Abstract
Introduction
Chronic kidney disease (CKD) is a major public health problem worldwide, due to its epidemic proportions and to its association with high cardiovascular risk. Therefore, screening for CKD is an increasingly important concept, aiming for early detection and prevention of progression and complications of this disease.
Materials and methods
We studied the prevalence of CKD in the adult population of Iaşi, the largest county in Romania, based on the results of a national general health screening program from 2007 to 2008. The patients were tested for CKD with serum creatinine and urinary dipstick. We used two different methods to estimate the glomerular filtration rate (eGFR): the simplified Modification of Diet in Renal Disease (MDRD) and the CKD Epidemiology Collaboration (CKD-EPI) equations. Based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, we defined CKD as the presence of either eGFR < 60 ml/min/1.73 m2 and/or dipstick proteinuria. The classification of CKD by stage was also done according to the KDIGO criteria.
Results
The study population included 60,969 people. The global prevalence of CKD was found to be 6.69% by the MDRD formula and 7.32% when using the CKD-EPI equation. The prevalence of CKD was much higher in women than in men: 9.09% versus 3.7%, by MDRD, and 9.32% versus 4.85%, by CKD-EPI. By age groups, the prevalence of CKD was 0.95% and 0.64% in persons aged 18–44 years old, 4.27% and 3.57% (45–64 years old), 13.36% and 15.34% (65–79 years old), and 23.59% and 34.56% (>80 years old), according to MDRD and CKD-EPI, respectively. By stages, the prevalence of CKD stage 3a (eGFR 59 to 45 ml/min/1.73 m2) was 5.72% by MDRD and 5.96% according to CKD-EPI, whereas the prevalence of stages 3b, 4, and 5 taken together (eGFR < 45 ml/min/1.73 m2) was 0.96% (MDRD) and 1.35% (CKD-EPI). Patients with CKD were significantly older (71.0 years versus 53.7 years) and had lower levels of serum Hb, total cholesterol, and glutamic pyruvic transaminase, and significantly higher serum creatinine and blood glucose, in comparison with the individuals without CKD. Impaired fasting glucose (106 mg/dl) was found in the CKD population, but not in non-CKD individuals.
Conclusions
Our study is one of the largest ever reported on the prevalence of CKD worldwide, the first one in Romania, and one of the very few of its kind in Europe (particularly in Eastern Europe). The study showed that the prevalence of CKD in our country is around 7%, which is lower than in other countries; however, this could be underestimated due to population selection bias. The prevalence is similar with the MDRD and the CKD-EPI equations; it increases with age and is much higher in women than in men. Impaired fasting glucose was detected in CKD patients, a finding that should probably raise the awareness of the high cardiovascular risk associated with CKD.
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References
Stenvinkel P (2010) Chronic kidney disease: a public health priority and harbinger of premature cardiovascular disease. J Intern Med 268:456–467
Levey AS, Atkins R, Coresh J, Cohen EP, Collins AJ, Eckardt KU, Nahas ME, Jaber BL, Jadoul M, Levin A, Powe NR, Rossert J, Wheeler DC, Lameire N, Eknoyan G (2007) Chronic kidney disease as a global public health problem: approaches and initiatives - a position statement from Kidney Disease Improving Global Outcomes. Kidney Int 72:247–259
Whaley-Connell AT, Sowers JR, Stevens LA, McFarlane SI, Shlipak MG, Norris KC, Chen SC, Qiu Y, Wang C, Li S, Vassalotti JA, Collins AJ (2008) Kidney Early Evaluation Program Investigators. CKD in the United States: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999–2004. Am J Kidney Dis 51(4 Suppl 2):S13–S20
Hosseinpanah F, Kasraei F, Nassiri AA, Azizi F (2009) High prevalence of chronic kidney disease in Iran: a large population-based study. BMC Public Health 31(9):44
