Dialysis in Russia, key issues Prevalence of 2HPT in Russian dialysis population Dr. Valeriy Shilo Mоscow, Russia Russian Zemplar® Advisory Board Meeting. - презентация

1 Dialysis in Russia, key issues Prevalence of 2HPT in Russian dialysis population Dr. Valeriy Shilo Mоscow, Russia Russian Zemplar® Advisory Board Meeting Moscow 2009

2 General information about Russia and Healthcare Dialysis in Russia Prevalence and current management of HPT in Russian Dialysis Population Zemplar

3 Macroeconomic snapshot of Russia Area sq.km. Population –

4 Russia: economic state Per capita GDP in international dollars, 2004 GDP = gross domestic product 52 Russia15,922 IMF 2008Russia World Bank Russia14,743 World Bank 2007Russia

5 Healthcare structure/personnel Hospitals5 285 Hospitals Policlinics2 350 Policlinics Dispansers1 152 Dispansers MDs 43,3 per MDs 43,3 per Nurses 94,3 per Nurses 94,3 per MD : nurse ratio 1:2,2MD : nurse ratio 1:2,2 12, 4 Hospital beds per 1000

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7 GDP 2,6% 3,7% 3,5%

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12 Data from Russian Registry of Renal Replacement Therapy Dialysis in Russia: key issues Data from Russian Registry of Renal Replacement Therapy

13 HD units distribution (number per на 100k km 2 ) by the end 2005

14 RRT centers ( ) Число отделений (Δ 47%) (Δ 36%) ( Δ 258%)

15 Dialysis Units (Types) Type Proportion (%) Patients # (%) Federal Academic Institution

16 Prevalence of patients on RRT in Russia in yrs (increase 13,6% ) Число больных ГД ПД Tx ,7% 6,8% 21.5% 19483

17 Access to RRT in Moscow(2006 г), whole Russia (2006 г.) in comparison to other countries (2005 г.) (International comparison. USRDS 2006) Обеспеченность на млн. населения

18 Comparison in RRT prevalence in Federal Parts of Russia ,5 2006

19 Incidence rates in yrs HD PD Per million pop. 2,1 15,6 16,9 19,2 20,2 24,3 29, Summary grouth 135%

20 Incidence rates HD + PD per Million Population in Moscow, whole Russia, Austria, USA Число больных, впервые приятых на лечение ГД и ПД за год, на млн. населеня 132, ,7 39, ,

21 Age of RRT Pts ( ) PrevalentIncident Children on RRT 451 pts (18,8 PMCP )

22 Prevalence of HPT an other disturbances in mineral metabolism in Russian dialysis population

23 Исследование распространенности ВГПТ в РФ фаза I – II HPT Russian Study Vaves I-II центра РФ –10 Москва –3 Санкт – Петербург –Екатеринбург –Краснодар –Нижний Новгород –Петрозаводск –Самара –Липецк –Новосибирск –Кемерово –Волгоград Всего включено 1569 пациентов на ГД

24 PTH Comparison

25 PTH Distribution

26 Phosphate distribution

27 Фосфор сыворотки – сравнение с международными данными

28 Total pts Russia pts 2009 Q1

29 Corrected Ca distribution

30 Corrected Ca comparison

31 Са х РО4 Product

32 Available options for HPT Management in Russia Active Vitamin D sterols –Calcitriol –Alfacalcidol –Paricalcitol - not reimbursed Calcimimetics –Mimpara - not reimbursed Phosphate binders (cont)

33 Available phosphate binders in Russia Calcium carbonate Aluminum gel salts Sevelamer HCl (Renagel) – not reimbursed Calcium acetate Lantanum carbonate Not Available

34 Vit D Usage

35 Conclusion (I) RTT in Russia is still unacceptable poor comparable to industrial countries, though some improvement are obviousRTT in Russia is still unacceptable poor comparable to industrial countries, though some improvement are obvious No central (Federal) reimbursement for HD and PD creates unequal access to dialysis throughout the countryNo central (Federal) reimbursement for HD and PD creates unequal access to dialysis throughout the country From 2005 EPO and iron become available due to federal reimbursement programFrom 2005 EPO and iron become available due to federal reimbursement program Rapidly grown economy promise further improvement in health care systemRapidly grown economy promise further improvement in health care system