Lifestyle related kidney diseases and their impact on the kidneys

1. LIFE-STYLE RELATED DISEASES
IMPACT ON THE KIDNEYS
Dr Sanjay Maitra
MD,DM(PGI,CHD)
Clinical Fellowship,Univ.of Toronto(CANADA)
Senior Consultant Nephrologist
Apollo Health City, Hyderabad

2. Why Bother About
Them?
NCD –A Misnomer!!!

3. These are all Lifestyle
Related Diseases
Life style Related Diseases
are just a subset of NCD’s

6. OUT LINE OF TALK
 The Epidemiology and impact of NCD
 Globally
 India
 Four major causes:
 Hypertension, Diabetes, Obesity & Smoking
 NCD’s are the leading cause of Kidney
disease too
 The road ahead “25 by 25”

7. Global Deaths According to Cause and Sex, 2008.
Hunter DJ, Reddy KS. N Engl J Med 2013;369:1336-1343

8. Proportion of Deaths from Noncommunicable Diseases among Persons Younger than 60
Years of Age, According to Income Group of Countries.
Hunter DJ, Reddy KS. N Engl J Med 2013;369:1336-1343

9. DISTRIBUTION OF AGE AT DEATH BY REGION, 2011
High-income countriesLow- and middle-income countries

10. MORTALITY RATES BY WORLD BANK INCOME GROUP* AND CAUSE-OF-DEATH GROUP,
2000 AND 2011
Group I: Communicable, maternal,
perinatal and nutritional conditions
Group II: Noncommunicable diseases
Group III: Injuries
* Countries are classified according to the World Bank income group for the year 2011 (World Bank list of economies, July 2012).
Equatorial Guinea is classified as high income; it is kept here with upper middle income to avoid a regional grouping containing only
one country and because its mortality profile is not dissimilar to neighbouring countries.
Low income
Lower-middle
income
Upper-middle
income High income
World

11. Africa Western PacificEastern
Mediterranean
EuropeSouth-East
Asia
Americas
Low- and middle-income countries
High-
income
countries
MORTALITY RATES AMONG MEN AND WOMEN AGED 15–69 YEARS,
BY REGION AND CAUSE-OF-DEATH GROUP, 2011
Group I: Communicable, maternal,
perinatal and nutritional conditions
Group II: Noncommunicable diseases
Group III: Injuries

12. THE 10 LEADING CAUSES OF DEATH, WORLD, 2000 AND 2011
No Causes of death, 2000 Deaths
(million)
% of
deaths
No Causes of death, 2011 Deaths
(million)
% of
deaths
1 Ischaemic heart disease 5.9 11.2 1 Ischaemic heart disease 7.0 12.9
2 Stroke 5.6 10.6 2 Stroke 6.2 11.4
3 Lower respiratory
infections
3.5 6.7 3 Lower respiratory
infections
3.2 5.9
4 Chronic obstructive
pulmonary disease
3.0 5.8 4 Chronic obstructive
pulmonary disease
3.0 5.4
5 Diarrhoeal diseases 2.5 4.7 5 Diarrhoeal diseases 1.9 3.5
6 HIV/AIDS 1.6 3.0 6 HIV/AIDS 1.6 2.9
7 Preterm birth
complications
1.4 2.7 7 Trachea, bronchus, lung
cancers
1.5 2.7
8 Tuberculosis 1.3 2.6 8 Diabetes mellitus 1.4 2.6
9 Trachea, bronchus, lung
cancers
1.2 2.2 9 Road injury 1.3 2.3
10 Diabetes mellitus 1.0 1.9 10 Preterm birth
complications
1.2 2.2
11 Road injury 1.0 1.9
13 Tuberculosis 1.0 1.8

13. 10 LEADING CAUSES OF DEATH BY SEX, WORLD, 2011
Males Females
Per cent of total deaths in sex group

