Estimated Prevalence Of Chronic Kidney Disease Research Articles

#2449 Prevalence and determinants of chronic kidney disease among older community-dwelling adults in Ireland

Abstract Background and Aims Chronic Kidney Disease (CKD) is a major global health challenge with substantial morbidity and mortality. In Ireland, a comprehensive understanding of the determinants of CKD is lacking, with limited data on the combined impact of socioeconomic and traditional risk factors. While the Irish Longitudinal Study on Ageing (TILDA) has offered insights into CKD burden, a detailed examination of its determinants remains unexplored. The goal of this study was to explore the prevalence and determinants of CKD at the community level within the Irish population. Method This is a retrospective cohort study that utilised cross sectional data from the first wave of TILDA conducted between 2009 and 2011. Participants aged 50 years and older who had health assessment and kidney function tests performed were included. The 2012 and 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations were employed to calculate estimated glomerular filtration rates (eGFR) based on cystatin C and creatinine levels. CKD was classified as eGFR < 60 ml/min/1.73 m². We determined the weighted prevalence of CKD using sample weights. Stepwise multivariable logistic regression models were used to identify correlates of CKD and models’ performance were assessed using AUC-ROC curves and the Akaike Information Criterion (AIC). Associations were expressed using adjusted odds ratios (AOR) with 95% confidence intervals (CIs). Results Among the 5 386 participants tested for cystatin C and serum creatinine, the weighted CKD prevalence was 11.3% based on the 2021 CKD-EPI definition (excluding race) and 13.9% using the 2012 definition. Prevalence was significantly higher in women than men, and increased with age, reaching about 45% in women over 71 years versus 29% in men. Burden of comorbid conditions in CKD individuals varied from 11% (for cancer) to 89% (for hypertension) and were significantly higher than non-CKD individuals (P< 0.001). Adjusting for age, sex, education, and employment, the adjusted odds of CKD were significantly higher for individuals with hypertension AOR 2.15 (95% CI: 1.58–2.96), diabetes AOR 2.00 (95% CI: 1.50–2.66), cardiovascular disease AOR 1.72 (95% CI: 1.43–2.21), cancer AOR 1.64 (95% CI: 1.16–2.30), and obesity AOR 2.18 (95% CI: 1.61–2.96). The likelihood of CKD was also higher for patients with a hospital admission in the previous year AOR = 1.50 (95% CI: 1.14–1.96), possession of a medical card AOR 1.41 (95% CI: 1.06–1.89), and unemployed individuals AOR 1.61, (95% CI: 1.06–2.50), while the likelihood was significantly lower for individuals with a tertiary education (versus primary) AOR 0.73 (95% CI: 0.54–0.98). With further adjustment for medications, the magnitude of these associations was greatly attenuated with increasing odds of CKD for those receiving higher medication burden: 2-3 drugs AOR 2.02, (95% CI: 1.29–3.29), 3-4 drugs AOR 2.52 (95% CI: 1. 59–4.11), and > 5 drugs AOR 4.49 (95% CI: 2.81–7.39) (see Fig. 1). The AUC score ranged from 0.84 to 0.88, indicating strong model performance. Conclusion This study brings renewed attention to observed variation in national estimates of CKD prevalence (11.3% vs 13.9%) that are derived from current prediction equations with important implications for the strategic planning and resourcing of CKD care. This study emphasises the impact of socioeconomic factors, such as health coverage and financial barriers to heath care, education attainment, and employment, on CKD beyond traditional risk factors. Furthermore, the attenuation of known risk factors with increasing medication use highlights the influence of these treatments on CKD dynamics. These findings provide valuable insights for targeted public health strategies and awareness programs in Irish communities to address the increasing burden of CKD.

Estimating the population-level impacts of improved uptake of SGLT2 inhibitors in patients with chronic kidney disease: a cross-sectional observational study using routinely collected Australian primary care data

