Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey
Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey
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DOI：
10.1053/ajkd.2003.50007
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发表时间：
2003-01-01
影响因子：
13.2
通讯作者：
Levey, AS
中科院分区：
文献类型：
--
作者：
Coresh, J;Astor, BC;Levey, AS
背景：近期制定的临床实践指南以及对第三次全国健康和营养检查调查（NHANES III）血清肌酐测定的校准，为依据基于估算的肾小球滤过率（GFR）和持续性蛋白尿的标准化标准来估算美国慢性肾脏病（CKD）的患病率和分布情况提供了基础。
方法：对来自NHANES III的15625名20岁及以上的非机构化成年人进行了具有全国代表性的样本分析。根据校准后的血清肌酐水平、即时尿白蛋白水平、年龄、性别和种族来估算肾功能（GFR）、肾损伤（蛋白尿）以及慢性肾脏病的分期（GFR和蛋白尿）。使用简化的肾脏病饮食改良研究方程估算GFR，并与用于肌酐清除率（CCr）的考克罗夫特 - 高尔特方程进行比较。
结果：美国成年人群中慢性肾脏病的患病率为11%（1920万人）。按分期来看，估计有590万人（3.3%）处于1期（持续性蛋白尿且GFR正常），530万人（3.0%）处于2期（持续性蛋白尿且GFR为60 - 89 mL/min/1.73 m²），760万人（4.3%）处于3期（GFR为30 - 59 mL/min/1.73 m²），40万人（0.2%）处于4期（GFR为15 - 29 mL/min/1.73 m²），30万人（0.2%）处于5期，即肾衰竭。除了高血压和糖尿病，年龄是慢性肾脏病的关键预测因素，在65岁以上无高血压或糖尿病的人群中，11%患有3期或更严重的慢性肾脏病。与GFR估算值相比，CCr估算值随年龄下降得更陡，并且在非西班牙裔黑人中更低。
结论：慢性肾脏病很常见，需要使用标准化标准来改进检测和分类，以改善预后。
Background: Recently developed clinical practice guidelines and calibration of the Third National Health and Nutrition Examination Survey (NHANES III) serum creatinine assay provide a basis for estimating the prevalence and distribution of chronic kidney disease (CKD) in the United States using standardized criteria based on estimated glomerular filtration rate (GFR) and persistent albuminuria. Methods: A nationally representative sample of 15,625 noninstitutionalized adults aged 20 years and older from the NHANES III was analyzed. Kidney function (GFR), kidney damage (albuminuria), and stages of CKD (GFR and albuminuria) were estimated from calibrated serum creatinine level, spot urine albumin level, age, sex, and race. GFR was estimated using the simplified Modification of Diet in Renal Disease Study equation and compared with the Cockcroft-Gault equation for creatinine clearance (CCr). Results: The prevalence of CKD in the US adult population was 11% (19.2 million). By stage, an estimated 5.9 million individuals (3.3%) had stage 1 (persistent albuminuria with a normal GFR), 5.3 million (3.0%) had stage 2 (persistent albuminuria with a GFR of 60 to 89 mL/min/1.73 m(2)), 7.6 million (4.3%) had stage 3 (GFR, 30 to 59 mL/min/1.73 m2), 400,000 individuals (0.2%) had stage 4 (GFR, 15 to 29 mL/min/1.73 m(2)), and 300,000 individuals (0.2%) had stage 5, or kidney failure. Aside from hypertension and diabetes, age is a key predictor of CKD, and 11% of individuals older than 65 years without hypertension or diabetes had stage 3 or worse CKD. Compared with GFR estimates, CCr estimates showed a steeper decline with age and were lower in non-Hispanic blacks. Conclusion: CKD is common and warrants improved detection and classification using standardized criteria to improve outcomes.