14. IMPACT OF RISING NCD DEATHS
UNITED NATIONS HIGH LEVEL MEETING ON NCD
 Till date the UN has held 2 meetings of
heads of states
 In 2001 on HIV and AIDS
 In September 2011 on NCD’s
 Coined the Slogan “25 by 25”
 25% reduction by 2025 in NCD
 Among persons between 30-70 yrs
 Compared to the mortality figures of 2010

15. GLOBAL BURDEN OF DISEASE STUDY -2010
Between 1990 and 2010
 Mortality due to NCD ↑ from 57% to 65%
 90% of the 9 million NCD deaths are in persons < 60
yrs
 Disability adjusted Life Years(DALY) in 2010 -54%
 DALY= Sum of years of life lost from premature death or years
lived with disability
 Between 1990 and 2010 DALY’s due to CVS,
Cancer and DM ↑
 22.6%, 27.3 % and 69%
 WHO projections- By 2030 NCD will cause 70%
deaths

16. WORLD ECONOMIC FORUM Estimates a total loss of $47
trillion by NCD between 2010 and 2030
By 4 Major diseases

18. The Indian scenario

19. NCD – The BALANCE SHEET
Developmental causes Tobacco use
Alcohol consumption,
Poor Diet
 Lack of Physical Activity
Measurable Phenotypes High BP
High Blood Sugars
Hypercholesterolemia
Obesity
Changes of Incidence vary
between and within regions
Level of Economic Development
Pace of Demographic Transition
Prevalence of Risk factors
Ethnic Variations-↑ CAD risk in Asians , Stroke In
East Asians
Some diseases have their
roots in Infectious diseases,
Malnutrition and poverty
 Rheumatic Heart Disease causing cardiac
problems
 Barker Hypothesis
i. Cardiac disease and high cholesterol -Due to
liver cause
ii. High BP Low Nephron Hypothesis
iii. Insulin resistance, obesity and diabetes more

20. Global Deaths and Global Disability-Adjusted Life-Years (DALYs) Due to Noncommunicable
Diseases in 1990 and 2010.
Hunter DJ, Reddy KS. N Engl J Med
2013;369:1336-1343
NCD –The Trends

21. Deaths and Burden of Disease Attributable to Selected Behavioral and Dietary Risk Factors in
2010 and the Metabolic and Physiological Mediators of Their Hazardous Effects.
Ezzati M, Riboli E. N Engl J Med 2013;369:954-964

22. Trends in the Number of Obese Persons, According to Region.
Ezzati M, Riboli E. N Engl J Med 2013;369:954-964

23. Trends in Lung-Cancer Mortality and Prevalence of Daily Tobacco Smoking in 2008.
Ezzati M, Riboli E. N Engl J Med
2013;369:954-964

24. WHAT IS CKD?

25. WHAT IS CKD- CURRENT UNDERSTANDING
Heterogeneous group of disorders
characterized by alterations in kidney
structure and function, which manifest in
various ways depending upon the underlying
cause or causes and the severity of disease

26. CKD- a continuum
Stages of CKD –KDIGO 2012

27. Incidence and Prevalence OF CKD worldwide

28. Incidence of CKD in India – 800 per million
population
Incidence of ESRD in India- 150-200 per million
population

29. Cross sectional study involving 52,273 patients
Mean age 50.1±14.6 yrs
M:F ratio 70:30
Diabetic nephropathy –commonest cause of CKD (31%)
CKD of unknown aetiology (16%)
CGN (14%)
Hypertensive nephrosclerosis (13%)

30. Diabetics likely to be detected early
Patients of unknown etiology are likely to be younger ,females and to have CKD-5
INDIAN CKD REGISTRY DATA-2012

31. SIGNIFICANCE OF CKD & ESRD
 Increases the chance of mortality in any
patient
Directly and by increasing CVD deaths
NCD cause ↑mortality in patients
worldwide(66%)
 Estimates from India put it at 48%
 Increases morbidity and a poorer quality
of life
 Increases cost of treatment

