International comparison of the relationship of chronic kidney disease prevalence and ESRD risk
International comparison of the relationship of chronic kidney disease prevalence and ESRD risk
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DOI：
10.1681/asn.2005121273
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发表时间：
2006-08-01
影响因子：
13.6
通讯作者：
Holmen, Jostein
中科院分区：
文献类型：
--
作者：
Hallan, Stein I.;Coresh, Josef;Holmen, Jostein
欧洲的ESRD发病率远低于美国。这项研究调查了这是否反映了慢性肾脏病（CKD）或其他机制早期患病率的差异。挪威的CKD患病率是根据Nord-Trondelag县基于人群的健康调查（HUNT 11）估计的，该调查包括1995年至1997年的65，181名成年人（参与率70.4%）。使用与1988年至1994年（n = 15，488）和1999年至2000年（n = 4101）的两次美国国家健康和营养检查调查相同的方法分析数据。主要分析使用性别特异性临界值估计CKD 1期和2期的持续性白蛋白尿。ESRD发生率和其他相关数据摘自国家登记处。挪威的CKD总患病率为10.2%（SE 0.5）：CKD 1期（每1.73 m（2）和蛋白尿的GFR > 90 ml/min），2.7%（SE 0.3）; 2期（GFR 60 - 89 ml/min/1.73 m2和蛋白尿），3.2%（SE 0.4）; 3期（GFR 30 - 59 ml/min/1.73 m2），4.2%（SE 0.1）; 4期（GFR 15 - 29 ml/min/1.73 m2），0.2%（SE 0.01）。这非常接近报告的美国CKD患病率（1988年至1994年为11.0%，1999年至2000年为11.7%）。与挪威患者相比，美国白色患者从CKD 3期或4期进展为ESRD的相对风险为2.5。这只是通过调整年龄，性别和糖尿病进行了适度修改。透析开始时的年龄和GFR相似，人群中的高血压和心血管死亡率相似，但美国白色患者后来被转诊至肾病学家，肥胖和糖尿病的患病率较高。总之，挪威的CKD患病率与美国相似，这表明挪威的ESRD发病率较低，而不是风险个体较少。
ESRD incidence is much lower in Europe compared with the United States. This study investigated whether this reflects a difference in the prevalence of earlier stages of chronic kidney disease (CKD) or other mechanisms. CKD prevalence in Norway was estimated from the population-based Health Survey of Nord-Trondelag County (HUNT 11), which included 65,181 adults in 1995 through 1997 (participation rate 70.4%). Data were analyzed using the same methods as two US National Health and Nutrition Examination Surveys in 1988 through 1994 (n = 15,488) and 1999 through 2000 (n = 4101). The primary analysis used gender-specific cutoffs in estimating persistent albuminuria for CKD stages 1 and 2. ESRD rates and other relevant data were extracted from national registries. Total CKD prevalence in Norway was 10.2% (SE 0.5): CKD stage 1 (GFR > 90 ml/min per 1.73 m(2) and albuminuria), 2.7% (SE 0.3); stage 2 (GFR 60 to 89 ml/min per 1.73 m(2) and albuminuria), 3.2% (SE 0.4); stage 3 (GFR 30 to 59 ml/min per 1.73 m(2)), 4.2% (SE 0.1); and stage 4 (GFR 15 to 29 ml/min per 1.73 m(2)), 0.2% (SE 0.01). This closely approximates reported US CKD prevalence (11.0% in 1988 through 1994 and 11.7% in 1999 through 2000). The relative risk for progression from CKD stages 3 or 4 to ESRD in US white patients compared with Norwegian patients was 2.5. This was only modestly modified by adjustment for age, gender, and diabetes. Age and GFR at start of dialysis were similar, hypertension and cardiovascular mortality in the populations were comparable, but US white patients were referred later to a nephrologist and had higher prevalence of obesity and diabetes. In conclusion, CKD prevalence in Norway was similar to that in the United States, suggesting that lower progression to ESRD rather than a smaller pool of individuals at risk accounts for the lower incidence of ESRD in Norway.