Sodium glucose co-transporter 2 (SGLT2) inhibitors reduce the risk of kidney failure and death in patients with chronic kidney disease (CKD) but are underused. We evaluated the number of patients with CKD in Australia that would be eligible for treatment and estimated the number of cardiorenal and kidney failure events that could be averted with improved uptake of SGLT2 inhibitors. This cross-sectional observational study leveraged nationally representative primary care data from 392 Australian general practices (MedicineInsight) between 1 January 2020 and 31 December 2021. We identified patients that would have met inclusion criteria of key SGLT2 inhibitor trials and applied these data to age and sex-stratified estimates of CKD prevalence for the Australian population (using national census data), estimating the number of preventable events using trial event rates. Key outcomes included cardiorenal events (CKD progression, kidney failure, or death due to cardiovascular or kidney disease) and kidney failure. In MedicineInsight, 44.2% of adults with CKD would have met CKD eligibility criteria for an SGLT2 inhibitor;baseline use was 4.1%. Applying these data to the Australian population, 230,246 patients with CKD would have been eligible for treatment with an SGLT2 inhibitor. Optimal implementation of SGLT2 inhibitors (75% uptake) could reduce cardiorenal and kidney failure events annually in Australia by 3644 (95% CI 3526-3764) and 1312 (95% CI 1242-1385), respectively. Improved uptake of SGLT2 inhibitors for patients with CKD in Australia has the potential to prevent large numbers of patients experiencing CKD progression or dying due to cardiovascular or kidney disease. Identifying strategies to increase the uptake of SGLT2 inhibitors is critical to realising the population-level benefits of this drug class. University of New South Wales Scientia Program and Boehringer IngelheimEli Lilly Alliance.

#4522 PREVALENCE OF CHRONIC KIDNEY DISEASE IN PREGNANCY: A UK POPULATION STUDY

Abstract Background and Aims Women with chronic kidney disease (CKD) are at greater risk of adverse pregnancy outcomes. Historically CKD in has been proposed to affect 3% of all pregnancies (0.13% with ‘moderate to severe’ CKD) but is based on expert opinion and numbers affected are propose to rise due to the rise of maternal obesity and age and could impact on service planning. However, there are no accurate estimates of CKD prevalence in pregnancy. This study aimed to investigate how many pregnancies may be affected by CKD, according to disease severity, in a UK population cohort. Method Routinely collected pregnancy data from three NHS Trust hospitals in Kent (UK) between 2010 and 2020 were extracted with Research Ethics Committee approval (19/LO/1242 and 18/SC/0158). Local laboratory and health care records were linked and used to identify women between 18 and 50 years of age with a confirmed eGFR measurement (Chronic Kidney Disease Epidemiology Collaboration 2009 without ethnicity correction) within two years prior to conception, and no current pregnancy recorded at the time of sampling. Baseline characteristics and prevalence of CKD at different stages were described. Results A total of 76, 755 pregnancies were recorded between 2010 and 2020, including 14,257/76,755 (18.6%) pregnancies with preconception eGFR (median eGFR 115 ml/min/1.73 m2 (IQR 21)). There were 1,184/14,257 (8.3%) pregnancies with a preconception eGFR <90ml/min/1.73 m2, including eGFR between 60-89 ml/min/1.73 m2 (1170 /14,257, 8.2%). Only 12/14,257 (0.08%) of pregnancies had an eGFR 30-59 ml/min/1.73 m2 and two pregnancies (0.01%) had an eGFR between eGFR 15-29 ml/min/1.73 m2. There were no pregnancies in the cohort with an eGFR <15 ml/min/1.73 m2. The cohort was majority White ethnicity (12911/13790; 94%) with 6.4% (879/13790) from Black, Asian, Mixed and East Asian ethnicities. Women with pregnancies that were affected with CKD were significantly older at conception (27, SD 5.5, vs 30.8, SD 5.5, p <0.001) and had greater prevalence of chronic hypertension (8.6% vs 11.3%, p = 0.013). Considering the whole cohort, including those without kidney function testing, the proportion of pregnancies affected by CKD was low (1,185/76,755; 1.5%). Conclusion This is the largest cohort reporting the prevalence of CKD including severity in pregnancies in the UK. Overall the total number of pregnancies affected by CKD was lower than previous estimates, especially for those with advanced disease. This finding may represent reduced fertility in women with CKD, individual decisions not to conceive, negative advice from clinicians or obstetric management at different centres not captured in this cohort. However, only 1 in 5 women prior to pregnancy had an eGFR and gestational changes in creatinine may mask identification of CKD in pregnancy. A further limitation includes only eGFR measurement prior to pregnancy was used thus women with temporary eGFR reduction may have been incorrectly included in the CKD cohort. Finally there were few women from ethnic minority groups who are disproportionately affected by CKD. Further information regarding kidney function in women of reproductive age and at conception is needed to enable true estimated of CKD prevalence in obstetric care.

