2-7
Managing CKD in developing communities-how can developed countries help? A Developed Country's view
David Harris, Department of Renal Medicine, University of Sydney, Westmead Hospital, NSW, Australia

The current international epidemic of chronic kidney disease (CKD) affects developing and developed nations alike. It is being driven by the epidemic of diabetes (and obesity). It is estimated that the number of diabetics will double to 300m during the first quarter of this century, with a 30% increase in developed nations but a 130% increase in developing nations, which are less equipped to handle the long term consequences of this epidemic, namely cardiovascular disease and ESKD. Therefore, it is essential that developing nations develop a strategy to stem this tide by primary prevention and by early detection and treatment of diabetic and non-diabetic CKD.
Such programs are already underway in a number of developing communities in Asia, the subcontinent, Africa and Latin America. Occasional successful programs have been initiated without any external support (eg. in India); others with encouragement and limited support from the International Society of Nephrology (including Bolivia, Moldavia, China, Philippines, South Africa and Cuba). In addition, ISN has held a number of conferences on early detection and prevention of CKD. ISN has developed a KHDC (chronic kidney disease, hypertension, diabetes, cardiovascular disease) program to be used as the basis of detection and long term management. Via the Research Committee of COMGAN it has limited funds available to support the initiation of such programs.

Two such programs will be discussed. Indonesia has recently undertaken a screening program of a representative population of more than 10,000 from 5 different areas. This has revealed a high prevalence of renal abnormalities, hypertension, obesity and diabetes. Brunei has a population of 300,000 with a very high incidence of diabetes and ESKD. Its Ministry of Health is planning to undertake a nationwide screening and treatment program for diabetes, CKD and cardiovascular disease. As a neighbouring developed nation, Australia is committed to assisting with both programs.