Epidemiology Of Chronic Kidney Disease Research Articles

Epidemiology of Chronic Kidney Disease Among Normotensives

Among adults in the United States, 1 in 4 has hypertension and 1 in 8 has chronic kidney disease (CKD). Although the relationship between hypertension and CKD has been recognized for several hundred years, the prevalence of CKD among patients with normal blood pressure has not been assessed in randomly sampled populations. Crews et al1 in this issue of Hypertension are the first to report such estimates: 13.4% of people who have normal blood pressure have CKD. Among those with prehypertension, the prevalence is 17.3%; among those with undiagnosed hypertension, the prevalence is 22.0%; and among those with diagnosed hypertension, the prevalence is 27.4%. The magnitude of these CKD prevalence estimates is astounding and may even be misleading unless placed in appropriate context. The awareness of CKD diagnosis was dismal: <10% of people were aware of CKD regardless of hypertension category. A thorough analysis of the definition of CKD is necessary to understand how the varying definitions of CKD may have influenced both the prevalence and awareness estimates. The prevalence estimates may be inflated because of CKD that is so mild that it may not be considered a disease at all. For example, examination of the Figure (derived from Table 3 of the article) shows that if one considers the prevalence of more severe CKD defined as macroalbuminuria or estimated glomerular filtration rate (GFR) <45 mL/min per 1.73 m2, then the prevalence estimates fall dramatically. These stricter definitions of CKD yield the following prevalence estimates of CKD: normal blood pressure 0.5%; prehypertension 1.0%; undiagnosed hypertension 2.0%; and <5.0% prevalence of CKD among those with diagnosed hypertension. These prevalence estimates are much lower than those obtained with the more sensitive definition that is typically used to define CKD. Thus, the prevalence estimates of CKD may be driven up …

Ethnic disparities in prevalence and impact of risk factors of chronic kidney disease

There is substantial heterogeneity in literature regarding the epidemiology for chronic kidney disease (CKD) in different Asian populations. We aimed to assess the prevalence and risk factors of CKD in a multi-ethnic Asian population in Singapore. We examined 4499 participants of Chinese, Malay and Indian ethnicity, aged 24-95 years, who participated in the Singapore Prospective Study Program. CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m(2) or the presence of micro/macroalbuminuria. The age, sex-standardized prevalence of CKD was 12.8% (11.4%, 18.6% and 17.6% in Chinese, Malays and Indians). Older age and the presence of diabetes, hypertension and dyslipidaemia were significantly associated with CKD in all ethnic groups. Clinical, metabolic, socioeconomic and behavioral factors accounted for 68% and 78% of excess risk of CKD in Malays and in Indians, respectively. Diabetes (45%) and dyslipidaemia (16%) among Malays and hypertension among Indians (23%) had greater population-attributable risk of CKD. The prevalence of CKD is high in all three major Asian ethnic groups, in particular Malays and Indians, but risk factors are similar to those reported from previous studies in Western populations. The association of modifiable risk factors with CKD emphasizes the need to screen and treat high-risk populations for early detection and prevention of CKD.

Peritoneal dialysis and its role in the demography and epidemiology of chronic kidney disease

In a population of patients who have undergone renal replacement therapy, the 21st century brought a rise in the number of elderly people as well as patients with obesity, with renal complications of systemic diseases, especially diabetes and hypertension, and a constantly increasing number of patients with congestive heart failure who require intermittent or permanent dialysis support. In keeping with the concept of an integrated approach to renal replacement therapy, peritoneal dialysis should be the first option in renal replacement treatment, especially in patients with residual renal function. This paper summarizes the current evidence supporting the view that the changing demography and epidemiology of chronic kidney disease imposes an introduction of patient-friendly modifications of therapeutic options available in these patient groups.

Chronic kidney disease and end-stage renal disease-a review produced to contribute to the report 'the status of health in the European union: towards a healthier Europe'.

