Transcript prevention strategies in renal diseases in the middle

"PREVENTION STRATEGIES IN
RENAL DISEASES IN THE MIDDLE
EAST AND ARAB WORLD"
Faissal Shaheen MD.,
Saudi Center for Organ Transplantation
Saudi Arabia
The Middle East Countries
Ukraine
Azerbaizan
Cyprus
Zone A (Green) : Cadaveric and living renal tx. (also other organs)
Zone B (Yellow) : Active living renal tx only (no other organs)
Zone C (Orange) : Non-active; Zone D (Lilac) : No data
Pakistan
Middle Eastern countries
There are more than 29
countries that can be
considered Middle Eastern
with more than 600 million
population
Introduction
Health expenditure and Income
Country
USA
France
Gulf Countries
Iran
Turkey
Arabs in Asia
Arabs in Africa
Pakistan
Gross Income
per Capita
(US dollars)
23,000
23,000
17,000
2,000
2,647
500 - 1,100
1,000
452
Expenditure by
government on health
(per capita)
(US$)
2000
1800
150-550
180
200
80-150
7-125
15
Why there is defect in Preventive
measures in the Middle East?
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Lack of effective health insurance
Lack of proper health planning
Uneven health infrastructure
Poor government support
Inadequate awareness of the medical
community
Poor awareness of the public at large of
environmental issues and proper life style
Major predisposing factors for renal
failure in the Middle East
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Infectious diseases
Hypertension
Diabetes mellitus
Obstructive uropathy
Inherited diseases
Acute renal failure
Infectious diseases prevalent in the
Middle East with potential to cause
renal failure
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Schistosomiasis (Bilharzias)
Prevalent in tropical areas ( Egypt, Sudan, Saudi Arabia,
Yemen, Somalia)
Malaria (Sudan)
Hepatitis B and C ( Egypt)
Tuberculosis ( several countries)
Other viral diseases such as West Nile fever , Rift valley
fever
HIV infection
WHO. 2003 report
Hypertension in the Middle East
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There are not many studies on hypertension but
from the studies available, it is safe to say that the
incidence is increasing and the therapy is poor or
non existent in a large percentage of sufferers
Screening clinics, primary care physician education
and public awareness will be useful here as has
been shown in the Singaporean mobile screening
and health education program.
Diabetes mellitus in the Middle East
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Very common cause for ESRD (prevalence
among dialysis patients is around 25%,
incidence 1999 was 45%).
Obesity prevalence in school children is about
18% .
ACE inhibitors are prohibitively expensive in
most countries in the area.
Jondeby et al. Saudi Medical Journal (2001): 22:199-24
Al-Khader A. Nephrol Dial Transplant: 16(11): 2132-5.
Obstructive uropathy in the Middle
East
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In some Arab countries, obstructive uropathy
constitutes a major cause (40%) of ESRD.
Early referrals for stone formers and
eradication of shistosomiasis are crucial here
Suliman et al. Hum Toxicol. 1983
Preventable inherited and congenital
conditions in the Middle East
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Congenital kidney diseases occur in 3.3/1000 births (80% of
which are hydronephrosis)
Primary hyperoxaluria in 13.5% of Tunisian children with CRF
Reflux nephropathy in 53% of ESRD causes in Libyan children
Intra-uterinally discovered hydronephrosis, hypoplastic
kidneys, and urethral valves
In Iran >70% of childhood CRF is due to congenital or
hereditary diseases
Thalasemia and sickle cell disease are common (intermarriage)
Madani et al. Pediatr Nephrol, 2001, Kamoun et al.Pediatr Nephrol 1996
Barbari et al Mol Immunol: 2003, Onuora et al. Pediatr Nephrol: 2000
Acute renal failure in the Middle
East
 In many Arab countries ,ARF is eminently
preventable (malaria , renal stones (in Sudan
12% of ESRD are due to renal calculi), hair dye
ingestion and herbal ingestion
Sheiban A. Ren Fail21(1) 1999
Abboud et al Ann Trop Med Parasitol. 1989
Suliman et al. Hum Toxicol. 1983
Non-compliance and improper
follow-up
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There is a high percentage of patients who
are non-compliant and may believe in
Alternative than Conventional Medicine
 Education efforts are poor and at best limited
to large cities
Suggested Strategies to adopt by
governments
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Implementing health insurance
Eradication programs against infectious
diseases such as malaria , shistosomiasis ,
tuberculosis and hepatitis
Emphasis on primary care and screening
programs (hypertension and diabetes)
Improving the health manpower training
and their ratio to the population
Suggested strategies to adopt the
medical community
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Early referral of patients with renal
insufficiency to nephrologists
Prenatal/postnatal screening for renal
anomalies and genetic counseling
Aggressive treatment of dehydration
especially in children and infants
If cannot prevent the disease then to
prevent progression of the disease
Suggested strategies to adopt by
the society at large
 Schools, charitable and scientific
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societies can have a role in increasing the
awareness of the public at large toward
environmental and hygienic issues
Campaign of life style changes to reduce
Diabetes , hypertension and smoking
Research is needed
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For Follow-up of volume of the preventable causes of
renal failure
The effect of the various approaches for prevention on
the outcomes
The economical impact of the therapeutic versus the
preventive measures
It should be noted that the budget for research is in the
region of 0.15% of the national domestic product
compared to international average of 1.5 %
News feature. Nature 2002 March; 14:120-120.
TYPE OF PUBLICATION up till now are
retrospective not prospective
100
89.8
90
78.2
80
70
61.1
60
Total
50
International
44
40
30
Local
39.5
35.9
34.2
25.2 26.2
21.7
20
16.3
9.9
12.7
14.6
11
10.2
6
7.1
10
1.7
LA
B
CL
IN
PR
O
RE
TR
O
RA
CR
A
0
O
%
50.3
4.2
Area of study. Hardly any on prevention
40
35
34.1
30
24.4
%
25
18.4
20
13.5
15
10
4.5
5
3.1
2.8
CAPD
HT
0
TX
HD
NEPH
PED
ARF
Media contribution
 30 satellite channels in Arabic, reaching all Arab
Countries-free of cost
 Internet can also be utilized. With Kim Solez,
we have a public kidney education site in Arabic"Tawasol"
 The public is fond of following medical news and
often phone in live TV shows on medical matters
 Therefore, this type of media and
cyberinformatic contribution to prevention of
renal disease should be utilized to the full
CONCLUSIONS
Kidney disease is common in Arab
Countries; the opportunity for prevention
is immense such as:
 Media for public education
 Campaign of life style changes to reduce
DM,HTN and smoking
 Eradication programs against infectious
diseases
CONCLUSIONS
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Early referral & detection of renal disease
Prevention & treatment of infants’ dehydration
Mobile screening clinics for hypertension
Prenatal/postnatal screening for renal
anomalies
Genetic pre-marriage counseling
patient education for compliance
Research is needed for evaluation of the
preventive measures