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Rully Roesli , 2009

Rully Roesli , 2009


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Prevalence of GFR Category
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ESRD Rates Continue to Rise
USRDS, 2004
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Kidney Failure Compared to
Cancer Deaths in the U.S. in 2000
(in Thousands)

Lung Cancer
Kidney
Failure
Colorectal
Cancer
Breast
Cancer
Prostate
Cancer
57
100
41
30
160
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Costs of Kidney Failure are High
(in $billions for 2002)

Kidney
Failure
Care
Total NIH
Budget
25.2
23.2
Kidney Failure Accounts for
6% of Medicare Payments

Lost Income for Patients is $2-
4 Billion/Yr
USRDS, 2004
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Incidence & Prevalence of CKD
Incidence Prevalence
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Etiologi penyebab Gagal Ginjal di Malasia
14th Report of the Malaysian Dialysis and Transplant Registry, 2006,
Rully Roesli , 2009
Etiologi penyebab Gagal Ginjal di Singapura
3rd Report of the Singapore Renal Registry, 1999/2000
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The bad companions...
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Diabetes: The Most Common Cause of ESRD
Primary Diagnosis for Patients Who Start Dialysis
Diabetes
50.1%
Hypertension
27%
Glomerulonephritis
13%
Other
10%
United States Renal Data System. Annual data report. 2000.
No. of Patients
Projection
95% CI
1984 1988
1992 1996 2000 2004
2008
0
100
200
300
400
500
600
700
r
2
= 99.8%
243,524
281,355
520,240
No. of
Dialysis
Patients
(Thousands)
DIABETES HYPERTENSION - ESRD
Rully Roesli , 2009
Hypertension Is Prevalent
Among Diabetic Adults
Geiss LS et al. Am J Prev Med. 2002;22:42-8.
NHANES III = Third US National Health and Nutrition Examination Survey (19881994).
29%
71%
Diabetes + HTN*
Diabetes alone
* Hypertension defined according to JNC-6: BP 130/85 mm Hg
Rully Roesli , 2009
Gress et al .N.Engl.J.Med. 2000;342: 905
6 Year Follow-up of the Atherosclerosis Risk in Communities (ARIC-Study)
0
10
20
30
Incidence of Diabetes
(Cases per 1000 Person Years)
No Hypertension
(n=8.746)
12,0
All Subjects
(n=12.550)
16,6

* RR for Development of Type 2
Diabetes in Hypertension: 2.43
Hypertension
(n=3.804)
29,1
*
Hypertension: A Significant Risk Factor
for Type 2 Diabetes
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Parallels Between Hypertension
in 1972 and Kidney Disease in 2005
Recent documentation of effective therapy
Treatment of a silent disease to reduce risk
for a disastrous outcome
Simple screening
Advantages for patients, physicians, industry
Rully Roesli , 2009
2.11
3.65
11.29
21.8
36.6
0
5
10
15
20
25
30
35
40
60 45-59 30-44 15-29 < 15
Go, et al., 2004
A
g
e
-
S
t
a
n
d
a
r
d
i
z
e
d

R
a
t
e

o
f

C
a
r
d
i
o
v
a
s
c
u
l
a
r

E
v
e
n
t
s

(
p
e
r

1
0
0

p
e
r
s
o
n
-
y
r
)

Estimated GFR (mL/min/1.73 m2)
Rully Roesli , 2009
CKD is Not Being
Recognized or Treated
Most practices screen fewer than 20% of their Medicare
patients with diabetes*
Patients are referred late to a nephrologist, especially
African-American men
Less than 1/3 of people with identified CKD get an ACE
Inhibitor

Kinchen, et al., 2002;
McClellan et al.,1997
*Data provided by the USRDS based on 5 percent Medicare enrollment and claims data

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Who to Test for Chronic
Kidney Disease
Regular testing of people at risk
Diabetes
Hypertension
Relative with kidney failure
Cardiovascular disease
Rully Roesli , 2009
How to Test for Chronic
Kidney Disease*
In individuals with diabetes:
Spot urine albumin to creatinine ratio

In others at risk:
Spot urine albumin to creatinine ratio OR standard dipstick
(Bouleware, et al., 2003)
Estimate GFR from serum creatinine using the MDRD prediction
equation

