Many people in the world are unaware of the existence and implications of chronic kidney disease (CKD). The high and increasing prevalence of CKD in the general population and its associated all-cause mortality should make the condition a public-health priority. These are the conclusions of authors of an Article published in this week's edition of The Lancet.
CKD is associated with a wide range of causes of increased mortality, but the public-health effect of this has not been fully assessed. At earlier stages, chronic kidney disease is believed to be treatable and preventable. But in most countries, national prevalence of chronic kidney disease data are not yet established or have just been assembled, further complicating the full magnitude of the disorder.
Dr Chi-Pang Wen, National Health Research Institutes, Taiwan, and colleagues have taken advantage of the availability of a cohort of almost half a million patients in Taiwan to assess the prevalence and mortality risks for all stages of CKD and quantify its attributable mortality. The cohort consisted of 462 293 people aged over 20 years who participated in a standard medical screening programme from 1994. As of Dec 31, 2006, 14 436 deaths were counted. CKD was calculated using the glomerular filtration rate (GFR - the flow rate of filtered fluid through the kidney), and urinary protein levels.
The national prevalence of CKD was almost 12% (similar to that in USA), but only 3.54% of the cohort were aware of their disorder (compared to 10% in USA). Prevalence was substantially higher in the group with low socioeconomic status than in high status group (19.87% vs 7.33%). A total of 56 777 (12%) of the cohort had CKD; those with the condition had an 83% higher mortality for all causes, and twice as high (100% higher) mortality for cardiovascular causes. The cohort was observed for 13 years with a median follow-up of 7.5 years. Of the deaths in the entire population, 10.3% were attributable to CKD, but this proportion increased to 17.5% in the low socioeconomic status group. Almost 40% of deaths occurred before age 65 years in people with CKD. Interestingly, the authors also noted that people who regularly took Chinese herbal medicines had a 20% increased risk of developing CKD.
The authors say that the number of people affected by CKD was several times more than that for diabetes, and more than half the number affected by high blood pressure. They add that the underdiagnosis and undertreatment of CKD is universal, and that the lack of awareness of the problem and the lost opportunities for prevention are global. They conclude: "The high prevalence and its associated all-cause mortality, especially in people with low socioeconomic status, make reduction of CKD a public-health priority. Promotion of its recognition through the general public knowing their GFR and testing their urine is crucial to reduce premature deaths from all causes and to attenuate this global epidemic."
See also accompanying Comment.
Dr Chi-Pang Wen, National Health Research Institutes, Taiwan T) +886 37 246 166 E) cwengood@nhri.org.tw / 900210@nhri.org.tw
http://multimedia.thelancet.com/pdf/press/kidneydisease.pdf
Journal
The Lancet