Prevalence of chronic kidney disease in China: a cross-sectional survey

StephenW

                        
                                                                                          The Lancet, Volume 379, Issue 9818,  Pages 815 - 822, 3 March 2012

doi:10.1016/S0140-6736(12)60033-6Cite or Link Using DOI

Prevalence of chronic kidney disease in China: a cross-sectional surveyLuxia Zhang MD a *, Fang Wang MD a *, Prof Li Wang MD b †, Prof Wenke Wang MD c †, Prof Bicheng Liu MD d †, Prof Jian Liu MD e †, Prof Menghua Chen MD f †, Prof Qiang He MD g †, Prof Yunhua Liao MD h †, Prof Xueqing Yu MD i †, Prof Nan Chen MD j †, Prof Jian-e Zhang MD k, Prof Zhao Hu MD l, Prof Fuyou Liu MD m, Daqing Hong MD b, Lijie Ma MD c, Hong Liu MD d, Xiaoling Zhou MD f, Jianghua Chen MD g, Ling Pan MD h, Wei Chen MD i, Weiming Wang MD j, Prof Xiaomei Li MD a, Prof Haiyan Wang MD a
Summary
Background
The prevalence of chronic kidney disease is high in developing countries. However, no national survey of chronic kidney disease has been done incorporating both estimated glomerular filtration rate (eGFR) and albuminuria in a developing country with the economic diversity of China. We aimed to measure the prevalence of chronic kidney disease in China with such a survey.

Methods
We did a cross-sectional survey of a nationally representative sample of Chinese adults. Chronic kidney disease was defined as eGFR less than 60 mL/min per 1·73 m2 or the presence of albuminuria. Participants completed a lifestyle and medical history questionnaire and had their blood pressure measured, and blood and urine samples taken. Serum creatinine was measured and used to estimate glomerular filtration rate. Urinary albumin and creatinine were tested to assess albuminuria. The crude and adjusted prevalence of indicators of kidney damage were calculated and factors associated with the presence of chronic kidney disease analysed by logistic regression.

Findings
50 550 people were invited to participate, of whom 47 204 agreed. The adjusted prevalence of eGFR less than 60 mL/min per 1·73 m2 was 1·7% (95% CI 1·5—1·9) and of albuminuria was 9·4% (8·9—10·0). The overall prevalence of chronic kidney disease was 10·8% (10·2—11·3); therefore the number of patients with chronic kidney disease in China is estimated to be about 119·5 million (112·9—125·0 million). In rural areas, economic development was independently associated with the presence of albuminuria. The prevalence of chronic kidney disease was high in north (16·9% [15·1—18·7]) and southwest (18·3% [16·4—20·4]) regions compared with other regions. Other factors independently associated with kidney damage were age, sex, hypertension, diabetes, history of cardiovascular disease, hyperuricaemia, area of residence, and economic status.

Interpretation
Chronic kidney disease has become an important public health problem in China. Special attention should be paid to residents in economically improving rural areas and specific geographical regions in China.

Funding
The Ministry of Science and Technology (China); the Science and Technology Commission of Shanghai; the National Natural Science Foundation of China; the Department of Health, Jiangsu Province; the Sichuan Science and Technology Department; the Ministry of Education (China); the International Society of Nephrology Research Committee; and the China Health and Medical Development Foundation.

StephenW

总结
背景
慢性肾脏病的患病率是在发展中国家。然而，没有慢性肾脏疾病的全国性调查已经完成，纳入一个发展中国家，中国经济的多样性都估计肾小球滤过率（eGFR）和蛋白尿。我们的目的是在中国这样的一项调查显示，慢性肾脏病的患病率来衡量。

方法
我们做了一个中国成年人的全国代表性的样本的横断面调查。被定义为慢性肾脏病的eGFR小于60毫升/分钟每1.73平方米或蛋白尿的存在。参与者完成的生活方式和病史问卷，并测量他们的血压，并采取血液和尿液样本。血清肌酐测定和估计肾小球滤过率。尿白蛋白，肌酐进行了测试，以评估蛋白尿。原油和调整后的患病率肾功能损害的指标进行了计算和因素logistic回归分析慢性肾脏疾病存在关联。

发现
50 550人被邀请参加，其中47 204同意。调整后的EGFR患病率小于60毫升/分钟每1.73平方米，分别为1.7％（95％CI为1.5 -1·9％）和蛋白尿为9.4％（8.9 -10·0） 。慢性肾脏病的总患病率为10.8％（10.2 -11·3），因此，中国慢性肾脏病的患者人数估计约1.195亿美元（112.9 -125·0万美元）。在农村地区，经济发展的独立与蛋白尿的存在。慢性肾脏病的患病率在北高（16.9％[15.1 -18·7]）和西南（18.3％16.4 -20·4]）地区与其他地区相比。肾损害独立相关的其他因素包括年龄，性别，高血压，糖尿病，心血管疾病史，高尿酸血症，居住面积和经济地位。

解释
慢性肾脏病已经成为中国重要的公共卫生问题。特别应注意在经济，改善农村地区和在中国特定的地理区域的居民。

资金
部科技（中国），上海的科学和技术委员会，中国国家自然科学基金，江苏省卫生署;四川科学技术部，教育部（中国）​​;国际肾脏病学会研究委员会;和中国医药卫生事业发展基金会。

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