U-Shaped Relationship between Sleep Duration and CKD in US Adults: Data from National Health and Nutrition Examination Survey (NHANES) 2005–2014

Introduction: Short and long sleep durations have been associated with adverse health outcomes. The objective of this study was to examine the association between self-reported sleep duration and chronic kidney disease (CKD) in the general population on the basis of the National Health and Nutrition Examination Survey (NHANES) database. Methods: A total of 28,239 adults aged ≥18 years who participated in the 2005–2014 NHANES were analyzed. CKD was defined as an estimated glomerular filtration rate <60 mL/min per 1.73 m2 or urinary albumin/urine creatinine ratio ≥300 mg/g. Very short sleepers and short sleepers were defined as those who sleep ≤5 h or 5.1–6.9 h per day, respectively. Long sleepers and very long sleepers were defined as those who sleep 9.0–10.9 h or ≥11 h per day, respectively. Normal sleepers were defined as those who sleep 7.0–8.9 h. The association between sleep duration and CKD was assessed using a logistic regression model. Results: Very short (≤5 h) sleep duration was associated with higher odds of CKD (multiadjusted OR, 1.38; 95% confidence interval, 1.17–1.62 comparing normal categories of 7.0–8.9 h; P trend = 0.01), after adjusting for potential confounders. Participants with long (9–10.9 h) sleep duration also tended to have a higher odds of CKD (multiadjusted OR, 1.39; 95% confidence interval, 1.20–1.61 comparing normal categories of 7.0–8.9 h; P trend = 0.01). This risk was further increased in those whose sleep duration exceeded 11 h (multiadjusted OR, 2.35; 95% confidence interval, 1.64–3.37 comparing normal categories of 7.0–8.9; P trend = 0.01). However, there was no statistically significant association between short (≤6.0–7.9 h) sleep duration and CKD (multiadjusted OR, 1.05; 95% confidence interval, 0.96–1.14 comparing normal categories of 7.0–8.9 h; P trend = 0.32). Conclusion: We demonstrated that the higher CKD prevalence estimates were found in very short (≤5 h) and long (9.0–10.9 h) sleep durations in an apparently healthy population aged ≥18 years in the USA. This prevalence of CKD is further increased in those whose sleep duration exceeds 11 h. Our cross-sectional analyses clarified the U-shaped temporal relationship between sleep duration and CKD.

THE CHRONIC KIDNEY DISEASE IN AFRICA (CKD-AFRICA) COLLABORATION: A NEW PAN-AFRICAN NETWORK

Objective: Evidence points to an increasing prevalence of chronic kidney disease (CKD) across Africa, particularly in high-risk groups, like those with hypertension, diabetes, and HIV. However, there has not been a concerted, Africa-wide, effort to provide estimates to inform health services planning and policy development to address CKD. The CKD-Africa Collaboration seeks to fill this gap by collating data, at individual participant data (IPD) level, from African studies. The main aims of this platform are, (1) to utilize the available data from relevant prevalence studies of CKD, to provide updated and comprehensive syntheses on the burden of CKD in Africa, and (2) to link investigators in the field of CKD epidemiology and prevention, by providing a platform to plan future observational and interventional studies on CKD in Africa. Design and method: Establishing the CKD-Africa Collaboration followed a stepwise approach, through the identification of data sources, developing the database platform, and acquiring and processing participant-level data. Inclusion criteria: 1) observational study with primary data; 2) ethical approval; 3) minimum sample size of 300 participants and 4) participants of African descent residing in Africa. Results: To date, we have curated data from 42 studies conducted in 12 African countries, with a total of 37,842 participants (Fig.). The sample sizes ranges between 300 and 2,543 per study, with adults aged 18 to 100 years. In 36% of the studies data collection took place before 2010, with the remaining 64% sampled between 2010 and 2017. Overall, 74.6% of the IPD were sampled from the general population, with CKD prevalence estimates ranging from 1% to 22%. The remaining IPD were from high-risk populations, including people with hypertension, diabetes, HIV, and first-degree relatives of people with CKD. All studies used serum creatinine to estimate glomerular filtration rate, with 85.7% of these studies employing the Jaffe method. fx155 Conclusions: This network has far-reaching potential for Africa, as it is in an ideal position to test hypotheses and compare findings across geographical and national boundaries, and to generate a new understanding of CKD progression and its complications in this under-researched context.