32. Monthly Cost Of haemodialysis at 3
HD/wk
Rs 12,000- Rs 25,000
Monthly cost Of Erythropoeitin per
month
Rs 7,000-Rs 10,000
Monthly cost of CAPD 3 exchanges per
day
Rs. 20,000-Rs 25,000
Cost of transplant procedure Rs 3,00,000- Rs, 6,00,000
Cost of immunosuppressive medicines
(Using Tacrolimus,MMF and steroids)
Rs 10,000-Rs 12,000 per
month
Approx.cost of Renal replacement therapy in
India

33. PODOCYTE INJURY AND PROGRESSION OF CKD

34. Kidney & Nephron Schematic diagram of
Glomerular filtration
Glomerular cross section
Cross section of
single
Glomerular Filtration Barrier
Including Podocytes
Kidney Structure –All in a nutshell

35. The role of podocyte dysfunction in proteinuria
Brinkkoetter, P. T. et al. (2013) The role of the podocyte in albumin filtration
Nat. Rev. Nephrol. doi:10.1038/nrneph.2013.78
The glomerular filtration barrier of
the kidney retains most of the
circulating protein
Podocytes contribute to the
formation of this barrier
Damage to podocytes can result in
effacement of foot processes and
the detachment or apoptosis of
podocytes.
The resulting loss of integrity of the
podocyte seal on the glomerular
basement membrane , results in
proteinuria.

36. Many factors can cause podocyte injury.
As a result of this initiating injury there is a critical level of podocyte
depletion,
The glomerulus becomes destabilized
Further podocyte loss occurs independent of the initiating event
Driven by the renin–angiotensin system
This progression-accelerating mechanism can be retarded or prevented
by angiotensin II (AngII) blockade (glomerular restabilization)
These events can be monitored noninvasively by measuring the
podocyte mRNA products in urine.
ROLE OF RAAS BLOCKADE IN PREVENTING PODOCYTE INJURY

37. FACTORS CAUSING PROGRESSION OF CKD
WHAT WE UNDERSTAND
 Worsening proteinuria is an important marker
of progression
 Blocking of the Renin –Angiotensin-
Aldosterone System is helpful in reducing
proteinuria and thus preventing progression
of CKD

38. Overall scheme of factors and pathways contributing to the
progression of renal disease.

39. DIABETES –THE GORY DETAILS

40. India has around 61 Million diabetics

42. Nearly 35-40% 0f Diabetics will develop diabetic kidney
disease

54. HOW TO DETECT DIABETIC KIDNEY
DISEASE & CKD?

66. Disruption of the glomerular filtration barrier in type 2 diabetes
includes
Thickening of the GBM
Podocyte foot process widening, and podocyte detachment.
The overall proportion of fenestrated endothelium is reduced,
Disruption of the endothelial glycocalyx is strongly implicated.
VEGF -Possibility is that an initial increase is followed by a decrease
as the disease progresses

67. 1.The diabetic milieu has effects on all cell types within the kidney
2.These contribute either primarily or secondarily to the development of
albuminuria/proteinuria and reduced GFR.
3.At the glomerulus, both hemodynamic effects and injury to the individual
components of the glomerular filtration barrier (podocyte, GBM, and glomerular
endothelial cell) leading to proteinuria (green arrows).
4.Tubulointerstitial injury may diminish tubular protein reuptake.
5.Mesangial cell injury likely contributes secondarily to proteinuria by (i)
mesangial expansion causing a loss of glomerular filtration surface area
leading to glomerular hyperfiltration (dashed green arrows) or (ii) by
mesangiolysis leading to structural changes in the capillary loops.
6.Proteinuria itself may result in a decrease in GFR by causing tubulointerstitial
injury.
Proposed schema unifying the mechanisms of proteinuria and
decrease in GFR in DKD.

