Prevalence of chronic kidney disease in China

– – – Low birth weight Genetic differences Unmeasured confounders (e.g. dietary factors)
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Hale Waihona Puke Residual confounding might exist (e.g. isolated impaired glucose)
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In the analysis of different geographical regions, the north and southwest were associated with high prevalence of low eGFR and albuminuria. These associations were still statistically significant after adjustment for multiple confounders; two possible explanations exist.
Discussion
• A major strength of this study is that it is a nationwide survey in a developing country with large economic heterogeneity and therefore provides a unique dataset with which to explore the effect of multiple demographic variables on the burden and trends of CKD. The prevalence of CKD estimated in this study was similar to that in developed countries such as the USA (13.0%) and Norway (10.2%). The prevalence of CKD stage 3 and stage 4 in study was lower.
Discussion
Limitations
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Laboratory tests were done at central laboratories of 13 study provinces. All the indicators obtained on the basis of single measurements. The definition of hypertension and diabetes was partly based on self-reported history and oral glucose-tolerance test was not done to confirm the diagnosis of diabetes. Finally, the cross-sectional design of the study makes inference of a causal relationship between indicators of kidney damage and associated factors impossible.
Prevalence of chronic kidney disease in China: a cross-sectional survey
Luxia Zhang, Fang Wang, Haiyan Wang. Lancet 2012; 379: 815–822
Background
• The prevalence of CKD is high in developing countries. However, no national survey has been done incorporating both estimated eGFR and albuminuria in a developing country with the economic diversity of China.
Methods
• This study aimed to measure the prevalence of CKD in China with a cross-sectional survey of a nationally representative sample of Chinese adults. • CKD was defined as eGFR<60ml/min/1.73m2 or the presence of albuminuria (albumin to creatinine ratio greater than 30 mg/g or urinary albumin concentration more than 20 mg/L). • Participants completed a lifestyle and medical history questionnaire and had their blood pressure measured, and blood and urine samples taken.
Findings
1. 50550 people were invited to participate (47204 completed the survey and examination). The adjusted prevalence of eGFR<60 ml/min/1.73 m2 was 1.7% and of albuminuria was 9.4%. The overall prevalence of CKD was 10.8%; therefore the number of patients with CKD in China is estimated to be about 119.5 million. In rural areas, economic development was independently associated with the presence of albuminuria. The prevalence of CKD was high in north (16.9%) and southwest (18.3%), compared with other regions. Other factors independently associated with kidney damage were age, sex, hypertension, diabetes, history of cardiovascular disease, hyperuricemia, area of residence, and economic status.
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Discussion
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Several possible explanations for the discrepancy between urban and rural areas exist.
Non-communicable diseases including Health care Factors not captured (e.g. unhealthy lifestyle )
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Participants with low eGFR or albuminuria were older, less educated, more likely to be women, and had higher prevalences of cardiovascular disease, hypertension, and diabetes, than the participants without indicators of kidney damage.
• In the north, the prevalence of hypertension was similar to that of the total population (27· 9% vs 30· 2%), but control of hypertension was substantially lower (6· 2%, vs 12· 0%). For the southwest, the prevalence of hypertension (11· 1%) was low and control of hypertension (23· 1%) was higher than that of the total population. The prevalence of diabetes was lower in the north (3· 6%) and the southwest (3· 8%) than in the total population (4· 9%). • Awareness of CKD was 12· 5%, and did not vary significantly between rural and urban areas (12· 9% vs 10· 5%).