Chronic kidney disease awareness, prevalence, and trends among US adults, 1999 to 2000
Chronic kidney disease awareness, prevalence, and trends among US adults, 1999 to 2000
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DOI：
10.1681/asn.2004070539
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发表时间：
2005-01-01
影响因子：
13.6
通讯作者：
Hostetter, TH
中科院分区：
文献类型：
--
作者：
Coresh, J;Byrd-Holt, D;Hostetter, TH
从 1991 年到 2000 年，美国肾衰竭治疗的发生率增加了 57%。在 1988 年到 1994 年调查的美国成年人中，慢性肾病 (CKD) 患病率为 11%。本研究的目的是估计 1999 年到 2000 年期间美国人群对 CKD 的认识，并确定与 1988 年到 2000 年相比，美国 CKD 的患病率是否有所增加。 1994. 对具有全国代表性的样本进行了分析 1988 年至 1994 年（n = 15,488）和 1999 年至 2000 年（n = 4101）进行的两次全国健康和营养检查调查中，对 20 岁及以上非收容成年人的 SE 患病率进行了调查。对 CKD 的认知是自我报告的。根据校准的血清肌酐、现场尿白蛋白与肌酐比 (ACR)、年龄、性别和种族来估计肾功能 (GFR)、肾损伤（微量白蛋白尿或更高）和 CKD 阶段（GFR 和白蛋白尿）。 GFR 使用简化的肾脏疾病研究方程中的饮食修改进行估算。 1999 年至 2000 年期间，自我报告的肾脏衰弱或衰竭的意识与肾功能下降和蛋白尿密切相关，但即使同时存在这两种情况，意识也很低。在 GFR 为 15 至 59 ml/min 每 1.73 m(2) 且有蛋白尿的患者中，仅有 24.3 +/- 6.4% 的患者意识到 CKD，而在 GFR 为 90 ml/min 每 1.73 m(2) 或更高且无微量白蛋白尿的患者中，这一比例为 1.1 +/- 0.3%。在肾功能中度下降（GFR 30 至 59 ml/min/1.73 m(2)）时，女性的知晓率远低于男性（2.9 +/- 1.6 vs 17.9 +/- 5.9%；P = 0.008）。中度或严重肾功能下降（GFR 15至59 ml/min/1.73 m(2)）的患病率在过去十年中保持稳定（1988年至1994年为4.4 +/- 0.3%，1999年至2000年为3.8 +/- 0.4%；P = 0.23）。与此同时，单点尿液中白蛋白尿（ACR 2：30 mg/g）的患病率从8.2 +/- 0.4%增加到10.1 +/- 0.7%（P = 0.01）。两项调查中总体 CKD 患病率相似（9% 使用 ACR > 30 mg/g 表示持续性微量白蛋白尿；1988 年至 1994 年为 11%，1999 年至 2000 年为 12%，使用性别特异性 ACR 临界值）。尽管 CKD 患病率很高，但美国人对 CKD 的认识却很低。与接受治疗的肾衰竭人数急剧增加相比，美国人口中 CKD 的总体患病率相对稳定。
The incidence of kidney failure treatment in the United States increased 57% from 1991 to 2000. Chronic kidney disease (CKD) prevalence was 11% among U.S. adults surveyed in 1988 to 1994. The objective of this study was to estimate awareness of CKD in the U.S. population during 1999 to 2000 and to determine whether the prevalence of CKD in the United States increased compared with 1988 to 1994. Analysis was conducted of nationally representative samples of noninstitutionalized adults, aged 20 yr and older, in two National Health and Nutrition Examination Surveys conducted in 1988 to 1994 (n = 15,488) and 1999 to 2000 (n = 4101) for prevalence SE. Awareness of CKD is self-reported. Kidney function (GFR), kidney damage (microalbuminuria or greater), and stages of CKD (GFR and albuminuria) were estimated from calibrated serum creatinine, spot urine albumin to creatinine ratio (ACR), age, gender, and race. GFR was estimated using the simplified Modification of Diet in Renal Disease Study equation. Self-reported awareness of weak or failing kidneys in 1999 to 2000 was strongly associated with decreased kidney function and albuminuria but was low even in the presence of both conditions. Only 24.3 +/- 6.4% of patients at GFR 15 to 59 ml/min per 1.73 m(2) and albuminuria were aware of CKD compared with 1.1 +/- 0.3% at GFR of 90 ml/min per 1.73 m(2) or greater and no microalbuminuria. At moderately decreased kidney function (GFR 30 to 59 ml/min per 1.73 m(2)), awareness was much lower among women than men (2.9 +/- 1.6 versus 17.9 +/- 5.9%; P = 0.008). The prevalence of moderately or severely decreased kidney function (GFR 15 to 59 ml/min per 1.73 m(2)) remained stable over the past decade (4.4 +/- 0.3% in 1988 to 1994 and 3.8 +/- 0.4% in 1999 to 2000; P = 0.23). At the same time, the prevalence of albuminuria (ACR 2: 30 mg/g) in single spot urine increased from 8.2 +/- 0.4% to 10.1 +/- 0.7% (P = 0.01). Overall CKD prevalence was similar in both surveys (9% using ACR > 30 mg/g for persistent microalbuminuria; 11% in 1988 to 1994 and 12% in 1999 to 2000 using gender-specific ACR cutoffs). Despite a high prevalence, CKD awareness in the U.S. population is low. In contrast to the dramatic increase in treated kidney failure, overall CKD prevalence in the U.S. population has been relatively stable.