Prevalence Of Chronic Kidney Disease Stage Research Articles

Trends in estimated kidney function: the FINRISK surveys

We evaluated the temporary trend in estimated glomerular filtration rate (eGFR) of subjects aged from 25 to 74 years between two cross-sectional population surveys in 2002 and in 2007. The mean eGFR across age-groups, the prevalences of eGFR categories, and the prevalence of chronic kidney disease (CKD) stage 3–5 defined by eGFR\60 mL/min/1.73 m2 were defined in sex- and age-specific groups using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Study equation. The eGFR decreased from year 2002 to 2007 across the age-groups in both genders. The prevalence of CKD stage 3–5 (eGFR\60 mL/min/1.73) increased in women from 1.8 to 3.1% (P=0.017), but not in men. In the combined analysis of both genders, CKD stage 3–5 was markedly more common in 2007 compared to 2002, with odds ratio (OR) 1.59 (95% confidence interval (CI) 1.22–2.08) remaining significant after adjusting the model for age, gender, study area, hypertension, obesity, prior cardiovascular disease, and diabetes mellitus, and being at lowest when only age, gender and waist circumference were included in the model (OR 1.34; 95% CI 1.02–1.76). To conclude, the mean eGFR decreased significantly during 2002–2007 in both sexes, and CKD stage 3–5 increased in women. This trend was concurrent with increases in mean waist circumference and in the prevalence of diabetes mellitus.

Comparison of Lipid-Related Ratios for Prediction of Chronic Kidney Disease Stage 3 or More in Korean Adults

Dyslipidemia is implicated in increased cardiovascular risk associated with chronic kidney disease (CKD) and in the progression of renal damage. This study compared 4 different lipid-related ratios (total cholesterol [TC]/high-density lipoprotein cholesterol [HDL-C], triglyceride [TG]/HDL-C, calculated low-density lipoprotein cholesterol [c-LDL-C]/HDL-C, and non-HDL-C/HDL-C ratio) for prediction of CKD stage 3 or more to investigate the association between them. This cross-sectional study included 8,650 adults who participated in the 2007-2008 Korean National Health and Nutrition Examination Survey. The overall prevalence of CKD stage 3 or more was 6.4%. For TG/HDL-C, the prevalence with CKD stage 3 or more increased with increasing quartile group in both sexes (P value for trend = 0.046 in men, 0.002 in women) while other lipid-related ratios showed increasing prevalence only in women. In comparison with the lowest quartile of the lipid-related ratios, only the fourth quartile of TG/HDL-C was associated with the prevalence of CKD stage 3 or more in both sexes after adjustment for multiple covariates (odds ratio [OR] for TG/HDL-C-Q4, 1.82; 95% CI [confidence interval], 1.09-3.03 in men, OR 2.45; 95% CI, 1.52-3.95 in women). In conclusion, TG/HDL-C is the only lipid-related ratio that is independently associated with CKD stage 3 or more in both sexes of Koreans.

A new tool for predicting the probability of chronic kidney disease from a specific value of estimated GFR

Objective. To demonstrate how patients’ probability of having chronic kidney disease (CKD) stage 3–5 (measured GFR <60 mL/min/1.73 m2) can be predicted from a specific value of estimated glomerular filtration rate (eGFR). Material and methods. The probability of CKD stage 3–5 was predicted from a logistic regression model (n = 850) using three different eGFR prediction equations: Lund-Malmö, MDRD and CKD-EPI. Population weighting was used to illustrate how this probability varies in three different populations: original sample (55% true prevalence of CKD stage 3–5), a screening (6.7% prevalence) and a CKD population (84% prevalence). Results. All three eGFR-equations had high classification ability (area under the receiver-operating-characteristic curve = 97%). The probability of CKD stage 3–5 increased with decreasing eGFR, varied substantially among the populations studied and to some extent between the eGFR-equations. Using the Lund-Malmö equation as illustration, the probability of CKD stage 3–5 is > 90% only when eGFR is <38 mL/min/1.73 m2 in a screening population, whereas it is > 90% already when eGFR is <51 mL/min/1.73 m2 in a CKD population. Conversely, the probability of CKD stage 3–5 is <10% if eGFR > 59 mL/min/1.73 m2 in a screening population, whereas it is <10% only when eGFR is > 88 mL/min/1.73 m2 in a CKD population. Conclusion. Instead of reporting diagnostic accuracy as sensitivity, specificity, and predictive values, actual eGFR supplemented with the probability that it represents a true GFR <60 mL/min/1.73 m2 may be more valuable for physicians. Clinical (pre-test) probability in the population must be considered when predicting this probability.