MO513: Implications of Using Various Equations to Estimate Glomerular Filtration Rate in the GNC (NAKO) Study

Abstract BACKGROUND AND AIMS Glomerular filtration rate (GFR) is the most common measure of kidney function. Measuring GFR is often infeasible in routine clinical practice and population studies, where it is estimated instead from blood biomarkers. Three currently recommended equations, eGFR(crea), eGFR(cystC) and eGFR(cr + cy), use either creatinine, cystatin C or both, respectively, to calculate eGFR [1]. In addition, three alternative equations were introduced recently: two of them update eGFR(crea) and eGFR(cr + cy) by excluding the race term used in them [2], and the full age spectrum (FAS) equation (creatinine-based), which was specifically developed to estimate GFR across the full age range [3]. We aimed to assess the impact of these six equations on GFR estimates and the proportion of participants with chronic kidney disease (CKD) in the German National Cohort (GNC, NAKO) Study. METHOD The NAKO study is a prospective cohort study in Germany. Data to estimate GFR (eGFR) using the six equations was available for 112 843 participants aged 19–75 years, mostly of European ancestry. Pairwise Spearman correlation coefficients between GFR estimates were calculated. CKD was defined as an eGFR &amp;lt;60 mL/min/1.73 m² for each calculation. Agreement between CKD status derived from the different GFR equations was assessed using Cohen's κ. Measured GFR was not available. RESULTS Median eGFR/equation ranged from 92.2 mL/min/1.73 m² using the new FAS-equation [3] to 105.7 mL/min/1.73 m² using the updated race-free eGFR(cr + cy)2 (Fig. 1). eGFR values of the three equations using creatinine only, as well as eGFR values from the two equations using both creatinine and cystatin C, correlated well (r &amp;gt; 0.95), while the correlation of GFR estimates based on equations either using creatinine or cystatin C was only moderate (r = 0.6, Fig. 1). The frequency of CKD ranged from 1.0% to 2.3%, a &amp;gt;2-fold difference. The agreement assessed as Cohen's κ was the smallest when comparing the CKD status based on eGFR(cy) [1] with the CKD status based on the updated race-free eGFR (crea) [2] (Cohen's κ = 0.38). While both equations led to a mutual CKD classification in 707 participants (0.6%), 613 (0.5%) were only classified as having CKD when the updated race-free eGFR (crea) [2] was used, and 1580 (1.4%) were only classified as having CKD using eGFR (cy) [1]. Interestingly, the respective serum biomarker that led to the discordant classification of CKD was abnormally high, while the other biomarker was mainly in the normal range, highlighting the potential influence of non-kidney related factors on biomarker levels that influence estimates of CKD prevalence. CONCLUSION The use of different GFR equations leads to variable estimates, affecting the proportion classified as having CKD. Non-GFR determinants with an impact on the levels of either creatinine or cystatin C may lead to incorrect estimates of GFR and affect CKD prevalence estimates, which underscores the utility of a joint view using various equations.

Prevalence of chronic kidney disease in Asia: a systematic review and analysis

IntroductionThe burden of chronic kidney disease (CKD) is growing rapidly around the world. However, there is limited information on the overall regional prevalence of CKD, as well as the variations...

New Creatinine- and Cystatin C–Based Equations to Estimate GFR without Race

BackgroundCurrent equations for estimated glomerular filtration rate (eGFR) that use serum creatinine or cystatin C incorporate age, sex, and race to estimate measured GFR. However, race in eGFR equations is a social and not a biologic construct.MethodsWe developed new eGFR equations without race using data from two development data sets: 10 studies (8254 participants, 31.5% Black) for serum creatinine and 13 studies (5352 participants, 39.7% Black) for both serum creatinine and cystatin C. In a validation data set of 12 studies (4050 participants, 14.3% Black), we compared the accuracy of new eGFR equations to measured GFR. We projected the prevalence of chronic kidney disease (CKD) and GFR stages in a sample of U.S. adults, using current and new equations.ResultsIn the validation data set, the current creatinine equation that uses age, sex, and race overestimated measured GFR in Blacks (median, 3.7 ml per minute per 1.73 m2 of body-surface area; 95% confidence interval [CI], 1.8 to 5.4) and to a lesser degree in non-Blacks (median, 0.5 ml per minute per 1.73 m2; 95% CI, 0.0 to 0.9). When the adjustment for Black race was omitted from the current eGFR equation, measured GFR in Blacks was underestimated (median, 7.1 ml per minute per 1.73 m2; 95% CI, 5.9 to 8.8). A new equation using age and sex and omitting race underestimated measured GFR in Blacks (median, 3.6 ml per minute per 1.73 m2; 95% CI, 1.8 to 5.5) and overestimated measured GFR in non-Blacks (median, 3.9 ml per minute per 1.73 m2; 95% CI, 3.4 to 4.4). For all equations, 85% or more of the eGFRs for Blacks and non-Blacks were within 30% of measured GFR. New creatinine–cystatin C equations without race were more accurate than new creatinine equations, with smaller differences between race groups. As compared with the current creatinine equation, the new creatinine equations, but not the new creatinine–cystatin C equations, increased population estimates of CKD prevalence among Blacks and yielded similar or lower prevalence among non-Blacks.ConclusionsNew eGFR equations that incorporate creatinine and cystatin C but omit race are more accurate and led to smaller differences between Black participants and non-Black participants than new equations without race with either creatinine or cystatin C alone. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases.)

