Prevalence of CKD in the United States: a sensitivity analysis using the National Health and Nutrition Examination Survey (NHANES) 1999-2004.
Prevalence of CKD in the United States: a sensitivity analysis using the National Health and Nutrition Examination Survey (NHANES) 1999-2004.
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DOI：
10.1053/j.ajkd.2008.07.034
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发表时间：
2009-02
期刊：
影响因子：
--
通讯作者：
Collins AJ
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文献类型：
--
作者：
Snyder JJ;Foley RN;Collins AJ
使用1999-2004年连续国家健康和营养检查调查（NHANES）数据集对美国慢性肾病（CKD）的估计表明，13.1%的人口（基于2000年人口普查的2630万人）患有CKD 1-4期。我们进行了敏感度分析，以突出这些估计的基础假设，并说明其对不同假设的稳健性。NHANES 1999-2004是一项全国代表性的跨部门连续调查，针对美国平民和非机构化人口。我们的样本包括年龄≥ 20岁的参与者。估计肾小球滤过率（GFR）< 60 mL/min/1.73 m2，根据肾脏疾病饮食改良（MDRD）研究4变量方程定义;白蛋白尿定义为尿白蛋白与肌酐比值持续> 30 mg/g。[EF1].我们比较了使用MDRD研究方程和其他2个GFR估计方程（Rule及其同事来自马约诊所献血者研究的方程5;根据体表面积校正并校正MDRD研究样本偏倚的Cockcroft-Gault方程）的患病率估计值，以及定义白蛋白尿的性别特异性临界点。我们发现CKD 1-4期患病率估计值范围为11.7%至24.9%，相差超过2倍，使用2006年人口估计值得出的人口估计值介于2580万至5400万之间。仅考虑3期和4期（不受定义白蛋白尿的截点选择的影响），患病率估计值范围为6.3%至18.6%，导致人口估计值为1370万至4030万人，相差近3倍。NHANES 1999-2004是一项横断面调查，允许在一个时间点估计GFR和白蛋白-肌酐比值。NHANES不考虑长期护理设施中的老年人。尽管CKD患病率很高，但无论不同的建模假设如何，不同的假设都会产生患病率估计值的巨大差异。
Estimates of chronic kidney disease (CKD) in the United States, using the continuous National Health and Nutrition Examination Survey (NHANES) dataset 1999–2004, indicate that 13.1% of the population (26.3 million people based on the 2000 census) has CKD stages 1–4. We performed sensitivity analyses to highlight assumptions underlying these estimates and to illustrate their robustness to varying assumptions. NHANES 1999–2004 was a nationally representative cross-sectional continuous survey of the civilian, non-institutionalized US population. Our sample included participants aged ≥ 20 years. Estimated glomerular filtration rate (GFR) < 60 mL/min/1.73m2 defined from the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation; albuminuria defined as persistence of urinary albumin-to-creatinine ratio > 30 mg/g. [EF1]. We compared the prevalence estimates using the MDRD Study equation with 2 other GFR estimating equations (equation #5 by Rule and colleagues from the Mayo Clinic Donors study; Cockcroft-Gault equation adjusted for body surface area and corrected for the bias in the MDRD Study sample), and sex-specific cut points to define albuminuria. We found CKD stages 1–4 prevalence estimates ranging from 11.7% to 24.9%, a more than 2-fold difference, resulting in population estimates between 25.8 million and 54.0 million people using 2006 population estimates. Considering only stages 3 and 4, which are not affected by the choice of cut points to define albuminuria, prevalence estimates ranged from 6.3% to 18.6%, resulting in population estimates of 13.7 million to 40.3 million people, a nearly 3-fold difference. NHANES 1999–2004 is a cross-sectional survey, and allows for GFR and albumin-creatinine ratio estimates at one point in time. NHANES does not account for seniors in long-term care facilities. While CKD prevalence is high regardless of varying modeling assumptions, different assumptions yield large differences in prevalence estimates.
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