The Report on the Status of Health in the European Union (EUGLOREH) is a project aimed at describing health problems in member states of the European Community. This project is an effort of more than 170 European experts and the collaboration of the health authorities or institutions from all EU Member States, major intergovernmental, International and European Organizations and Agencies. In this report, for the first time special emphasis is given to chronic diseases. Chronic kidney disease (CKD) is increasingly recognized as a major public health problem. However, with some notable exceptions, until now this disease has received scarce attention both at European level and at member states level. In 2007, the ERA-EDTA Registry was invited to contribute to EUGLOREH. The Registry made a major effort to gather published and unpublished information on the epidemiology of CKD and ESRD and to provide a comprehensive overview on CKD and ESRD in European countries. The review was completed in early 2008 and included into the final EUGLOREH published in the WEB as of 20 March 2009.

Chronic Kidney Disease Epidemic: Cost and Health Care Implications in China

Chronic kidney disease is growing as a global public health problem. With more than 1.3 billion people, China is the world's largest and most populous country. Understanding the epidemiology of chronic kidney disease in China could be helpful to predict its impact on the health care system and to establish comprehensive strategies to reduce its burden.

Prevalence of chronic kidney disease in patients with suspected sleep apnoea

Little is known about the epidemiology of chronic kidney disease (CKD) in patients with suspected sleep apnoea (SA). Glomerular filtration rate (eGFR) was calculated in consecutive patients referred for full-night observed in-hospital polysomnography. SA was defined as the respiratory disturbance index (RDI) > 5. One hundred and fifty-eight patients were studied. The age (mean +/- SD) was 61.2 +/- 12.7 years, body mass index 29.5 +/- 5.9 kg/m(2) and eGFR 86.1 +/- 21.7 mL/min/1.73 m(2). SA was present in 133 patients (85%). The eGFR was 94.6 7 mL/min/1.73 m(2) in patients without SA and 84.5 7 mL/min/1.73 m(2) in patients with SA [mean difference (95% confidence interval) 10.0 (0.6-19.4) mL/min/1.73 m(2); P = 0.037]. Seventy patients had eGFR > or = 90 mL/min/1.73 m(2) (group 1), and 70 patients had between 60 and 89 mL/min/1.73 m(2) (group 2), and 18 patients had 30-59 mL/min/1.73 m(2) (CKD 3). Although the prevalence of SA did not differ among the groups (group 1: 80%; group 2: 86%; CKD 3: 94%), the number of central sleep apnoeas (CSA) per hour was 5.9 +/- 12.2 in CKD 3, six times greater compared to patients with eGFR > or = 60 mL/min/1.73 m(2) (1.0 +/- 2.1; P = 0.01). The prevalence of obstructive SA did not differ between the groups. After adjustment for age, gender, BMI, hypertension, diabetes mellitus and smoking status, CKD 3 (P = 0.0004) and New York Heart Association class > or =3 (P = 0.0001) remained predictive of CSA events per hour. eGFR is reduced in patients with SA, particularly in those with episodes of CSA.

Chronic Renal Insufficiency Cohort (CRIC) Study

The Chronic Renal Insufficiency Cohort (CRIC) Study was established to examine risk factors for the progression of chronic kidney disease (CKD) and cardiovascular disease (CVD) in patients with CKD. We examined baseline demographic and clinical characteristics. Seven clinical centers recruited adults who were aged 21 to 74 yr and had CKD using age-based estimated GFR (eGFR) inclusion criteria. At baseline, blood and urine specimens were collected and information regarding health behaviors, diet, quality of life, and functional status was obtained. GFR was measured using radiolabeled iothalamate in one third of participants. A total of 3612 participants were enrolled with mean age +/- SD of 58.2 +/- 11.0 yr; 46% were women, and 47% had diabetes. Overall, 45% were non-Hispanic white, 46% were non-Hispanic black, and 5% were Hispanic. Eighty-six percent reported hypertension, 22% coronary disease, and 10% heart failure. Mean body mass index was 32.1 +/- 7.9 kg/m(2), and 47% had a BP >130/80 mmHg. Mean eGFR was 43.4 +/- 13.5 ml/min per 1.73 m(2), and median (interquartile range) protein excretion was 0.17 g/24 h (0.07 to 0.81 g/24 h). Lower eGFR was associated with older age, lower socioeconomic and educational level, cigarette smoking, self-reported CVD, peripheral arterial disease, and elevated BP. Lower level of eGFR was associated with a greater burden of CVD as well as lower socioeconomic and educational status. Long-term follow-up of participants will provide critical insights into the epidemiology of CKD and its relationship to adverse outcomes.