DIFFERENTIAL PREVALENCE AND ASSOCIATIONS OF CHRONIC KIDNEY DISEASE BY FIVE ESTIMATORS IN A SOUTH AFRICAN POPULATION-BASED STUDY

Objective: The aim was to determine the prevalence, distribution, concordance and associations of chronic kidney disease (CKD) assessed by five glomerular filtration rate (GFR) formulae in urban black residents of Cape Town. Design and method: In this population-based cross-sectional study, stratified for age and gender, data collection included administered questionnaires, clinical measurements and biochemical analyses, including serum creatinine and cystatin C levels. GFR was based on the CKD Epidemiology Collaboration (CKD-EPI) equations (CKD-EPI creatinine (CKD-EPIcr), CKD-EPI cystatin C (CKD-EPIcys), CKD-EPI creatinine-cystatins (CKD-EPIcr-cys)), Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault formula (CGF). GFR &lt;60 mL/min/1.73 m2 defined CKD. Results: Mean estimated GFR, among 392 men and 700 women, was between 114.0 (CKD-EPIcr) and 135.4 mL/min/1.73 m2 (CGF) in men, and between 107.5 (CKD-EPIcr-cys) and 173.4 mL/min/1.73 m2 (CGF) in women. CKD prevalence ranged from 2.3% (CKD-EPIcr and MDRD) to 5.1% (CKD-EPIcys) in men and 1.6% (CGF) to 6.7% (CKD-EPIcr-cys) in women. Correlations between different estimates of GFR were positive and significant, and there were no significant differences between any two coefficients. The kappa statistic was high between CKD-EPIcr and MDRD (0.934), and CKD-EPIcys and CKD-EPIcr-cys (0.815), but fair-to-moderate between the other equations (0.353–0.565). In the basic regressions, older age and body mass index &gt;30 kg/m2, but not gender, were significantly associated with CKD-EPIcr-defined CKD. In the presence of these three variables, but in separate models, hypertension, heart rate &gt;90 beats/minute, diabetes and increasing low-density lipoprotein cholesterol were significant predictors of prevalent CKD by CKD-EPIcr and MDRD (except for diabetes). Metabolic syndrome, in the model with age and gender only, was significantly associated with CKD-EPIcr- and MDRD-defined CKD. No cardio-metabolic variable was associated with CKD determined by CKD-EPIcys, CKD-EPIcr-cys or CGF. Conclusions: The varying CKD prevalence estimates, on account of different GFR equations used, underscores the need to improve accuracy of CKD diagnoses. Moreover, considering the significant associations of cardio-metabolic diseases with CKD-EPIcr- and MDRD-defined CKD, screening for CKD should be incorporated into the routine assessment of high-risk patients such as those with hypertension or diabetes.

Prevalence, concordance and associations of chronic kidney disease by five estimators in South Africa

BackgroundTo determine the prevalence, distribution, concordance and associations of chronic kidney disease (CKD) determined by five glomerular filtration rate (GFR) formulae in urban black residents of Cape Town.MethodsData collection in this cross-sectional study included interviews, clinical measurements and biochemical analyses, including serum creatinine and cystatin C levels. GFR was based on the CKD Epidemiology Collaboration (CKD-EPI) equations (CKD-EPI creatinine (CKD-EPIcr), CKD-EPI cystatin C (CKD-EPIcys), CKD-EPI creatinine-cystatins (CKD-EPIcr-cys)), Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault formula (CGF). GFR < 60 mL/min/1.73 m2 defined CKD.ResultsAmong 392 men and 700 women, mean GFR, was between 114.0 (CKD-EPIcr) and 135.4 mL/min/1.73 m2 (CGF) in men, and between 107.5 (CKD-EPIcr-cys) and 173.4 mL/min/1.73 m2 (CGF) in women. CKD prevalence ranged from 2.3% (CKD-EPIcr and MDRD) to 5.1% (CKD-EPIcys) in men and 1.6% (CGF) to 6.7% (CKD-EPIcr-cys) in women. The kappa statistic was high between CKD-EPIcr and MDRD (0.934), and CKD-EPIcys and CKD-EPIcr-cys (0.815), but fair-to-moderate between the other eqs. (0.353–0.565). In the basic regressions, older age and body mass index ≥30 kg/m2, but not gender, were significantly associated with CKD-EPIcr-defined CKD. In the presence of these three variables, hypertension, heart rate ≥ 90 beats/minute, diabetes and low-density lipoprotein cholesterol were significant predictors of prevalent CKD.ConclusionsVarying CKD prevalence estimates, because of different GFR equations used, underscores the need to improve accuracy of CKD diagnoses. Furthermore, screening for CKD should be incorporated into the routine assessment of high-risk patients such as those with hypertension or diabetes.