68. HYPERTENSION AND ITS RELATIONSHIP TO CKD

69. EPIDEMIOLOGY OF HYPERTENSION
 In 2012 of the 57 million deaths globally
 36 mill.(63%) were due to NCD
 Largest proportion of NCD deaths (48%) by CVD
 Raised BP estimated to be responsible for 13%
of deaths globally
 Hypertension as a contributor to premature
death
 Ranks 4th in developed countries
 Ranks 7th in developing countries.

70. EPIDEMIOLOGY OF HYPERTENSION
 Nearly 1 billion adults (more than a quarter of
the world’s population) had hypertension in
2000
 predicted to increase to 1.56 billion by 2025.
 Mean BP has ↓ in nearly all high-income
countries
 It is stable or increasing in most African countries.
 Today, mean BP remains very high in many
African and some European countries.
 The prevalence of raised blood pressure in 2008
was highest in the WHO African Region at 36.8%
(34.0–39.7).

71. EPIDEMIOLOGY OF HYPERTENSION
 The Global Burden of Diseases Study 2010
 Mean systolic BP declined in high and middle-
income countries but increased in low-income
countries and is now more than in high-income
countries.
 The India specific data are similar to the overall
trends in low-income countries.

72. EPIDEMIOLOGY OF HYPERTENSION-INDIA
 The prevalence of hypertension in the late
nineties and second half of the twentieth
century varied among different studies in
India, ranging from 2-15% in Urban India and
2-8% in Rural India.
 Prevalence of hypertension has increased in
both urban and rural subjects and presently
is 25% in urban adults and 10-15% among
rural adults

74. CVD DEATHS IN INDIA
 In a meta-analysis of multiple cardiovascular epidemiological
studies, it was reported that
 Prevalence rates of coronary artery disease and stroke have more
than trebled in the Indian population.
 In the INTERHEART and INTERSTROKE study, hypertension
accounted for 17.9% and 34.6% of population attributable risk of
various cardiovascular risk factors for coronary artery disease and
stroke respectively.
 As per the Registrar General of India and Million Death Study
investigators (2001-2003),
 CVD was the largest cause of deaths in males (20.3%) as well as
females (16.9%) and led to about 2 million deaths annually.
 The Global Status on Non-Communicable Diseases Report
(2011) has reported that
 There were more than 2.5 million deaths from CVD in India in 2008,
two-thirds due to coronary artery disease and one-third to stroke.

75. CVD DEATHS IN INDIA
 There are large regional differences in cardiovascular
mortality in India
 . The mortality is highest in south Indian states, eastern and north
eastern states and Punjab in both men and women,
 Mortality is the lowest in the central Indian states of Rajasthan, Uttar
Pradesh and Bihar.
 The prevalence of high normal blood pressure (also called
pre hypertension in JNC-VII)
 Was found to 32% in a recent urban study from Central India.
 Some studies from South India (Chennai) and from Delhi prevalence
of high normal blood pressure has been upto 36% and 44%
respectively
 The prevalence of hypertension increases with age in all
populations.
 In a recent urban study it increased from 13.7% in the 3rd decade to
64% in the 6th decade.
 In last 2 decades the prevalence of hypertension has been
seen to be static in some urban areas.
 The prevalence of smoking has declined while that of diabetes,

76. HYPERTENSION COMPLICATIONS Hypertensive Heart Disease
 Hypertension has the following effects on the heart
 Left ventricular hypertrophy, increased risk of coronary artery disease,
arrhythmias, congestive cardiac failure and sudden death.
 Most episodes of left ventricular failure in hypertensive patients are
associated with diastolic heart dysfunction.
 Treatment of hypertension can reverse ventricular hypertrophy.
 The impact of reduction of LVH on reduction of morbidity and mortality is still
debated.
 Cerebrovascular Disease
 Hypertension is the most important modifiable risk factor for
 All types of atherothrombotic stroke and intracerebral haemorrhage due to
rupture of Charcot-Bouchard aneurysms.
 The relation between the incidence of stroke and blood pressure is
continuous.
 A 5-6 mm Hg reduction in diastolic blood pressure reduces the risk
of stroke by 40%
 The SHEP (Systolic Hypertension Elderly Program) study showed
substantial benefit following control of systolic blood pressure in the
elderly