Prodjosudjadi W, Suhardjono KS, Pranawa, Widiana IG, Loekman JS, Nainggolan G, Prasanto H, Wijayanti Y, Dharmeizar SM, Nasution MY, Basuki W, Aditiawardana, Harris DC, Pugsley DJ, Working Group of the Indonesian Society of Nephrology (2009) Detection and prevention of chronic kidney disease in Indonesia: initial community screening. Nephrology (Carlton) 14(7):669–674
Chen N, Wang W, Huang Y, Shen P, Pei D, Yu H, Shi H, Zhang Q, Xu J, Lv Y, Fan Q (2009) Community-based study on CKD subjects and the associated risk factors. Nephrol Dial Transplant 24(7):2117–2123
Ingsathit A, Thakkinstian A, Chaiprasert A, Sangthawan P, Gojaseni P, Kiattisunthorn K, Ongaiyooth L, Vanavanan S, Sirivongs D, Thirakhupt P, Mittal B, Singh AK, Thai-SEEK Group (2010) Prevalence and risk factors of chronic kidney disease in the Thai adult population: Thai SEEK study. Nephrol Dial Transplant 25:1567–1575
Kim S, Lim CS, Han DC, Kim GS, Chin HJ, Kim SJ, Cho WY, Kim YH, Kim YS (2009) The prevalence of chronic kidney disease (CKD) and the associated factors to CKD in urban Korea: a population-based cross-sectional epidemiologic study. J Korean Med Sci 24(Suppl):S11–S21
Bastos RM, Bastos MG, Ribeiro LC, Bastos RV, Teixeira MT (2009) Prevalence of chronic kidney disease, stages 3, 4 and 5 in adults. Rev Assoc Med Bras 55:40–44
Vassalotti JA, Li S, Chen SC, Collins AJ (2009) Screening populations at increased risk of CKD: the Kidney Early Evaluation Program (KEEP) and the public health problem. Am J Kidney Dis 53(3):S107–S114
New JP, Middleton RJ, Klebe B, Farmer CK, de Lusignan S, Stevens PE, O’Donoghue DJ (2007) Assessing the prevalence, monitoring and management of chronic kidney disease in patients with diabetes compared with those without diabetes in general practice. Diabet Med 24:364–369
McCullough PA, Li S, Jurkovitz CT, Stevens L, Collins AJ, Chen SC, Norris KC, McFarlane S, Johnson B, Shlipak MG, Obialo CI, Brown WW, Vassalotti J, Whaley-Connell AT, Brenner RM, Bakris GL, KEEP Investigators (2008) Chronic kidney disease, prevalence of premature cardiovascular disease, and relationship to short-term mortality. Am Heart J 156:277–283
Hallan SI, Stevens P (2010) Screening for chronic kidney disease: which strategy? J Nephrol 23:147–155
Public Health Department and National House Insurance Order no. 994/354 regarding the approval of methodological norms for performing and reporting specific activities within the National Program for the Evaluation of the Population’s Health State in Primary Care. Official Journal of Romania no. 409, 19 June 2007
Levey AS, Greene T, Kusek J, Beck GJ, Group MS (2000) A simplified equation to predict glomerular filtration rate from serum creatinine [Abstract]. J Am Soc Nephrol 11:A0828
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J (2009) CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612
Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, De Zeeuw D, Hostetter TH, Lameire N, Eknoyan G (2005) Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 67:2089–2100
Zoccali C, Kramer A, Jager KJ (2010) Chronic kidney disease and end-stage renal disease: a review produced to contribute to the report ‘the status of health in the European Union: towards a healthier Europe’. NDT Plus 3:213–224
de Jong PE, van der Velde M, Gansevoort RT, Zoccali C (2008) Screening for chronic kidney disease: Where does Europe go? Clin J Am Soc Nephrol 3:616–623
Levey AS, Coresh J, Balk E et al (2003) National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification and stratification. Ann Intern Med 139:137–147
De Zeeuw D, Hillege HL, de Jong PE (2005) The kidney, a cardiovascular risk marker and a new target for therapy. Kidney Int 68(Supp 98):S25–S29
Hallan SI, Coresh J, Astor BC, Asberg A, Powe NR, Romundstad S, Hallan H, Lydersen S, Holmen J (2006) International comparison of the relationship of chronic kidney disease prevalence and ESRD risk. J Am Soc Nephrol 17:2275–2284
Otero A, Gayoso P, Garcia F, de Francisco AL, on behalf of the EPIRCE study group (2005) Epidemiology of chronic renal disease in the Galician population: Results of the pilot Spanish EPIRCE study. Kidney Int 68(Supp 99):S16–S19