The Nexus of Acute Kidney Injury, Chronic Kidney Disease, and World Kidney Day 2009

Acute kidney injury (AKI) is a devastating disease that affects patients throughout the world and is associated with high morbidity and mortality. It has been traditionally thought that patients who do survive recover renal function; however, recent population-based evidence strongly suggests that this may not be the case in many instances. New data suggest that a strikingly large percentage of patients who have AKI require permanent renal replacement therapy or do not fully recover renal function, and that this population has an important and growing impact on the global epidemiology of chronic kidney disease (CKD) and end-stage renal disease (ESRD). World Kidney Day is a campaign to increase global health awareness of the importance of CKD. This campaign, representing a joint initiative of the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF) will be held on March 12, 2009 and will be celebrated in more than 100 countries and on six continents. The impetus for this campaign is to increase public awareness of the burgeoning impact of CKD and ESRD to global health. By some estimates based on the Kidney Disease Outcome Quality Initiative (K/DOQI)-defined stage 1 to 4, approximately 13% of the world population may have CKD (1,2). Current estimates suggest that 1.6 million individuals worldwide undergo maintenance dialysis; however, many developing countries remain without adequate access to renal replacement therapy (3). In the United States, 0.5 million patients were treated for ESRD (with dialysis or kidney transplantation) in 2005, a number which is projected to increase to 0.7 million by 2015 (4). Although nephrologists collectively expend considerable effort attempting to attenuate the progression of CKD with a variety of therapeutic strategies, only a small fraction of patients with CKD progress to ESRD because death from other causes, including cardiovascular disease, is …

Current diagnostic evaluation of autosomal dominant polycystic kidney disease

Despite changing epidemiology of chronic kidney disease, autosomal dominant polycystic kidney disease (ADPKD) is one of the most prevalent causes of end stage renal disease. The first symptoms of the disease occur usually in the 3rd or 4th decade of life, however, it can often be diagnosed much earlier. Advances in the understanding of the disease may lead, in the near future, to slowing the progression of ADPKD in asymptomatic individuals. ADPKD is diagnosed on the basis of family history (autosomal dominant inheritance) and radiological imaging. Ultrasound examination (US) of the kidneys is the most important imaging diagnostic method. US is highly sensitive and specific in patients >30 years of age. In US, Ravine criteria are applied and their modifications with other imaging techniques (computed tomography [CT], magnetic resonance [MR]). In all cases, however, there are multiple cysts in both kidneys and, importantly, concomitant renal enlargement can be observed, which is typical of ADPKD. High expectations for early ADPKD diagnosis are risen by genetics and proteomics. However, these methods are not used routinely. The most sensitive parameter in the evaluation of the disease progression is total renal volume. This parameter is presently used in clinical studies, but its utility in monitoring an individual patient has not been fully proven. Unfortunately, MR and CT are expensive and in case of significantly enlarged kidneys US does not yield accurate assessment of their size and is not sensitive enough for monitoring the disease progression. The rate of glomerular filtration rate (GFR) decline is usually constant. Therefore, it is important to monitor GFR in individuals who have developed renal insufficiency. Other tests, including markers of kidney injury, e.g. albuminuria, or vascular flow parameters, are used mainly in clinical studies. Thus, before more efficient therapeutic approaches have been developed, an early diagnosis and prevention of the disease complications are most essential.

