Prevalence of chronic kidney disease in the United States
Prevalence of chronic kidney disease in the United States
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DOI：
10.1001/jama.298.17.2038
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发表时间：
2007-11-07
影响因子：
120.7
通讯作者：
Levey, Andrew S.
中科院分区：
文献类型：
--
作者：
Coresh, Josef;Selvin, Elizabeth;Levey, Andrew S.
上下文从1988年到2004年，通过透析和移植治疗的肾衰竭的患病率和发病率增加了。在此期间，慢性肾脏病（CKD）的早期阶段的患病率是否存在变化。更新美国CKD的估计患病率。设计，设置和参与者对最新的国家健康和营养检查调查的横断面分析（NHANES 1988-1994和NHANES 1999-2004），一个全国代表性的样本，是1988年至1994年20岁以上的非机构化成年人（n = 15 488）和1999-2004（n = 13 233）。疾病患病率是基于持续性蛋白尿和估计肾小球滤过率（GFR）降低的。从NHANES 1988 - 1994年的重复访问数据中估计微量白蛋白尿症（> 30 mg/g）的持久性。使用肾脏疾病研究方程中的缩写对标准血清肌酐的饮食方程进行了缩写，从1988-1994至1999-2004估计了GFR。 CKD阶段1到4的患病率从1988年至1994年的10.0％（95％置信区间[CI]，9.2％-10.9％）增加到1999 - 2004年的13.1％（95％CI，12.0％-14.1％）患病率为1.3（95％CI，1.2-1.4）。 1988 - 1994年和1999 - 2004年CKD阶段的患病率估计值分别为1.7％（95％CI，1.3％-2.2％）和1.8％（95％CI，1.4％-2.3％）的患病率为1阶段1； 2.7％（95％CI，2.2％3.2％）和3.2％（95％CI，2.6％-3.9％）; 5.4％（95％CI，4.9％-6.0％）和7.7％（95％CI，7.0％-8.4％）的第3阶段；对于4阶段4和0.21％（95％CI，0.15％-0.27％）和0.35％（0.25％-0.45％）和0.25％（0.25％-0.45％）。 GFR降低的患病率仅增加了一部分。从血清肌酐中估计GFR的精度有限，而平均血清肌酐的变化则是CKD的某些患病率的某些患病率。结论率在1999年至2004年美国CKD的患病率高于1988年至1994年的19994年。这种增加的部分原因是糖尿病患病率的增加和高血压的患病率增加，并引起了人们对肾衰竭和CKD其他并发症的未来增加的担忧。
Context The prevalence and incidence of kidney failure treated by dialysis and transplantation in the United States have increased from 1988 to 2004. Whether there have been changes in the prevalence of earlier stages of chronic kidney disease (CKD) during this period is uncertain.Objective To update the estimated prevalence of CKD in the United States.Design, Setting, and Participants Cross-sectional analysis of the most recent National Health and Nutrition Examination Surveys (NHANES 1988-1994 and NHANES 1999-2004), a nationally representative sample of noninstitutionalized adults aged 20 years or older in 1988-1994 (n = 15 488) and 1999-2004 (n = 13 233).Main Outcome Measures Chronic kidney disease prevalence was determined based on persistent albuminuria and decreased estimated glomerular filtration rate (GFR). Persistence of microalbuminuria (> 30 mg/g) was estimated from repeat visit data in NHANES 1988-1994. The GFR was estimated using the abbreviated Modification of Diet in Renal Disease Study equation reexpressed to standard serum creatinine.Results The prevalence of both albuminuria and decreased GFR increased from 1988-1994 to 1999-2004. The prevalence of CKD stages 1 to 4 increased from 10.0% (95% confidence interval [CI], 9.2%-10.9%) in 1988-1994 to 13.1% (95% CI, 12.0%-14.1%) in 1999-2004 with a prevalence ratio of 1.3 (95% CI, 1.2-1.4). The prevalence estimates of CKD stages in 1988-1994 and 1999-2004, respectively, were 1.7% (95% CI, 1.3%-2.2%) and 1.8% (95% CI, 1.4%-2.3%) for stage 1; 2.7% (95% CI, 2.2%3.2%) and 3.2% (95% CI, 2.6%-3.9%) for stage 2; 5.4% (95% CI, 4.9%-6.0%) and 7.7% (95% CI, 7.0%-8.4%) for stage 3; and 0.21% (95% CI, 0.15%-0.27%) and 0.35% (0.25%-0.45%) for stage 4. A higher prevalence of diagnosed diabetes and hypertension and higher body mass index explained the entire increase in prevalence of albuminuria but only part of the increase in the prevalence of decreased GFR. Estimation of GFR from serum creatinine has limited precision and a change in mean serum creatinine accounted for some of the increased prevalence of CKD.Conclusions The prevalence of CKD in the United States in 1999-2004 is higher than it was in 1988-1994. This increase is partly explained by the increasing prevalence of diabetes and hypertension and raises concerns about future increased incidence of kidney failure and other complications of CKD.