SAT-212 Is Chronic Kidney Disease on the rise in Malaysia? Findings from a nationwide study

Abstract

CKD represents a significant public health problem because of its associated socio-economic and health consequences. In 2011 the National Health and Morbidity Survey (NHMS) showed a 9.07% prevalence of CKD in West Malaysia. and identified diabetes, hypertension and older age as risk factors. The objective of this population-based study was to determine the trend in prevalence and risk factors of CKD in adults aged >18 years in both East and West Malaysia. A total of 1398 individuals ≥ 18 years old, representative of the adult population in Malaysia was randomly selected using a stratified cluster method. Respondents completed a lifestyle and medical history questionnaire and had blood pressure measured before blood and urine samples were taken. Glomerular filtration rate (eGFR) was estimated from calibrated serum creatinine using the CKD-EPI equation. Urinary albumin and creatinine were tested to assess albuminuria. CKD was defined as eGFR < 60 ml/min/1.73m2 or the presence of persistent albuminuria if eGFR ≥ 60 ml/min/1.73m2. The national CKD prevalence was estimated using complex design analysis where the sampling procedure and the population weight were adjusted for gender and urban/rural residence. Multivariate analysis was used to identify risk factors for CKD. A total of 1,047 individuals (75%) agreed to participate in this study. Of these, 977 respondents had serum creatinine measured. The final analysis set comprised 890 respondents i.e. those with eGFR< 60 ml/min/1.73m2 (N = 65) and those with eGFR ≥ 60 ml/min/1.73m2 who either had an initial negative urine albumin creatinine ratio (ACR) (N = 691) or a repeated sample of urine if the initial urine ACR was positive (N = 134). Mean age of respondents was 48.8 years, 41.1% were males, 19.6% had diabetes and 51% had hypertension. The overall prevalence of CKD was 15.48% (95% CI: 12.30, 19.31). An estimated 3.85% had stage 1 CKD (eGFR > 90 ml/min/1.73m2 and persistent albuminuria), 4.82% had stage 2 (eGFR of 60 – 89 ml/min/1.73m2 and persistent albuminuria), and 6.81% had stage 3 - 5 (eGFR < 60ml/min/1.73 m2). Only 5% of respondents with CKD were aware of their diagnosis. Risk factors for CKD included increasing age (aOR 1.06), Body Mass Index (aOR 1.06), diabetes mellitus (aOR 3.32) and hypertension (aOR 3.72). The prevalence of CKD in Malaysia has increased from 9.07% in 2011 to 15.48% in 2018. The risk factors for CKD are highly prevalent among the Malaysian population and now include Body Mass Index. The National CKD prevention program, adopted into the National Strategic Plan for Non-Communicable Disease in Malaysia in 2018, needs to be successfully implemented to address the rising tide of CKD.