Abstract
Objectives
End-stage renal disease (ESRD) is a serious public health problem in Guangxi, a province of south China. This prospective study evaluated the characteristics and outcome of rural patients with ESRD in a dialysis center of Guangxi, compared with urban patients in the same period.
Methods
A total of 238 patients (96 rural and 142 urban) who enrolled in 2007 was included in this study and followed up for 1 year. Clinical data including patient basic information, clinical parameters, laboratory tests, data associated with dialysis and prognosis were evaluated and compared between rural and urban groups.
Results
Glomerulonephritis was found to be the most common cause of ESRD in all the cohorts studied, with similar rates of 47.9 and 46.5% in the rural and urban patients, respectively. Compared to urban patients, the rural patients had significantly lower prevalence of diabetic nephropathy (8.3 vs. 24.6%, P < 0.001) and higher prevalence of obstructive uropathy (20.8 vs. 3.5%, P < 0.001); the rural patients were overall younger, with poorer financial supports, but with higher rates of late referrals, poorer renal functions as indicated by related laboratory tests including lower levels of GFR, serum hemoglobin, bicarbonate and Kt/V, but higher prevalence of very low GFR, severe metabolic acidosis, severe anemia and hyperkalemia, higher rate of not initiating dialysis, radial artery puncture and mortality. The cardiovascular events were found to be the most common cause of death in both rural and urban groups.
Conclusions
Glomerulonephritis was found to be the most common cause of ESRD in all the studied patients. The rural patients with ESRD in Guangxi had kidney disease in more advanced stage at the time of first visit to a nephrologist and higher rates of mortality after dialysis initiation, compared to urban patients.
Similar content being viewed by others
References
Yang GH, Huang ZJ, Tan J (1996) Priorities of disease control in China-analysis on mortality data of national disease surveillance points system. Zhonghua Liu Xing Bing Xue Za Zhi 17(4):199–202
Diczfalusy E (1996) The third age, the third world and the third millennium. Contraception 53(1):1–7
Wu Z, Yao C, Zhao D et al (2001) Sino-MONICA project: a collaborative study on trends and determinants in cardiovascular diseases in China. Part I: morbidity and mortality monitoring. Circulation 103:462–468
Yao C, Wu Z, Wu Y (1993) The changing pattern of cardiovascular diseases in China. World Health Stat Q 46:113–118
Lin SY (2003) Nephrology in China: a great mission and momentous challenge. Kidney Int 83:108–110
Bi SH, Cheng LT, Wang T (2008) A survey of chronic kidney disease in a large hospital in China. Ren Fail 30(5):541–545
Zhang L, Zhang P, Wang F et al (2008) Prevalence and factors associated with CKD: a population study from Beijing. Am J Kidney Dis 51(3):373–384
Dialysis and Transplantation Registration Group CSoNCMA (2001) The report about the registration of dialysis and transplantation in China 1999. Chin J Nephrol 17:77–78 [in Chinese]
Demographic situation of Guangxi. http://www.gxzf.gov.cn/gxzf [in Chinese]
China’s statistical yearbook 2007. http://www.stats.gov.cn/tjsj/ndsj/2007/indexeh.htm [in Chinese]
Lok SH (1995) Market reforms and China’s health care system. Social Science and Medicine 41(8):1065–1072
Wong BA, Gabriel SJ (1998) The influence of economic liberalization on urban health care access in the People’s Republic of China. http://www.mtholyoke.edu/courses/sgabriel/chinahealth.htm
Center for China Cooperative Medical Scheme (CCMS) (2006) Progress made at NCMS piloting areas in 2005. http://www.ccms.org.cn/english
New cooperative medical scheme (NCMS) in Guangxi (2007) http://finance.sina.com.cn [in Chinese]
Gong ZF, Tang S, Peng XM et al (2008) The epidemiology characteristics of the uremia patients under maintenance hemodialysis in Guangxi dialysis center from 2006 to 2007. Chin J Nephrol 24(10):765–767 [in Chinese]
Ma YC, Zuo L, Chen JH et al (2006) Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol 17:2937–2944
Bai J (1986) Rural and urban populations of China. Popul Res 3(4):18–28
Cass A, Cunningham J, Snelling P et al (2003) Late referral to a nephrologist reduces access to renal transplantation. Am J Kidney Dis 42(5):1043–1049
Barsoum RS (2003) End-stage renal disease in North Africa. Kidney Int Suppl 94:S111–S114