*24 hour urine collections are NOT needed. Diabetics should be
tested once a year. Others at risk testing less frequently as long as
normal.
Rully Roesli , 2009
Who Should be Treated for
Chronic Kidney Disease
With diabetes:
With urine albumin/creatinine ratios more than 30mg
albumin/1 gram creatinine
Without diabetes:
With urine albumin/creatinine ratios more than 300mg
albumin/1 gram creatinine corresponding to about 1+ on
standard dipstick
Or
Any patient:
With estimated GFR less than 60 mL/min/1.73 m
2

Rully Roesli , 2009
How to Treat for Chronic
Kidney Disease
Maintain blood pressure less than
130/80 mmHg
Use an ACE Inhibitor or ARB
More than one drug is usually required and a diuretic
should be part of the regimen
Continue best possible glycemic control in individuals
with diabetes
Rully Roesli , 2009
How to Treat for Chronic
Kidney Disease
(continued)
Refer to dietician for a reduced protein diet
Consult a nephrologist early
Team with the nephrologist for care if GFR is less than
30 mL/min/1.73 m
2
Monitor hemoglobin and phosphorous with treatment as
needed
Treat cardiovascular risk, especially smoking and
hypercholesterolemia
Rully Roesli , 2009
Early Treatment Makes
a Difference
Brenner, et al., 2001
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DATA WHO
Rully Roesli , 2009
DAERAH TAHUN PREVALENSI
JAKARTA


MAKASAR


BALI
SINGAPARNA
1982
1993
2001
1981
1998
2005
2004
1995
1,7 %
5,7 %
14,7 %
1,5 %
2, 9 %
12,5 %
3,9 7,2 %
1,1 %
NASIONAL
(data PERSI)
2006 1,5 2,3 %
PREVALENSI DIABETES DI INDONESIA
Data : Perhimpunan Rumah Sakit Seluruh Indonesia (PERSI)
Rully Roesli , 2009
NEFROPATI DIABETES SEBAGAI PENYEBAB
GAGAL GINJALYANG MEMERLUKAN
CUCI DARAH DI INDONESIA
1980
1993 1998
Data : Pusat Registrasi Nasional untuk Hemodialisis
Tahun
Rully Roesli , 2009
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TAHUN PREVALENSI (%)
SKRT 1995 8,3
MONICA
(Jakarta)
1988
1993
2000
L=13,6 W=16
L=16,5 W=17
L=12.1 W=12,2
Boedhi
Darmojo
(Semarang)
1977
1985
1,8
3,3
PREVALENSI HIPERTENSI DI INDONESIA
DATA TIDAK AKURAT DAN TIDAK ADA DATA NASIONAL
Rully Roesli , 2009
TAHUN PREVALENSI (%)
MENKES 2007 URBAN RURAL
( 17 21 % )
FKM UI/SKRT
(Zamhir S)
2004 Pulau Jawa 41.9 %
Perkotaan 39,9 %
Pedesaan 44,1 %
FK UNSRI
(Zukhair Ali)
Sum Sel
( 6,3 9,17 % )
PREVALENSI HIPERTENSI DI INDONESIA
Rully Roesli , 2009
PERHIMPUNAN HIPERTENSI INDONESIA
RESUME RAPAT PLENO
Jakarta, 8 November 2008
CARA PENGUKURAN YANG BENAR DAN SERAGAM
( ROADSHOW : KURSUS HIPERTENSI)
CARA PENCATATAN DAN PELAPORAN
YANG BENAR DAN SERAGAM
(diusulkan dihubungkan dengan SKP IDI)