Epidemiology of chronic kidney disease: Results from a population of older adults in Germany

Objective To determine prevalences and stages of chronic kidney disease (CKD), and evaluate association of CKD with related covariables in a large population of older adults. Methods This cross-sectional analysis included 9806 participants of a general health check-up aged 50–74 years in Germany. We performed multivariate analysis to identify association of CKD with related covariables. Partial spearman correlations of eGFR with related biomarkers were calculated. Results Overall, 17.4% of subjects had CKD. Prevalences of stages 1, 2, 3, 4/5 CKD were 4.6%, 4.7%, 17.0% and 0.4%, respectively. Prevalence of CKD increased with age and peaked in age 70–74 years with 23.9%. In multivariable analysis of older age, female, self-reported history of cardiovascular diseases, diabetes and statin usage were independently associated with increased risk for CKD. Significant correlations were found between eGFR and serum cystatin C (− 0.28), C-reactive protein (− 0.04), fasting glucose (0.12), HbA 1c (− 0.06), total cholesterol (− 0.32), and triglycerides (− 0.07) after adjustment for covariates. Conclusions This study shows a high prevalence of CKD among older adults. It highlights the association of eGFR with history of cardiovascular diseases, glycemic markers, and cardiovascular risk factors and may point to further possible targets in early prevention of CKD.

Kidney disease in the elderly: update on recent literature

Purpose of review We review recent literature on the epidemiology and outcomes of chronic kidney disease in the elderly and discuss implications for management. Recent findings Chronic kidney disease is common in the elderly and associated with substantial morbidity and mortality. The prognostic significance of a given level of estimated glomerular filtration rate, however, varies substantially by age. Estimates of the prevalence of chronic kidney disease at the population level and estimates glomerular filtration rate at the individual level are exquisitely sensitive to the methods used to arrive at these estimates. At present there is no clear consensus on the optimal approach to estimating glomerular filtration rate in elderly individuals in the clinical setting. Available evidence to guide management of chronic kidney disease is based largely on trials in younger individuals. It is unclear to what extent the results of these trials can be extrapolated to older individuals with chronic kidney disease. Summary We advise caution in applying current guidelines to the care of the large number of individuals aged 70 years and older with chronic kidney disease. Ideally, the care of these patients should be individualized and carefully integrated with the management of other comorbid conditions and with patient preferences.

Progression From Acute Kidney Injury to Chronic Kidney Disease: A Pediatric Perspective

Although emerging evidence indicates that the incidence of both acute kidney injury (AKI) and chronic kidney disease (CKD) in children is rising and the etiologies are dramatically changing, relatively little is currently known regarding the potential for transition from AKI to CKD. In both situations, early intervention can significantly improve the dismal prognosis. However, the lack of a uniform AKI definition and the paucity of early, predictive biomarkers have impaired our ability diagnose AKI early to institute potentially effective therapies in a timely manner. Fortunately, recent data has validated a multidimensional AKI classification system for children. In addition, the application of innovative technologies has identified candidates that are emerging as early biomarkers of both AKI and CKD. These include neutrophil gelatinase-associated lipocalin, liver-type fatty acid-binding protein, and kidney injury molecule-1. Studies to validate the sensitivity and specificity of these biomarkers in clinical samples from large cohorts and from multiple clinical situations are currently in progress, facilitated by the development of commercial tools for the reproducible measurement of these biomarkers across different laboratories.

Epidemiology of Chronic Kidney Disease in Central and Eastern Europe

Background: The world population suffering from end-stage renal disease (ESRD) is growing. The epidemiology of ESRD is relatively well documented, but data on chronic kidney disease (CKD) are missing, especially in Central and Eastern Europe (CEE). Early detection of CKD is important because it allows introduction of the therapy that slows the progression of CKD. The aim of the present study was to estimate the prevalence of CKD and ESRD in CEE. Methods: Our data are based on two independent surveys: one concerns epidemiology of CKD, the other ESRD. Moreover, we present rough results from the pilot study PolNef on early detection of CKD, performed in North Poland. Estimated glomerular filtration rate, albuminuria and ultrasound examination were the main diagnostic tools. Results: Only limited data from South-East Hungary and North Poland were available: the number of CKD patients under nephrological care and on dialysis. According to the PolNef study, using a dipstick test albuminuria was detected in 15.6% of participants but dropped to 11.9% when it was measured using the turbidimetric method. Conclusions: Data concerning epidemiology of CKD in CEE are missing. Epidemiology of ESRD in CEE seems to be similar to that in Western Europe. PolNef is the first study dealing with renal epidemiological problems in CEE. It shows that renal epidemiological problems in CEE are comparable to those of the other parts of the world. Studies concerning CKD epidemiology in different CEE countries are necessary to confirm that the incidence and prevalence of CKD are similar to those in Western Europe and other parts of the globe.