Plata R, Silva C, Yahuita J et al (2002) The first clinical and epidemiological program on renal disease in Bolivia: a model for prevention and early diagnosis of renal diseases in the developing countries. Nephrol Dial Transplant 13:3034–3036
Zhang AH, Zhong H, Tang W et al (2008) Establishing a renal management clinic in China: initiative, challenges, and opportunities. Int Urol Nephrol 40(4):1053–1058
Liu LS, Chen MQ, Zeng GY et al (2002) A forty-year study on hypertension. Acta Acad Med Sin 24:401–408 [in Chinese]
Gao F (2005) The survey of medical service in Guangxi Zhuang autonomous region [M]. Nanning Guangxi 126–281 [in Chinese]
Ratcliffe PJ, Phillips RE, Oliver DV (1984) Late referral for maintenance dialysis. Br Med J 288:441–443
Roubicek C, Brunet P, Huiart L et al (2000) Timing of nephrology referral: influence on mortality and morbidity. Am J Kidney Dis 36(1):35–41
Arora P, Obrador GT, Ruthazer R et al (1999) Prevalence, predictors, and consequences of late nephrology referral at a tertiary care center. J Am Soc Nephrol 10:1281–1286
Vanherweghem JL, Depierreux M, Tielemans C et al (1993) Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs. Lancet 341:387–391
Debelle FD, Vanherweghem JL, Nortier JL (2008) Aristolochic acid nephropathy: a worldwide problem. Kidney Int 74(2):158–169
Yang HY, Lin JL, Chen KH et al (2006) Aristolochic acid-related nephropathy associated with the popular Chinese herb Xi Xin. J Nephrol 19(1):111–114
Li X, Wang H (2004) Aristolochic acid nephropathy: what we know and what we have to do. Nephrology (Carlton) 9:109–111
Lai MN, Lai JN, Chen PC et al (2009) Increased risks of chronic kidney disease associated with prescribed Chinese herbal products suspected to contain aristolochic acid. Nephrology (Carlton) 14(2):227–234
Dogan E, Erkoc R, Sayarlioglu H et al (2005) Effects of late referral to a nephrologist in patients with chronic renal failure. Nephrology (Carlton) 10:516–519
NKF-K/DOQI clinical practice guidelines for peritoneal dialysis adequacy: update 2000. Am J Kidney Dis 37(1 Suppl 1):S65–S136
Gilmore J (2006) KDOQI clinical practice guidelines and clinical practice recommendations—2006 updates. Nephrol Nurs J 33(5):487–488
Zuo L, Wang M, Wang HY (2005) Habit of nephrologists in monitoring and treatment of chronic kidney disease in China. Chin J Nephrol 21(3):127–132 [in Chinese]
Zhang AH, Cheng LT, Zhu N et al (2007) Comparison of quality of life and causes of hospitalization between hemodialysis and peritoneal dialysis patients in China. Health Qual Life Outcomes 5:49
Minister of Health, China (2005) China health statistics yearbook 2005. http://www.moh.gov.cn [in Chinese]
Wang H, Yip W, Zhang L, Wang L, Hsiao W (2005) Community based health insurance in poor rural China: the distribution of net benefits. Health Policy Plan 20(6):366–374
Center for China Cooperative Medical Scheme (CCMS) (2005) About CCMS: background. http://www.ccms.org.cn/english
World Health Organization (WHO) (2004) Implementing the new cooperative medical schemes in rapidly changing China: issues and options. Office of the World Health Organization Representative in China, Beijing
US Renal Data System (2004) USRDS 2004 annual data report: atlas of end-stage renal disease in the United States, Bethesda, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases
Soucie JM, McClellan WM (1996) Early death in dialysis patients: risk factors and impact on incidence and mortality rates. J Am Soc Nephrol 7:2169–2175
Zuo L, Wang M (2006) Current status of hemodialysis treatment in Beijing, China. Ethn Dis Spring 16(2 Suppl 2):S2-31-4
Avram MM, Sreedhara R, Fein P et al (2001) Survival on hemodialysis and peritoneal dialysis over 12 years with emphasis on nutritional parameters. Am J Kidney Dis 37(1 Suppl 2):S77–S80
Held PJ, Port FK, Wolfe RA et al (1996) The dose of hemodialysis and patient mortality. Kidney Int 50:550–556
US Renal Data System. USRDS 1997 Annual Data Report (1997) The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Bethesda, MD
Port FK, Wolfe RA, Levin NW et al (1990) Income and survival in chronic dialysis patients. ASAIO Transactions 36:M154–M157
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhang, W., Gong, Z., Peng, X. et al. Clinical characteristics and outcomes of rural patients with ESRD in Guangxi, China: one dialysis center experience. Int Urol Nephrol 42, 195–204 (2010). https://doi.org/10.1007/s11255-009-9609-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-009-9609-y