Renal outcomes in chronic kidney disease

The prevalence of treated patients with end-stage renal disease (ESRD) has been increasing steadily in Japan. High ESRD prevalence could be explained by multiple factors such as better survival on dialysis therapy, luxury acceptance due to insurance system to cover dialysis therapy, and 'truly' high incidence and prevalence of chronic kidney disease (CKD). The growing elderly population may also contribute to this trend. The Japanese Society of Nephrology estimated the prevalence of CKD stage 3 as 10.4%, 7.6% within the range of 50-59 mL/min per 1.73 m(2) in a screened population. Strong predictors of treated ESRD shown by using community-based screening programs and an ESRD registry in Okinawa are dip-stick-positive proteinuria and hypertension. Low glomerular filtration rate per se, which is often observed in the elderly population, is not a significant predictor of developing ESRD unless associated with proteinuria. CKD is common in Japan and is expected to increase, particularly in the elderly population. Benefits of proteinuria screening and automatic reporting of estimated glomerular filtration rate on the incidence of ESRD remain to be determined.

A Cross-sectional Survey of Chronic Kidney Disease and Diabetic Kidney Disease in Japanese Type 2 Diabetic Patients at Four Urban Diabetes Clinics

Management of chronic kidney disease (CKD) is a critical issue in public health in attempt to prevent kidney failure and dialysis dependency. Since 1998, diabetes mellitus has been the leading cause of dialysis dependency in Japan. Previous reports demonstrated that the prevalence of CKD in diabetic patients was high; however albuminuria was not always present. This cross-sectional survey was performed 1) to indicate the prevalence of CKD and co-morbid illness in diabetic patients seen at diabetic clinics, and 2) to demonstrate the relationship between estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (ACR). A total of 288 consecutive adult type 2 diabetic patients seen at four diabetic clinics in the Tokyo Metropolitan Area were enrolled in November 2007. We excluded patients with kidney failure. Estimated GFR was calculated by the MDRD Study equation with the Japanese coefficient. Patients had a mean age (+/- SD), 61 (+/- 12); male, 58%; mean BMI, 25.2 kg/m(2) (+/- 5.2); and mean HbA(1c), 7.1% (+/- 1.3). The prevalence of CKD stage 3 was 38% (109/288) with 64% (70/109) of them being normoalbuminuric. Co-morbid illnesses, including hypertension (p<0.001) and old stroke (p=0.02), were significantly higher in CKD stage 3 patients. Our patients were relatively young and obese, reflecting urban clinical settings. The prevalence of CKD stage 3 patients was high. Clinicians need to check both eGFR and ACR to avoid underdiagnosis of CKD and diabetic kidney disease.

Determining Prevalence of Chronic Kidney Disease Using Estimated Glomerular Filtration Rate

To the Editor: Using data from the National Health and Nutrition Examination Surveys (NHANES 1988-1994 and NHANES 1999-2004), Dr Coresh and colleagues documented an increasing prevalence of chronic kidney disease (CKD) in the United States related in part to increasing prevalence of hypertension and diabetes. However, we have some concern about the absolute percentage of patients with stage 3 CKD, defined as estimated glomerular filtration rate (GFR) between 30 and 59 mL/min/1.73 m. In the NHANES 19992004 study, the prevalence of CKD stage 3 was high (7.69%), implying that 15.5 million US individuals have GFR below 60 mL/min/1.73 m. There are 3 reasons these figures could be overestimated, due to the use of the Modification of Diet in Renal Disease (MDRD) Study formula with a resultant systematic GFR underestimation. First, as stated by the authors, the MDRD Study formula was developed based on 1628 participants in whom GFR was measured with a reference method. These patients had CKD (mean GFR of 39.8 mL/min/1.73 m). This is important because the relationship between serum creatinine and GFR is different in healthy and CKD populations. The MDRD Study formula strongly and systematically underestimates GFR in healthy populations. Second, the authors recalibrated their Jaffe creatinine measurement to an enzymatic, standardized creatinine method. Nevertheless, the creatinine values were determined with a Jaffe method, with its analytical limitations (analytical coefficients of variation are higher for the Jaffe method than for the enzymatic methods). The lower precision of the Jaffe methods affects the precision of the MDRD Study formula results. Third, the authors used the abbreviated MDRD Study formula that is intended for use with the standardized creatinine. The new constant used in this formula (175 in place of 186) may be too low. This constant was calculated calibrating creatinine (enzymatic vs Jaffe Beckman) between 1 and 4 mg/dL, although calibration is only relevant for creatinine values between 0.5 and 2 mg/dL (to convert to μmol/L, multiply by 88.4). In this range of creatinine (which is the range of most of the NHANES population), the constant 175 of the MDRD Study formula thus is likely to be too low, leading to a systematic underestimation of the GFR.