HIV and the Kidney: A Spotlight on Racial Disparities

In 1984, physicians at a New York City hospital described an aggressive form of kidney disease affecting 12% of their patients with AIDS [1]. Progression to endstage renal disease (ESRD) was nearly universal, and all affected patients were African American or Haitian immigrants. Subsequent studies have consistently demonstrated a strong association between black race and this unique form of kidney disease, now recognized as HIVassociated nephropathy (HIVAN) [2– 4]. In the United States, African Americans account for nearly 90% of the incident ESRD attributed to HIVAN [5], a racial predisposition rivaling that associated with sickle-cell nephropathy [6]. Because these data are based primarily on clinical diagnoses, it is likely that many cases of ESRD that are attributed to HIVAN actually reflect a broader spectrum of HIVrelated and comorbid kidney diseases [4, 7]. Until recently, the impact of race on these other forms of HIV-related kidney disease has not been well understood. Several recent publications have highlighted the significant influence of race on the epidemiology of chronic kidney disease (CKD) in HIV-infected patients, regardless of the underlying pathology [8–11]. Although decreased kidney function was identified in 5% of the largely white EuroSIDA cohort [8], cross-sectional data from a New York City HIV clinic demonstrated a high prevalence of kidney disease in minority patients, including ESRD in 4% and pre– end-stage CKD in 11% of patients [9]. In addition to this striking disparity in prevalence, investigators from the US Veterans Affairs Medical System have recently described racial differences in the incidence and progression of HIV-related kidney disease [10]. Although the baseline prevalence of decreased kidney function was similar in HIV-infected veterans regardless of their race, the incidence of ESRD was nearly 6-fold higher in HIV-infected African Americans. HIVAN was the most common presumed diagnosis, but more than half of the cases of ESRD were attributed to another etiology [10]. In a smaller cohort of veterans who had preexisting kidney disease the rate of progression in HIV-infected African Americans was similar to that observed in patients with diabetes [11]. In this issue of the Journal, Lucas et al. describe the impact of race on the epidemiology of CKD in the Johns Hopkins HIV Clinical Cohort [12]. The findings of their study are consistent with those arising from the study of the Veterans Affairs cohort [10] and suggest that the disproportionate burden of ESRD in HIVinfected African Americans is primarily attributable to more-rapid progression of kidney disease. Although the incidence of CKD was only slightly increased in African American participants compared with white participants, the risk of progression to ESRD was 18-fold higher. In a subgroup of patients, for whom kidneybiopsy data were available, African Americans were significantly more likely to progress to ESRD, regardless of the etiology of kidney disease, suggesting that the observed racial disparity is not unique to HIVAN. The incidence of ESRD in whites in the Johns Hopkins cohort was actually so low that Lucas et al. were unable to adjust for other demographic and clinical characteristics that could confound the relationship between race and the progression of kidney disease; however, it is reassuring that similar results were observed in the larger Veterans Affairs cohort after adjustment for age, sex, baseline kidney function, comorbid conditions, and socioeconomic status. Notably, fewer than one-tenth of HIV-infected veterans were women, compared with nearly one-third of the participants in the Johns Hopkins cohort. The impact of sex on the risk for progression of kidney disease should be the subject of further study in other patient cohorts, particularly because Lucas et al. have identified female sex as a risk factor for incident kidney disease but not for ESRD [12, 13]. Although the inclusion of data from a single institution or hospital network may limit the generalizability of these recent studies, singleand multicenter cohorts are increasingly important resources for Received 5 February 2008; accepted 6 February 2008; electronically published 18 April 2008. Potential conflicts of interest: The author is on the renal speakers bureau of Gilead Sciences. Reprints or correspondence: Christina M. Wyatt, Box 1243, One Gustave Levy Pl., New York, NY 10029 (christina.wyatt@mssm.edu). The Journal of Infectious Diseases 2008; 197:1490 –2 © 2008 by the Infectious Diseases Society of America. All rights reserved. 0022-1899/2008/19711-0002$15.00 DOI: 10.1086/587995 E D I T O R I A L C O M M E N T A R Y

D&amp;T Report

D&amp;T Report

Epidemiology of chronic kidney disease in a Sri Lankan population.

