EU (380 Mill.) + Rest of Europe (424 Mill.) resp.. & 221 pmp Middle East (271 Mill.) pmp Japan (127 Mill.) pmp Asia (excl. Japan) (3.316 Mill.) pmp South & Latin America (512 Mill.) pmp Africa (833 Mill.) pmp AUS & NZ (23 Mill.) pmp ~ in 2001 Moeller S, et al. Nephrol Dial Transplant 2002

35 ESRD Treatment Modalities % ~ pat. on RRT % HD PD TX % Moeller S, et al. Nephrol Dial Transplant 2002

36 ESRD RRT treatment worldwide per region 100% 5% Dialysis (HD+PD) 9% 16% 18% Transplant (Tx) 80% 27% 30% 34% 33% 44% 60% 40% 95% 91% 84% 82% 73% 70% 66% 67% 56% 20% 0% Japan Africa Latin America Asia (excl. Japan) Middle East North America EU-15 Total Europe AUS & NZ - Data calculated from Moeller S., et al. NDT (2002) 17 - ANZDATA Report 2003 (for AUS & NZ)

37 Factors influencing for the choice of ESRD treatment or RRT Demographic and Co morbidities Diabetic patients Cardiovascular disease Elderly patients (Age) Patients preference & Psychosocial factors Non-Medical Reasons FINANCIAL / Reimbursement (Economic status) Lack of training of nephrologists and nurses Poor education of patients about options Resources availability (PD fluid, Donor sources) Cultural (ethical, religious) Legal $ Mazzuchi et al. Kidney International 2000 suppl. 74

38 Dialysis Access type prevalence ESRD Death Kidney transplant (Tx) Dialysis Hemodialysis (HD) Peritonealdialysis (PD) Cont. access AV-Fistula Vasc Graft (Shunt) CV-Catheter Catheter

39 Access type prevalence DOPPS & CORR & SCOT AVF Grafts Catheters 100% 80% 6% 4% 5% 7% 4% 12% 15% 12% 22% 9% 3% 3% 17% 26% 8% 7% 60% 40% 77% 84% 90% 82% 67% 93% 58% 19% 55% 80% 20% 24% 0% France Germany Italy Spain UK Japan US Canada Saudi Arabia (1) The DOPPS Report October 2002 (2) CORR Report 2001 (3) Saudi Arabian Soc Organ Transplant

40 Access type at Start of Hemodialysis DOPPS AVF Grafts Catheters 100% 80% 60% 31% 31% 2% 3% 60% 40% 20% 66% 62% 24% 0% 15% Europe Japan US Large differences in Access Use at Start of HD - Differences in Referral patterns! - The DOPPS Report October

41 Prevalence of RRT - THE FUTURE

42 Prevalence of RRT - THE FUTURE 61% > 100 Mill. (11) 74% > 50 Mill. (12) 79% > 40 Mill. (6)

43 RRT prevalence 25 largest countries in 2001* represent 76% of the world population (= Mill.) Only USA, Japan and DEU, GBR, FRA, ITA & KOR, with significant RRT countries 50% of world population population in Mill. RRT prev in Only ~ Mill patients on RRT average of 253 pmp CHN 66 0 IND 62 6 USA IDN BRA RUS PAK BGD JPN NGA MEX DEU PHL VNM EGY TUR IRN ETH THA GBR FRA ITA ZAR UKR KOR various sources *data from 1998 to 2001

44 RRT prevalence 25 largest countries in 2001* population in Mill. RRT prev in RRT prev when all min 350 pmp RRT If all countries below 350 pmp (16 out of 25 countries) would have 350 pmp patients on RRT (level of Turkey or Mexico), already 2,6 Mill patients would be on RRT in 2001 (= + 1 Million) CHN IND USA IDN BRA RUS PAK BGD JPN NGA MEX DEU PHL VNM EGY TUR IRN ETH THA GBR FRA ITA ZAR UKR KOR various sources *data from 1998 to 2001

45 The future growth of ESRD - USA Total prevalent ESRD 1978 to May Growth rate: 6.5% (2004) to 5% in (2030) In ,236 Million ESRD patients in the USA USRDS Report 2003

46 Global Dialysis Population Lysaght, J Am Soc Nephrol 2002

47 Prevalence of RRT - THE FUTURE In 2015 approx. 3 Mill. Patients will be on RRT (5% growth p.a) The number of HD patients in Asia pacific will then exceed the ROW (approx. 1,3 Mill each) Woods F; Dialysis Times (2000) Vol. 7 No. 5:1-3

48 The future growth of ESRD - worldwide 25 10% growth of ESRD pop 23,8 Mill. 20 8% growth of ESRD pop 5% growth of ESRD pop Mill. ESRD Growth rates (selected) Asia Pacific 4,2% to 35,5% (1) Canada 5-9% (2) EU-15 8,2 % (3) HongKong 10% (4) AUS/NZ 5,4% (5) Japan 5,3% (1) Woods DT (2000) 14 Mill. 6,7 Mill (1) Lee G, Seminar in Nephrologie (2003) (2) CORR prelim. Report 2002 (3) Briggs JD, Kidney International (2000) (4) Liu SF, HongKong J of Nephrol (1999) (5) ANZDATA Report 2003

49 Conclusion 1 ESRD is a steadily increasing disease around the world Great differences in the underlying disease Increasing diabetic nephropathy Incidence and prevalence rates and treatment modalities differ around the world due to various reasons Demographic and Co morbidities Patients preference & Psychosocial factors Non-Medical Reasons Financial / Reimbursement (Economic status) Lack of training of nephrologists and nurses Poor education of patients about treatment options Resources availability (PD fluid, Donor sources) Cultural (ethical, religious) Legal

50 Conclusion 2 Health care institutions and politicians must establish ESRD-research, -educational, -supportive, and preventive programs Set up mandatory RRT registers and other sources National and international congresses on ESRD to exchange experiences regarding the different treatment modalities Cooperation with the medical industry to find new and improved ways for better treatment of ESRD

51 ESRD 2004 ESRD 2010 ESRD 2015 ESRD 2020 ESRD 2025

52 Merci de votre attention