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470
Levey AS, Greene T, Kusek J, Beck GJ, Group MS (2000) A simplified equation to predict glomerular filtration rate from serum creatinine [Abstract]. J Am Soc Nephrol 11:A0828
Rule AD (2010) The CKD-EPI Equation for Estimating GFR from Serum Creatinine: Real Improvement or More of the Same? Clin J Am Soc Nephrol 5:951–953
Poggio ED, Wang X, Greene T, Van Lente F (2005) Hall PM: Performance of the Modification of Diet in Renal Disease and Cockcroft-Gault equations in the estimation of GFR in health and in chronic kidney disease. J Am Soc Nephrol 16:459–466
Ibrahim H, Mondress M, Tello A, Fan Y, Koopmeiners J, Thomas W (2005) An alternative formula to the Cockcroft-Gault and the Modification of Diet in Renal Disease formulas in predicting GFR in individuals with type 1 diabetes. J Am Soc Nephrol 16:1051–1060
Rule AD, Larson TS, Bergstralh EJ, Slezak JM, Jacobsen SJ, Cosio FG (2004) Using serum creatinine to estimate glomerular filtration rate: Accuracy in good health and in chronic kidney disease. Ann Intern Med 141:929–937
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J (2009) CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612
Levey AS, Stevens LA (2010) Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis 55(4):622–627
Fesler P, Mimran A (2010) Estimation of glomerular filtration rate: What are the pitfalls? Curr Hypertens Rep 2011 Jan 5. [Epub ahead of print]
Schold JD, Navaneethan SD, Jolly SE, Poggio ED, Arrigain S, Saupe W, Jain A, Sharp JW, Simon JF, Schreiber MJ Jr, Nally JV Jr. (2010) Implications of the CKD-EPI GFR Estimation Equation in Clinical Practice. Clin J Am Soc Nephrol 29. [Epub ahead of print]
Delanaye P, Cavalier E, Mariat C, Maillard N, Krzesinski JM (2010) MDRD or CKD-EPI study equations for estimating prevalence of stage 3 CKD in epidemiological studies: which difference? Is this difference relevant? BMC Nephrol 11:8
Matsushita K, Selvin E, Bash LD, Astor BC, Coresh J (2010) Risk implications of the new Epidemiology Collaboration (CKD-EPI) equation compared with the MDRD Study equation for estimated GFR: the Atherosclerosis Risk in Communities (ARIC) study. Am J Kidney Dis 55(4):648–659
Banerjee D, Contreras G, Jaraba I, Carvalho D, Ortega L, Carvalho C, Pezon C, Rosenthal SP, De La Rosa N, Vemuri N, Cherla G, Nahar N (2009) Chronic kidney disease stages 3–5 and cardiovascular disease in the veterans affairs population. Int Urol Nephrol 41:443–451
Alberti KG, Zimmet P, Shaw J (2006) Metabolic syndrome - a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med 23(5):469–480
Guarnieri G, Zanetti M, Vinci P, Cattin MR, Pirulli A, Barazzoni R (2010) Metabolic syndrome and chronic kidney disease. J Ren Nutr 20(5 Supp):S19–S23
Whaley-Connell A, Pavey BS, McCullough PA, Saab G, Li S, McFarlane SI, Chen SC, Vassalotti JA, Collins AJ, Bakris G, Sowers JR, KEEP Investigators (2010) Dysglycemia predicts cardiovascular and kidney disease in the Kidney Early Evaluation Program. J Clin Hypertens (Greenwich) 12:51–58
Yoon YS, Park HS, Yun KE, Kim SB (2009) Obesity and metabolic syndrome-related chronic kidney disease in nondiabetic, nonhypertensive adults. Metabolism 58:1737–1742
Ritz E (2008) Metabolic syndrome and kidney disease. Blood Purif 26:59–62
American Diabetes Association (2003) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 26(suppl 1):S5–S20
Fouque D, Kalantar-Zadeh K, Kopple J et al (2008) A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 73:391–398
Cano NJ, Miolane-Debouit M, Léger J, Heng AE (2009) Assessment of body protein: energy status in chronic kidney disease. Semin Nephrol 29:59–66
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Cepoi, V., Onofriescu, M., Segall, L. et al. The prevalence of chronic kidney disease in the general population in Romania: a study on 60,000 persons. Int Urol Nephrol 44, 213–220 (2012). https://doi.org/10.1007/s11255-011-9923-z
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DOI: https://doi.org/10.1007/s11255-011-9923-z