The epidemiology of chronic kidney disease (CKD) in rural East Africa: A population-based study.

BackgroundChronic kidney disease (CKD) may be common among individuals living in sub-Saharan Africa due to the confluence of CKD risk factors and genetic predisposition.MethodsWe ascertained the prevalence of CKD and its risk factors among a sample of 3,686 participants of a population-based HIV trial in rural Uganda and Kenya. Prevalent CKD was defined as a serum creatinine-based estimated glomerular filtration rate <60 mL/min/1.73m2 or proteinuria (urine dipstick ≥1+). We used inverse-weighting to estimate the population prevalence of CKD, and multivariable log-link Poisson models to assess the associations of potential risk factors with CKD.ResultsThe estimated CKD prevalence was 6.8% (95% CI 5.7–8.1%) overall and varied by region, being 12.5% (10.1–15.4%) in eastern Uganda, 3.9% (2.2–6.8%) in southwestern Uganda and 3.7% (2.7–5.1%) in western Kenya. Risk factors associated with greater CKD prevalence included age ≥60 years (adjusted prevalence ratio [aPR] 3.5 [95% CI 1.9–6.5] compared with age 18–29 years), HIV infection (aPR 1.6 [1.1–2.2]), and residence in eastern Uganda (aPR 3.9 [2.6–5.9]). However, two-thirds of individuals with CKD did not have HIV, diabetes, or hypertension as risk factors. Furthermore, we noted many individuals who did not have proteinuria had dipstick positive leukocyturia or hematuria.ConclusionThe prevalence of CKD is appreciable in rural East Africa and there are considerable regional differences. Conventional risk factors appear to only explain a minority of cases, and leukocyturia and hematuria were common, highlighting the need for further research into understanding the nature of CKD in sub-Saharan Africa.

Prevalence and incidence of chronic kidney disease in Cuba.

Chronic kidney disease (CKD) is a health problem worldwide. This article's objective is to describe CKD's integration into Cuba's National Noncommunicable Diseases (NCD) Program and the main outcomes regarding the burden of CKD and associated risk factors in Cuba. Cuba offers free health services to all its citizens on the basis of a strong primary healthcare system focused on prevention. The CKD National Program is coordinated by the Institute of Nephrology and includes the National Program for Prevention of CKD, which addresses all levels of prevention. The following indicators for renal replacement treatment are from 2016. The incidence of new patients on dialysis was 109 per million population (pmp); the two main causes were hypertension (34.4%) and diabetes mellitus (29.2). In 6.3% of patients, CKD cause could not be determined because they presented at advanced stages. The prevalence of patients on dialysis was 289 pmp; 90% of dialysis patients were on hemodialysis. The main causes of death were cardiovascular diseases (30.25%), cerebrovascular diseases (11.1%), and infections (29.5%). The kidney transplant rate was 14.3 pmp. Kidney transplants performed with cadaveric donors were 86.5% of total, with living related donors 13.5%. The Isle of Youth Study (ISYS) was designed to assess predialysis chronic kidney disease patterns; its methodology has been published previously. Results: Risk factors: age > 59 years 32%, women 67.8%, overweight 34.3%, obesity 22.8%, hypertension 41.5%, diabetes 13%. Estimated CKD prevalence was 9.63%. The integration of CKD into Cuba's NCD Program has gathered knowledge of burden and trends of CKD and better risk factor control.

The epidemiology of chronic kidney disease and the association with non-communicable and communicable disorders in a population of sub-Saharan Africa.