CONTEXT:Chronic kidney disease (CKD) is characterized by progressive destruction of renal mass with irreversible sclerosis and loss of nephrons over a period of months to years, depending on the underlying etiology.AIM:To describe demographic patterns and identify common causes of CKD in patients admitted to ward 41 and 48B, National Hospital of Sri Lanka.SETTINGS AND DESIGN:A hospital based descriptive 3-month study was conducted at ward 41 and 48B, National Hospital of Sri Lanka. A case record form was used to record sociodemographic variables, stage of renal disease, and etiology of patients in established chronic renal failure. Sources of data included patient interviews, diagnosis cards and case records, ultrasound scan reports, and biopsy findings.RESULTS:One hundred and twenty-one patients were recruited with male to female ratio being 2.5:1 (86:35). Mean age of the population was 47.8 years (SD ± 13.7). Common causes of CKD identified in these patients included diabetic nephropathy (37, 30.6%), hypertension (16, 13.2%), glomerulonephritis (12, 9.9%), and obstructive uropathy (10, 8.3%). The cause was unknown in 25.6% of patients with chronic renal disease. Fifty percent of patients were from the Western Province. The leading cause of CKD in patients from the Western Province was diabetic nephropathy (26, 37.7%). The etiology of CKD was unknown in majority of the patients (14, 27.4%) from other provinces. The difference in incidence of diabetic nephropathy in the Western Province as to other provinces was not statistically significant (P > 0.05).CONCLUSION:Diabetes is a major contributor to CKD reflecting changing disease epidemiology in Sri Lanka.

Chronic kidney disease definition and classification: the quest for refinements

The definition and staging of chronic kidney disease (CKD) have provided a unifying approach to CKD that has generated considerable new information on the epidemiology, course, outcomes, and burden of CKD. Eriksen and Ingebretsen propose a change in the current 3 months chronicity criterion of CKD. Whereas longer lengths of chronicity changed the number of patients in stages 3 and 4, mortality remained high in each of their new groupings. Essentially, CKD persisted and remained a risk multiplier of death.

CHRONIC KIDNEY DISEASE: THE CINDERELLA OF GENERAL MEDICINE

Click to increase image sizeClick to decrease image sizeKeywords: chronic kidney diseasescreeningmicro albuminuriaepidemiology

New insights into the epidemiology of chronic kidney disease in US Asians and Pacific Islanders

In contrast to advances in our understanding of health disparities in other ethnic groups within the US, differential outcomes associated with chronic kidney disease among US Asians have gone largely unexamined. Until recently, risk estimates for chronic kidney disease outcomes among US Pacific Islanders were virtually unknown. This review highlights recent contributions to our understanding of chronic kidney disease outcomes in US Asians and Pacific Islanders. Asians in the US appear to have a higher risk of end-stage renal disease relative to US whites after accounting for baseline kidney disease and many of the known risk factors for end-stage renal disease. The origins of the discrepancy in risk for end-stage renal disease between US Asians and whites do not appear to be explained by the socioeconomic and comorbidity disparities paradigm present in the US black vs. white model. Mounting evidence suggests that US Asians and Pacific Islanders receive substantially less predialysis care and proportionally fewer kidney transplants compared with US whites. Paradoxically, these populations have equivalent or better survival on dialysis. These data highlight the need for studies to elucidate the mechanisms underlying the differential outcomes observed among US Asians and Pacific Islanders. Efforts to identify ethnicity-specific risk factors for kidney disease and interventions aimed at promoting predialysis care and kidney transplantation among US Asians and Pacific Islanders could substantially reduce morbidity, mortality, and costs.

Epidemiology and Classification of Chronic Kidney Disease and Management of Diabetic Nephropathy

Epidemiology and Classification of Chronic Kidney Disease and Management of Diabetic Nephropathy