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Fasilitas Hemodialisis di
Indonesia vs Singapura
0.34
6.8
0
1
2
3
4
5
6
7
Fasilitas HD
Indonesia
Singapura
Pusat Registrasi Nasional untuk Hemodialisis , 1992-1993
Rully Roesli , 2009
Fasilitas Hemodialisis di Indonesia
Berdasarkan Daerah
2.2
0.23
0.35
0.25
0.5
0.32
0.42 0.36
0.31
0
0
0.5
1
1.5
2
2.5
Propinsi
Jakarta
Jawa Barat
Jawa Tengah
Jawa Timur
Sumatera Utara
Sumatera Selatan
Kalimantan
Jambi
Riau
Propinsi lain
Pusat Registrasi Nasional untuk Hemodialisis , 1992-1993
Rully Roesli , 2009
Prevalence Rate (PR) penderita cuci darah
di Indonesia pada tahun 1993
0
100
200
300
400
500
600
700
Indonesia Belanda Perancis Itali Jerman Jepang Singapura
Pusat Registrasi Nasional untuk Hemodialisis , 1992-1993
Rully Roesli , 2009
KOTA TAHUN JUMLAH
TINDAKAN
TAHUN JUMLAH
TINDAKAN
JAKARTA 1980 389 X 1986 4487 X
BANDUNG 1984 115 X 1989 7223 X
MEDAN 1982 100 1990 1100 X
PENINGKATAN JUMLAH TIDAKAN DIALISIS DI INDONESIA
Rully Roesli , 2009
0
2000
4000
6000
8000
10000
12000
1989 1992 1995 1998 2005
TAHUN
JUMLAH KASUS DIALISIS PT ASKES
481
10.452
2770
Program Program
JAMKESMAS JAMKESMAS
9241
krisis krisis
moneter moneter
1327
2131
Jumlah kasus dialisis yang dibiayai oleh PT ASKES
pada tahun 1988-2006
Rully Roesli , 2009
0
100
200
300
400
500
600
700
800
DKI Jakarta Jawa Barat Jawa Tengah DI Yogya Jawa Timur
1995 1996 1997 1998 1999
TH.1997
KRISIS
EKONOMI
Penurunan jumlah kasus dialisis pada saat krisis ekonomi (1998-1999)
pada beberapa daerah
Rully Roesli , 2009
Etiologi pasien Gagal Ginjal yang menjalani dialisis
(Pusat Registrasi Nasional, PERNEFRI 1992)
392
190
156
53
20
17
17
Glomerulonefritis Diabetes Polikistik
Hipertensi Pielonefritis Batu
Urat
46,4 % 46,4 %
22,5 % 22,5 %
18,5 % 18,5 %
6,3 % 6,3 %
Pusat Registrasi Nasional untuk Hemodialisis , 1992-1993
DIABETES
Rully Roesli , 2009
25 % 25 %
23 % 23 %
20 % 20 %
10 % 10 %
DIABETES
Rully Roesli , 2009
1461
1647
86
1802
125 124
687
540
465
302
Data Etiologi Pasien Hemodialisis Di-IndonesiaThn.2007-2008
Sumber Data IRR:
RU-02 (Data Pasien HD Baru ) Thn.2007-2008 (Agt'08).
Terdiri dari: 8064 pasien, 74 Renal Unit
yang telah mengirimkan datanya.

Rully Roesli , 2009
Gambar 1. Laju filtrasi glomerulus
LAJU FILTRASI GLOMERULUS LAKI-LAKI DAN PEREMPUAN
40
60
80
100
1
8
2
0
2
2
2
4
2
6
2
8
3
0
3
2
3
4
3
6
3
8
4
0
4
2
4
4
4
6
4
8
5
0
5
2
5
4
5
6
5
8
6
0
6
2
6
4
6
6
6
8
7
0
7
2
7
4
7
6
7
8
8
0
UMUR
L
F
G
laki-laki
perempuan
Data kreatinin serum yang didapat selama tahun 2006 dan 2007 adalah :
Total : 31244 buah dengan 22047 laki-laki dan 9197 perempuan
Umur : 18 81 tahun
Rully Roesli , 2009
KESIMPULAN :

[] INSIDENSI PGK (CKD) MENINGKAT SECARA
GLOBAL

[] INSIDENSI PGK BERHUBUNGAN ERAT DENGAN
DIABETES DAN HIPERTENSI

[] DI INDONESIA, BELUM ADA PERENCANAAN
YANG MATANG UNTUK MENGHADAPI
LONJAKAN KASUS DIABETES ,
HIPERTENSI, DAN PENYAKITGINJAL KRONIS

Rully Roesli , 2009
Rully Roesli , 2009