In sub-Saharan Africa (SSA), epidemiological data for chronic kidney disease (CKD) are scarce. We conducted a prospective cross-sectional study including 952 patients in an outpatient clinic in Tanzania to explore CKD prevalence estimates and the association with cardiovascular and infectious disorders. According to KDIGO, we measured albumin-to-creatinine ratio and calculated eGFR using CKD-EPI formula. Factors associated with CKD were calculated by logistic regression. Venn diagrams were modelled to visualize interaction between associated factors and CKD. Overall, the estimated CKD prevalence was 13.6% (95% CI 11–16%). Ninety-eight patients (11.2%) (95% CI 9–14%) were categorized as moderate, 12 (1.4%) (95% CI 0–4%) as high, and 9 (1%) (95% CI 0–3%) as very high risk according to KDIGO. History of tuberculosis (OR 3.75, 95% CI 1.66–8.18; p = 0.001) and schistosomiasis (OR 2.49, 95% CI 1.13–5.18; p = 0.02) were associated with CKD. A trend was seen for increasing systolic blood pressure (OR 1.02 per 1 mmHg, 95% CI 1.00–1.03; p = 0.01). Increasing BMI (OR 0.92 per 1kg/m2, 95% CI 0.88–0.96; p = <0.001) and haemoglobin (OR 0.82 per 1g/dL, 95% CI 0.72–0.94; p = 0.004) were associated with risk reduction. Diabetes was associated with albuminuria (OR 2.81, 95% CI 1.26–6.00; p = 0.009). In 85% of all CKD cases at least one of the four most common factors (hypertension, diabetes, anaemia, and history of tuberculosis or schistosomiasis) was associated with CKD. A singular associated factor was found in 61%, two in 14%, and ≥3 in 10% of all CKD cases. We observed a high prevalence estimate for CKD and found that both classical cardiovascular and neglected infectious diseases might be associated with CKD in a semi-rural population of SSA. Our finding provides further evidence for the hypothesis that the “double burden” of non-communicable and endemic infectious diseases might affect kidney health in SSA.

International differences in chronic kidney disease prevalence: a key public health and epidemiologic research issue.

In this narrative review, we studied the association of risk factors for chronic kidney disease (CKD) and CKD prevalence at an ecological level and describe potential reasons for international differences in estimated CKD prevalence across European countries. We found substantial variation in risk factors for CKD such as in the prevalence of diabetes mellitus, obesity, raised blood pressure, physical inactivity, current smoking and salt intake per day. In general, the countries with a higher CKD prevalence also had a higher average score on CKD risk factors, and vice versa. There was no association between cardiovascular mortality rates and CKD prevalence. In countries with a high CKD prevalence, the prevention of noncommunicable diseases may be considered important, and, therefore, all five national response systems (e.g. an operational national policy, strategy or action plan to reduce physical inactivity and/or promote physical activity) have been implemented. Furthermore, both the heterogeneity in study methods to assess CKD prevalence as well as the international differences in the implementation of lifestyle measures will contribute to the observed variation in CKD prevalence. A robust public health approach to reduce risk factors in order to prevent CKD and reduce CKD progression risk is needed and will have co-benefits for other noncommunicable diseases.

The public health dimension of chronic kidney disease: what we have learnt over the past decade.

Much progress has been made in chronic kidney disease (CKD) epidemiology in the last decade to establish CKD as a condition that is common, harmful and treatable. The introduction of the new equations for estimating glomerular filtration rate (GFR) and the publication of international reference standards for creatinine and cystatin measurement paved the way for improved global estimates of CKD prevalence. The addition of albuminuria categories to the staging of CKD paved the way for research linking albuminuria and GFR to a wide range of renal and cardiovascular adverse outcomes. The advent of genome-wide association studies ushered in insights into genetic polymorphisms underpinning some types of CKD. Finally, a number of new randomized clinical trials and meta-analyses have informed evidence-based guidelines for the treatment and prevention of CKD. In this review, we discuss the lessons learnt from epidemiological investigations of the staging, etiology, prevalence and prognosis of CKD between 2007 and 2016.

Chronic kidney disease and risk factor prevalence in Saint Kitts and Nevis: a cross-sectional study

BackgroundThe prevalence of chronic kidney disease (CKD) in St. Kitts and Nevis, islands of the West Indies, is unknown. We sought to determine estimates of CKD and its risk factors (e.g. diabetes, hypertension and obesity) in St. Kitts and Nevis.MethodsThis was a chronic disease screening program. Three community-based locations in St. Kitts and Nevis were included in the program. Participants were adult community residents aged ≥18 years. The main outcome measures were estimated CKD prevalence (by serum creatinine-based estimated glomerular filtration rate (eGFR) and dipstick urine albumin); and estimated prevalence of CKD risk factors (diabetes, hypertension and obesity). Logistic regression was used to determine independent predictors of CKD.ResultsOne thousand nine hundred seventy eight persons, from Nevis (n = 950) and St. Kitts (n = 1028) were screened by the Caribbean Health and Education Foundation. Participants’ mean age was 49 ± 15 years, 65% were female, and 99% were black. Fully, 21.5% had diabetes and 53.1% had hypertension; and 40.3% were obese. Mean estimated eGFR was 98 ml/min/1.73 m2 (standard deviation = 30) and 4.7% had an eGFR <60 ml/min/1.73 m2, indicating CKD. Age [Odds Ratio (OR) = 1.08, 95% Confidence Interval (CI) 1.05–1.11], hypertension (OR = 2.89, 95% CI 1.18–7.07) and diabetes (OR = 3.12, 95% CI 1.80–5.43) were independent predictors of reduced eGFR in models adjusted for age, gender and obesity status. Of those with urine testing in Nevis (n = 929), 13.5% had urine albumin ≥30 mg/dL, and diabetes was an independent predictor of this finding (OR = 2.43, 95% CI 1.53–3.87).ConclusionsCKD and its risk factors were prevalent among adults in St. Kitts and Nevis. Public policy strategies for prevention and treatment of these conditions may be needed to reduce their associated morbidity, mortality and costs.