77. HYPERTENSION COMPLICATIONS
 Kidney Disease
 About 20-25% of renal failure is attributed to uncontrolled
hypertension.
 Development of renal damage is heralded by
microalbuminuria, which progresses to overt proteinuria and
may further progress to end-stage renal disease.
 Reduction of proteinuria can be achieved by effective blood
pressure control specially with use of ACE inhibitors and
ARBs.
 Retina
 Hypertensive retinopathy is a condition characterized by a
spectrum of retinal vascular signs in people with elevated
blood pressure.
 Peripheral Vascular Disease
 Hypertensive Emergencies

78. PREVALENCE OF CVS RISK FACTORS COMPARED IN THE JAIPUR HEART W

79. HYPERTENSION IN CKD

80. Hypertension – Both risk factor and progression factor for
CKD

81. Prevalence of Hypertension in CKD
USRDS data -2006

82. Control of Blood Pressure is Pathetic –Target BP 130/80
Source -CRIC Study

83. Cardiovascular disease increases with increasing
albuminuria and decreasing GFR

84. BLOOD PRESSURE TARGETS IN CKD
 Exact relationship between BP and
outcomes are variable
 Home and Ambulatory BP measurements
are better than office BP for assessing
progress of proteinuria
 A J-shaped relationship between
cardiovascular mortality and BP was shown
 According to KDIGO -2012 guidelines
 In CKD + alb. Excretion < 30mg/24 hours –BP
<140/90
 In CKD + Alb. Excretion > 30mg/24 hours – BP
<130/80

85. CONSEQUENCES OF POORLY CONTROLLED
HYPERTENSION IN CKD
 Deterioration of renal function
 Development of Left Ventricular
Hypertrophy
 Early mortality mainly due to vascular
complications
 Considered to be the second leading
cause of CKD after diabetes in the US
(USRDS data)

86. HYPERTENSION AS PROGRESSION OF CKD
NATURE REVIEWS NEPHROLOGY 7, 434-444 (AUGUST 2011) |
 Key points
 Hypertension and proteinuria are the most important
independent risk factors for disease progression in both
adult and pediatric patients with chronic kidney disease
(CKD)
 Pharmacological intervention can slow the rate of
renal-disease progression
 Blockade of the renin–angiotensin system should be
the first-line pharmacological intervention in
progressive CKD
 Tight blood-pressure control exerts a beneficial effect
on CKD progression in patients with proteinuria

87. Many factors can cause podocyte injury.
As a result of this initiating injury there is a critical level of podocyte
depletion,
The glomerulus becomes destabilized
Further podocyte loss occurs independent of the initiating event
Driven by the renin–angiotensin system
This progression-accelerating mechanism can be retarded or prevented
by angiotensin II (AngII) blockade (glomerular restabilization)
These events can be monitored noninvasively by measuring the
podocyte mRNA products in urine.
ROLE OF RAAS BLOCKADE IN PREVENTING PODOCYTE INJURY

88. PATHOPHYSIOLOGY OF HYPERTENSION IN CKD
 Expanded ECF volume from sodium retention
 Activation of the sympathetic nervous System
 Activation of the Renin Angiotensin Aldosterone
System
 Endothelin cell dysfunction
 Increased endothelin -1 release
 Accumulation of asymmetric dimethylarginine
 Decreased production of Nitric Oxide
 Oxidative stress
 Increased Vasopressin Release
 Hypertensinogenic drugs (Erythropoetin)

