Prevalence of chronic kidney disease in persons with undiagnosed or prehypertension in the United States.
Prevalence of chronic kidney disease in persons with undiagnosed or prehypertension in the United States.
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DOI：
10.1161/hypertensionaha.110.150722
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发表时间：
2010-05
期刊：
影响因子：
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通讯作者：
Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
中科院分区：
文献类型：
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作者：
Crews DC;Plantinga LC;Miller ER 3rd;Saran R;Hedgeman E;Saydah SH;Williams DE;Powe NR;Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
高血压既是慢性肾脏疾病的原因，也是其后果，但在整个血压诊断范围内慢性肾脏疾病的患病率尚未确定。我们确定了1999-2006年国家健康和营养检查调查中17,794名成年人血压类别中慢性肾脏疾病的患病率。确诊高血压定义为自我报告的提供者诊断（n= 5，832）;未确诊高血压定义为收缩压≥140 mmHg或舒张压≥90 mmHg，未报告提供者诊断（n= 3，046）;高血压前期定义为收缩压≥120且< 140 mmHg或舒张压≥80且< 90 mmHg（n= 3，719）;收缩压< 120 mmHg，舒张压< 80 mmHg为正常（n=5,197）。慢性肾脏疾病定义为估计肾小球滤过率15-60 ml/min/1.73 m2或尿白蛋白-肌酐比值> 30 mg/g。在多变量logistic回归中，调整年龄、性别和种族后，诊断前和未诊断高血压患者中慢性肾脏病的患病率分别为17.3%和22.0%，而诊断高血压患者为27.5%，血压正常者为13.4%。这种模式在不同的肾脏疾病定义中持续存在;大量白蛋白尿（尿白蛋白-肌酐比值> 300 mg/g）与血压升高类别的相关性最强[比值比2.37（95%置信区间，2.00-2.81）]。慢性肾脏病在未确诊的高血压和高血压前期患者中很普遍。早期识别和治疗这两种疾病可能会预防或延迟慢性肾脏疾病的发病率和死亡率。
Hypertension is both a cause and consequence of chronic kidney disease, but the prevalence of chronic kidney disease throughout the diagnostic spectrum of blood pressure has not been established. We determined the prevalence of chronic kidney disease within blood pressure categories in 17,794 adults surveyed by the National Health and Nutrition Examination Survey during 1999–2006. Diagnosed hypertension was defined as self-reported provider diagnosis (n=5,832); undiagnosed hypertension was defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, without report of provider diagnosis (n=3,046); pre-hypertension was defined as systolic blood pressure ≥120 and < 140 mmHg or diastolic blood pressure ≥80 and < 90 mmHg (n=3,719); and normal was defined as systolic blood pressure < 120 mmHg and diastolic blood pressure < 80 mmHg (n=5,197). Chronic kidney disease was defined as estimated glomerular filtration rate 15–60 ml/min/1.73m2 or urinary albumin-creatinine ratio > 30 mg/g. Prevalence of chronic kidney disease among those with pre- and undiagnosed hypertension was 17.3% and 22.0%, respectively, compared to 27.5% with diagnosed hypertension and 13.4% with normal blood pressure, after adjustment for age, gender and race in multivariable logistic regression. This pattern persisted with varying definitions of kidney disease; macro-albuminuria (urinary albumin-creatinine ratio > 300 mg/g) had the strongest association with increasing blood pressure category [odds ratio 2.37 (95% confidence interval, 2.00–2.81)]. Chronic kidney disease is prevalent in undiagnosed and pre-hypertension. Earlier identification and treatment of both these conditions may prevent or delay morbidity and mortality from chronic kidney disease.