The global burden of chronic kidney disease: estimates, variability and pitfalls.

Chronic kidney disease (CKD) is currently defined by abnormalities of kidney structure or function assessed using a matrix of variables - including glomerular filtration rate (GFR), thresholds of albuminuria and duration of injury - and is considered by many to be a common disorder globally. However, estimates of CKD prevalence vary widely, both within and between countries. The reasons for these variations are manifold, and include true regional differences in CKD prevalence, vagaries of using estimated GFR (eGFR) for identifying CKD, issues relating to the use of set GFR thresholds to define CKD in elderly populations, and concerns regarding the use of one-off testing for assessment of eGFR or albuminuria to define the prevalence of CKD in large-scale epidemiological studies. Although CKD is common, the suggestion that its prevalence is increasing in many countries might not be correct. Here, we discuss the possible origins of differences in estimates of CKD prevalence, and present possible solutions for tackling the factors responsible for the reported variations in GFR measurements. The strategies we discuss include approaches to improve testing methodologies for more accurate assessment of GFR, to improve awareness of factors that can alter GFR readouts, and to more accurately stage CKD in certain populations, including the elderly.

Creatinine based equations and glomerular filtration rate: interpretation and clinical relevance

No Abrsact

Worldwide growing epidemic of CKD: fact or fiction?

Chronic kidney disease (CKD) is recognized as a major noncommunicable disease of growing epidemic dimension worldwide. However, recent surveys have shown a marked heterogeneity of CKD prevalence in the general population, from ∼5% to 13% across countries. Methodological issues, genetic diversity, and dietary factors may all play a role. An important, currently emerging aspect of CKD epidemiology is the variability of CKD trends over time, with some countries showing a stable or even a decreased prevalence.

Exploration of chronic kidney disease prevalence estimates using new measures of kidney function in the health survey for England.

BackgroundChronic kidney disease (CKD) diagnosis relies on glomerular filtration rate (eGFR) estimation, traditionally using the creatinine-based Modification of Diet in Renal Disease (MDRD) equation. The Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation performs better in estimating eGFR and predicting mortality and CKD progression risk. Cystatin C is an alternative glomerular filtration marker less influenced by muscle mass. CKD risk stratification is improved by combining creatinine eGFR with cystatin C and urinary albumin to creatinine ratio (uACR). We aimed to identify the impact of introducing CKDEPI and cystatin C on the estimated prevalence and risk stratification of CKD in England and to describe prevalence and associations of cystatin C.Methods and FindingsCross sectional study of 5799 people in the nationally representative 2009 and 2010 Health Surveys for England. Primary outcome measures: prevalence of MDRD, CKDEPI and cystatin C-defined eGFR<60ml/min/1.73m2; prevalence of CKD biomarker combinations (creatinine, cystatin C, uACR). Using CKDEPI instead of MDRD reduced the prevalence of eGFR<60ml/min/1.73m2 from 6.0% (95% CI 5.4–6.6%) to 5.2% (4.7–5.8%) equivalent to around 340,000 fewer individuals in England. Those reclassified as not having CKD evidenced a lower risk profile. Prevalence of cystatin C eGFR<60ml/min/1.73m2 was 7.7% and independently associated with age, lack of qualifications, being an ex-smoker, BMI, hypertension, and albuminuria. Measuring cystatin C in the 3.9% people with CKDEPI-defined eGFR<60ml/min/1.73m2 without albuminuria (CKD Category G3a A1) reclassified about a third into a lower risk group with one of three biomarkers and two thirds into a group with two of three. Measuring cystatin C in the 6.7% people with CKDEPI eGFR >60ml/min/1.73m2 with albuminuria (CKD Category G1-2) reclassified almost a tenth into a higher risk group.LimitationsCross sectional study, single eGFR measure, no measured (‘true’) GFR.ConclusionsIntroducing the CKDEPI equation and targeted cystatin C measurement reduces estimated CKD prevalence and improves risk stratification.