89. Prime factors for generation of Blood Pressure

90. In CKD it is hypothesized that increases in Cardiac Output initiates the
increases in BP , but increased Peripheral Vasc. resistance sustains it.
Genesis of Blood pressure in CKD

91. Increased Renal
perfusion pressure leads
to increased sodium
excretion and vice versa
In CKD this mechanism
is impaired ,thus for
similar amount of salt
intake there is much
larger rise of BP , even in
patients on ACE
inhibitors or ARB’s

92. Figure 1 The relationship between pretreatment systolic blood pressure level
and the subsequent occurrence of ESRD
Udani, S. et al. (2010) Epidemiology of hypertensive kidney disease
Nat. Rev. Nephrol. doi:10.1038/nrneph.2010.154
Permission obtained from Wolters Kluwer Health © Perry, H. M. et al. 25, 587–594 (1995)

93. Figure 2 Mechanisms that contribute to salt sensitivity and hypertensive
kidney injury
Udani, S. et al. (2010) Epidemiology of hypertensive kidney disease
Nat. Rev. Nephrol. doi:10.1038/nrneph.2010.154

94. HYPERTENSION THE WAY TO GO
 Hypertension awareness, treatment and control
status is low,
 Only half of the urban and a quarter of the rural hypertensive
individuals being aware of its presence.
 Only one in five persons is on treatment and less than 5% are
controlled.
 Rural location is an important determinant of poor hypertension
awareness, treatment and control.
 It has been said that in India the rule- of-halves is not valid and only
a quarter to a third of subjects are aware of hypertension.
 Preventive measures are required
 To reduce obesity,
 Increasing physical activity,
 Decreasing the salt intake of the population
 Concerted effort to promote awareness about hypertension and
related risk behaviors
 ACE INHIBITORS/ARB’s.

95. Figure 2 Effect of strict blood-pressure control on renal survival
Wühl, E. & Schaefer, F. (2011) Managing kidney disease with blood-pressure control
Nat. Rev. Nephrol. doi:10.1038/nrneph.2011.73
Permission obtained from Massachusetts Medical Society ©
The ESCAPE trial group N. Engl. J. Med. 361, 1639–1650 (2009)

96. OBESITY-IT’S CONTRIBUTION TO CKD

99. Metabolic syndrome

101. OBESITY STATISTICS-AN OVERVIEW
 In 2008 worldwide
 1.5 billion adults were overweight (BMI >25 kg/m2).
 Over 200 million men and nearly 300 million women were obese
(BMI >30 kg/m2).
 Globally obesity rates have more than doubled since 1980
 5% to 10% in men and 8% to 14% in women.
 At least 2.8 million people die each year globally, as a result of
being overweight or obese.
 Worldwide 40 million children under the age of five were
overweight in 2010,.
 In the South-East Asia Region, 300 000 die of
overweight/obesity.
 Prevalence of overweight in countries across the Region
ranges from
 7.6% in male adults in Bangladesh to 53% female adults in
Maldives.
 Overweight and obesity are linked to more deaths worldwide
than underweight

102. INDIA- A LAND OF CONTRASTS

104. When obese, your leptin LEVELS spike
radically because you have higher leptin
AMOUNTS in your body (causing leptin
resistance in the brain)

105. Various systemic problems associated with obesity

106. OBESITY AND RENAL RISK
Studies of obesity and renal risk-Meta-analysis
 Studies reported on 19 cohorts—12 from the US, 4 from Europe, 2
from Japan and 1 from Korea.
 The median follow-up duration was 15 years (range 3–35 years).
 Estimated pooled relative risks (RRs) revealed that, compared with
normal-weight individuals (BMI 18.5–24.9 kg/m2),
 Overweight individuals (BMI 25–29.9 kg/m2) had a considerably
increased risk of kidney disease (RR 1.40, 95% CI 1.30–1.50).
 RR of kidney disease in obese individuals (BMI 30 kg/m2) was even
greater (RR 1.83, 95% CI 1.57–2.13).
 Each 1 kg/m2 increment in BMI increased the risk of kidney disease
by 6% (pooled RR 1.06, 95% CI 1.05–1.07).
 Stratification of the data by gender revealed a stronger association
between obesity and kidney disease in women than in men
 Population-attributable risk calculations for the US indicated that
approximately 24.2% of kidney disease cases in men and 33.9% of
cases in women could be attributable to obesity and being
overweight.

