Chronic kidney disease epidemic: myth and reality

SELECTED PAPERS - SUBCLINICAL RENAL INSUFFICIENCY
  • 189 Downloads

Abstract

In recent years, an epidemic of chronic kidney disease (CKD) has emerged as one of the major public health problem. The prevalence of CKD is largely sustained by the inclusion of a substantial proportion of the elderly population within stage 3 CKD, according to the Kidney Disease Outcomes Quality Initiative staging system. However, some clarifications are necessary when interpreting these data. In fact, renal function “normally” declines with age, without bearing any unfavourable outcome; in addition, the Modification of Diet in Renal Disease formula used to calculate glomerular filtration rate (GFR) underestimates kidney function in the elderly and in women. Considerable interest in CKD has been generated by the evidence that predialysis CKD is associated with the increased risk of cardiovascular disease (CVD). Again, potential confounding factors must be ruled out. Age is thought to play a major role in this context. The most common causes of CKD, hypertension and diabetes mellitus, are also known to affect cardiovascular outcomes directly, thus preventing the recognition of an independent effect of kidney dysfunction on mortality by CVD. Taken together, these considerations point for a better definition of CKD. Early identification of patients at risk for accelerated decline in renal function is mandatory to plan strategies for screening and preventing CKD and its complications. At present, detection of CKD in the general population requires a multi-dimensional approach that should include the evaluation of clinical risk conditions, evaluation of albuminuria and sequential monitoring of GFR.

Keywords

Chronic kidney disease Epidemic GFR estimation Cardiovascular diseases Cardio-renal syndrome 

References

  1. 1.
    National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 39(S1):S1–S246Google Scholar
  2. 2.
    Brenner BM (2003) Retarding the progression of renal disease. Kidney Int 64:370–378PubMedCrossRefGoogle Scholar
  3. 3.
    Levey AS, Bosch JP, Breyer Lewis J et al (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 130(6):461–470PubMedGoogle Scholar
  4. 4.
    Eknoyan G, Lameire N, Barsoum R et al (2004) The burden of kidney disease: improving global outcomes. Kidney Int 66(4):1310–1314PubMedCrossRefGoogle Scholar
  5. 5.
    El Nahas AM, Bello AK (2005) Chronic kidney disease: the global challenge. Lancet 365(9456):331–341CrossRefGoogle Scholar
  6. 6.
    US Renal Data System (2008) USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MDGoogle Scholar
  7. 7.
    Coresh J, Selvin E, Stevens LA et al (2007) Prevalence of chronic kidney disease in the United States. JAMA 298(17):2038–2048PubMedCrossRefGoogle Scholar
  8. 8.
    Cirillo M, Laurenzi M, Mancini M et al (2006) Low glomerular filtration in the population: prevalence, associated disorders, and awareness. Kidney Int 70:800–806PubMedCrossRefGoogle Scholar
  9. 9.
    Minutolo R, De Nicola L, Mazzaglia G et al (2009) Detection and awareness of moderate to advanced chronic kidney disease in Italian primary care offices: a cross sectional study. Am J Kidney Dis 52:444–453CrossRefGoogle Scholar
  10. 10.
    Hallan SI, Dahl K, Oien CM et al (2006) Screening strategies for chronic kidney disease in the general population: follow-up of cross sectional health survey. BMJ. 18:1047–1052CrossRefGoogle Scholar
  11. 11.
    Eriksen BO, Ingebretsen OC (2006) The progression of chronic kidney disease: a 10 year population-based study of the effects of gender and age. Kidney Int 69(2):375–382PubMedCrossRefGoogle Scholar
  12. 12.
    Coresh J, Astor BC, Greene T et al (2003) Prevalence of chronic kidney disease and decreased kidney function in the adult US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis 41(1):1–12PubMedCrossRefGoogle Scholar
  13. 13.
    Klahr S, Levey AS, Beck GJ et al (1994) The effects of dietary protein restriction and blood-pressure control on the progression of renal disease. Modification of Diet in Renal Disease Study Group. N Eng J Med 330(13):877–884CrossRefGoogle Scholar
  14. 14.
    Hemmelgarn BR, Zhan J, Manns BJ et al (2006) Progression of kidney dysfunction in the community dwelling elderly. Kidney Int 69(12):2155–2161PubMedCrossRefGoogle Scholar
  15. 15.
    United States Census Bureau (2010). http://www.census.gov
  16. 16.
    European Commissioni Eurostat database (2010). http://ec.europa.eu/eurostat
  17. 17.
    Davies DF, Shock NW (1950) Age changes in glomerular filtration rate, effective renal plasma flow and tubular excretory capacity in adult males. J Clin Invest 29(5):496–506PubMedCrossRefGoogle Scholar
  18. 18.
    Esposito C, Plati AR, Mazzullo T et al (2007) Renal function and functional reserve in healthy elderly individuals. J Nephrol 20(5):617–625PubMedGoogle Scholar
  19. 19.
    Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16(1):31–41PubMedCrossRefGoogle Scholar
  20. 20.
    Franch HA, Mitch WE (1998) Catabolism in uremia: the impact of metabolic acidosis. J Am Soc Nephrol 9(12 Suppl):S78–S81PubMedGoogle Scholar
  21. 21.
    Rule AD, Bailey KR, Schwartz GL et al (2009) For estimating creatinine clearance measuring muscle mass gives better results than those based on demographics. Kidney Int 75(10):1071–1078PubMedCrossRefGoogle Scholar
  22. 22.
    Wetzels JFM, Kiemeney LALM, Swinkels DW et al (2007) Age- and gender-specific reference values of estimated GFR in Caucasians: The Nijmengen Biomedical Study. Kidney Int 72(5):632–637PubMedCrossRefGoogle Scholar
  23. 23.
    Kung HC, Hoyert DL, Xu JQ, Murphy SL (2008) Deaths: Final data for 2005. National vital statistics reports, vol 56, no 10. National Center for Health Statistics, HyattsvilleGoogle Scholar
  24. 24.
    Foley RN, Parfrey PS, Sarnak MJ (1998) Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 5(suppl 3):S112–S119CrossRefGoogle Scholar
  25. 25.
    Go AS, Chertow GM, Fan D et al (2004) Chronic kidney disease and the risks of death, cardiovascular events and hospitalization. N Eng J Med 351(13):1296–1305CrossRefGoogle Scholar
  26. 26.
    O’Hare A, Bertenthal D, Covinsky KE et al (2006) Mortality risk stratification in chronic kidney disease: one size for all ages? J Am Soc Nephrol 17:846–853PubMedCrossRefGoogle Scholar
  27. 27.
    Roderick PJ, Atkins RJ, Smeeth L et al (2009) CKD and mortality risk in older people: a community-based population study in the United Kingdom. Am J Kidney Dis 53(6):950–960PubMedCrossRefGoogle Scholar
  28. 28.
    Raymond NT, Zehnder D, Smith SCH et al (2007) Elevated relative mortality risk with mild-to-moderate chronic kidney disease decreases with age. Nephrol Dial Transplant 22(11):3214–3220PubMedCrossRefGoogle Scholar
  29. 29.
    Ruilope LM, Salvetti A, Jamerson K et al (2001) Renal function and intensive lowering of blood pressure in hypertensive participants of hypertension optimal treatment (HOT) study. J Am Soc Nephrol 12(2):218–225PubMedGoogle Scholar
  30. 30.
    UK Prospective Diabetes Study (UKPDS) Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352(9178):837–853Google Scholar
  31. 31.
    Whelton PK, He J, Appel LJ et al (2002) Primary prevention of hypertension: clinical and public health advisory from the National High Blood Pressure Education Program. JAMA 288(155):1882–1888PubMedCrossRefGoogle Scholar
  32. 32.
    Winearls CG, Glassock RJ (2009) Dissecting and refining the staging of chronic kidney disease. Kidney Int 75:1009–1014PubMedCrossRefGoogle Scholar
  33. 33.
    Mangione F, Dal Canton A (2010) The epidemic of chronic kidney disease: looking at ageing and cardiovascular disease through kidney-shaped lenses. J Intern Med 268:449–455PubMedCrossRefGoogle Scholar
  34. 34.
    Viberti G, Hill RD, Jarrett RJ et al (1982) Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet 1(8287):1430–1432PubMedCrossRefGoogle Scholar
  35. 35.
    Gerstein HC, Mann JF, Yi Q et al (2001) Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 286:421–426PubMedCrossRefGoogle Scholar
  36. 36.
    Mann JF, Yi Q, Gerstein HC (2004) Albuminuria as a predictor of cardiovascular and renal outcomes in people with known atherosclerotic cardiovascular disease. Kidney Int Suppl 92:S59–S62PubMedCrossRefGoogle Scholar
  37. 37.
    Hillege HL, Fidler V, Diercks GF et al (2002) Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 106:1777–1782PubMedCrossRefGoogle Scholar
  38. 38.
    Hallan SI, Ritz E, Lydersen S et al (2009) Combining GFR and albuminuria to classify CKD improves prediction of ESRD. J Am Soc Nephrol 20:1069–1077PubMedCrossRefGoogle Scholar
  39. 39.
    Hoerger TJ, Wittenborn JS, Segel JE et al (2010) A health policy model of CKD: 2. The cost-effectiveness of microalbuminuria screening. Am J Kidney Dis 55:463–473PubMedCrossRefGoogle Scholar
  40. 40.
    Atthobari J, Asselbergs FW, Boersma C et al (2006) Cost-effectiveness of screening for albuminuria and subsequent fosinopril treatment to prevent cardiovascular events: a pharmacoeconomic analysis linked to the Prevention of Renal and Vascular End Stage Disease (PREVEND) Study and the Prevention of Renal and Vascular End Stage Disease Intervention Trial (PREVEND-IT). Clin Ther 28:432–444PubMedCrossRefGoogle Scholar
  41. 41.
    Mangione F, Esposito C, Dal Canton A (2010) Cost-effectiveness of screening for and treating albuminuria in individuals without diabetes or hypertension: are we moving beyond the evidence? Am J Kidney Dis 56:801PubMedCrossRefGoogle Scholar
  42. 42.
    Peralta CA, Shlipak MG, Judd S et al (2011) Detection of chronic kidney disease with creatinine, cystatin C and urine albumin-to-creatinine ratio and association with progression to end-stage renal disease and mortality. JAMA 305:1545–1552PubMedCrossRefGoogle Scholar

Copyright information

© SIMI 2011

Authors and Affiliations

  1. 1.Section of Nephrology, Department of Internal Medicine and Medical TherapeuticsUniversity of PaviaPaviaItaly
  2. 2.Unit of Nephrology, Dialysis and Renal TransplantationFondazione IRCCS Policlinico San MatteoPavia (PV)Italy

Personalised recommendations