108. Bogaert YE and Linas S (2008) The role of obesity in the pathogenesis of
hypertension
Nat Clin Pract Nephrol doi:10.1038/ncpneph1022
Figure 1 Factors associated with the induction of obesity-related hypertension

109. SMOKING AND CKD RISK

110. Smoking In India

111. SMOKING AND CKD
 In recent years, the tobacco industry has been focusing on
expanding its markets in developing countries.
 WHO predicts that by 2020,
 70% of deaths resulting from smoking related illnesses will occur
in developing countries
 India is one of the countries that is party to the WHO’s
Framework Convention on Tobacco Control.
 Banned advertisement of tobacco and smoking in public places
 Smoking dramatically affects the morbidity and mortality
associated with cancer, cardio vascular disease and
pulmonary disease.
 Less is known about the deleterious effects of smoking on
the kidney
 Smoking is one of the preventable causes of progression of renal
failure

112. The Road Ahead

113. NCD- SUSTAINED INTERVENTION WORKS

114. Declines in Rates of Death from Major Noncommunicable Diseases in the
United States, 1950 to 2010.
Hunter DJ, Reddy KS. N Engl J Med 2013;369:1336-1343

116. Opportunities for Prevention, Detection, and Treatment of Noncommunicable Diseases
in Low- and Middle-Income Countries.
Hunter DJ, Reddy KS. N Engl J Med 2013;369:1336-1343

117. Increase awareness
Change of Attitude
Obesity –The solutions

118. √

119. Solutions for the obesity problem

121. Figure 2 Proposed algorithm for the management of patients with
obesity-related cardiorenal syndrome
Fenske, W. et al. (2013) Obesity-related cardiorenal disease: the benefits of bariatric surgery
Nat. Rev. Nephrol. doi:10.1038/nrneph.2013.145

122. Table 3 Meta-analyses on the effect of RAS blockade on progression of renal
disease
Wühl, E. & Schaefer, F. (2011) Managing kidney disease with blood-pressure control
Nat. Rev. Nephrol. doi:10.1038/nrneph.2011.73

123. NCD MANAGEMENT INITIATIVES IN INDIA

124. Patient care pathway for Continuum of care – PHFI, Mamta & Medtronic Initiati

125. CONCLUSIONS
 NCD or Lifestyle related diseases are
responsible the majority of deaths ,even in
developing countries
 The same diseases cause Chronic Kidney
diseases(in adults) too
 There role in causing cardiovascular diseases
and COPD/Cancers are better known
 Hypertension, Diabetes, Obesity and
smoking are responsible for majority of CKD
in adults

126. CONCLUSIONS
Responding to the challenge: a whole-of-
government and a whole-of-society effort
 Recognize that the rising prevalence, morbidity and
mortality of non-communicable diseases worldwide can
be largely prevented and controlled through collective
and multisectoral action
 Acknowledge the contribution of and important
role played by all relevant stakeholders
 Individuals, families and communities
 intergovernmental organizations and religious
institutions,
 civil society, academia, the media, voluntary
associations
 the private sector and industry,
 insupport of national efforts for non-communicable

127. CONCLUSIONS
 Recognize the importance of strengthening
local, provincial, national and regional
capacities
 To address and effectively combat non-communicable
diseases particularly in developing countries,
 This may entail increased and sustained human,
financial and technical resources
 Reduce risk factors and create health-
promoting environments
 Strengthen national policies and health
systems
 International cooperation, including

128. Our Aim “25 by 25”