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Prevalence of chronic kidney disease across levels of glycemia among adults in Pudong New Area, Shanghai, China.

Zhou Y, Echouffo-Tcheugui JB, Gu JJ, Ruan XN, Zhao GM, Xu WH, Yang LM, Zhang H, Qiu H, Narayan KM, Sun Q - BMC Nephrol (2013)

Bottom Line: The prevalence of albuminuria, decreased kidney function and CKD each increased with higher glycemic levels (P < 0.001).In a multivariable analysis, the factors associated with CKD were hypertension (Odds ratio [OR] 1.70, 95% confidence interval [CI]: 1.42-2.03), dysglycemia (OR 1.65, 95% CI: 1.39-1.95), female gender (OR 1.48, 95% CI: 1.25-1.75), higher triglycerides (OR 1.14, 95% CI: 1.08-1.20 per mmol/L), higher body mass index (OR 1.08, 95% CI: 1.05-1.10 per kg/m2), and older age (OR 1.02, 95% CI: 1.01 -1.03 per year).As much as 30% of the CKD burden may be associated with dysglycemia among Chinese adults, independent of age, gender and hypertension status.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pudong New Area Center for Disease Control and Prevention, 3039 Zhang Yang Road, Shanghai 200136, China. sunqiao163@hotmail.com.

ABSTRACT

Background: Few population-based studies have examined the relationship between glycemic status and chronic kidney disease (CKD) in China. We examined the prevalence of CKD across categories of glycemia [diagnosed diabetes, undiagnosed diabetes (fasting plasma glucose [FPG] ≥ 126 mg/dL), prediabetes (FPG 100-126 mg/dL) and normal glycemia (FPG <100 mg/dL)] among Chinese adults and assessed the relative contribution of dysglycemia (prediabetes and/or diabetes) to the burden of CKD.

Methods: 5,584 Chinese adults aged 20-79 years were selected from the Pudong New Area of Shanghai through a multistage random sampling. Demographic and lifestyle characteristics, anthropometry and blood pressure were measured. Biochemical assays included FPG, serum creatinine and lipids, urinary creatinine and albumin. Prevalence of albuminuria [urine albumin-to-creatinine ratio (ACR) ≥ 30 mg/g], decreased kidney function and CKD (either decreased kidney function or albuminuria) across levels of glycemia were estimated.

Results: The prevalence of albuminuria, decreased kidney function and CKD each increased with higher glycemic levels (P < 0.001). Based on the MDRD Study equation, the unadjusted CKD prevalence was 30.9%, 28.5%, 14.1% and 9.2% in those with diagnosed diabetes, undiagnosed diabetes, prediabetes and normoglycemia, respectively. The corresponding age-, gender- and hypertension-adjusted CKD prevalence were 25.8%, 25.0%, 12.3% and 9.1%, respectively. In a multivariable analysis, the factors associated with CKD were hypertension (Odds ratio [OR] 1.70, 95% confidence interval [CI]: 1.42-2.03), dysglycemia (OR 1.65, 95% CI: 1.39-1.95), female gender (OR 1.48, 95% CI: 1.25-1.75), higher triglycerides (OR 1.14, 95% CI: 1.08-1.20 per mmol/L), higher body mass index (OR 1.08, 95% CI: 1.05-1.10 per kg/m2), and older age (OR 1.02, 95% CI: 1.01 -1.03 per year). The population attributable risks (PARs) associated with diabetes, prediabetes, dysglycemia (diabetes and prediabetes) and hypertension were 18.4%, 19.7%, 30.3% and 44.5% for CKD as defined by the MDRD study equation, and 15.8%, 24.4%, 29.2% and 10.0% with the CKD-EPI equation. Estimates of prevalence and ORs of the relative contribution of various risk factors to CKD obtained with the CKD-EPI equation were similar.

Conclusions: As much as 30% of the CKD burden may be associated with dysglycemia among Chinese adults, independent of age, gender and hypertension status. Prevention and control of diabetes and prediabetes should be a high priority in reducing the CKD burden in China.

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Comparison of age-adjusted prevalence of CKD with estimation of the GFR by the MDRD Study equation and the CKD-EPI equation, stratified by hypertension or hyperglycemic status. CKD prevalence expressed as mean ± SD. All P values less than 0.05 for ANOVA tests across all four groups. HTN refers to the self-reported patients, those with the use of antihypertensive drugs, or detected with undiagnosed hypertension; DM refers to self-reported type 2 diabetes or elevated FPG (FPG ≥ 100 mg/dL). Abbreviations: MDRD Modification of diet in renal disease, CKD-EPI Chronic kidney disease epidemiology collaboration, FPG Fasting plasma glucose, HTN Hypertension.
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Figure 1: Comparison of age-adjusted prevalence of CKD with estimation of the GFR by the MDRD Study equation and the CKD-EPI equation, stratified by hypertension or hyperglycemic status. CKD prevalence expressed as mean ± SD. All P values less than 0.05 for ANOVA tests across all four groups. HTN refers to the self-reported patients, those with the use of antihypertensive drugs, or detected with undiagnosed hypertension; DM refers to self-reported type 2 diabetes or elevated FPG (FPG ≥ 100 mg/dL). Abbreviations: MDRD Modification of diet in renal disease, CKD-EPI Chronic kidney disease epidemiology collaboration, FPG Fasting plasma glucose, HTN Hypertension.

Mentions: Figure 1 shows data on the relative contribution of dysglycemia (diabetes or prediabetes) and hypertension to the burden of CKD, through a comparison of the age-adjusted prevalence of CKD among individuals with only hypertension, only dysglycemia, both, and neither of these conditions. Regardless of the equation used to derive eGFR, the highest age-adjusted CKD prevalence was consistently observed in those with hypertension and dsyglycemia (19.4% in men and 23.5% in women using the MDRD Study equation; 18.5% in men and 23.8% in women using the CKD-EPI equation). Those with only hypertension or only dysglycemia had a lower prevalence of CKD, and those with neither of these conditions had the lowest prevalence (P < 0.05). Women had a higher prevalence of CKD than men, in any of the hypertension and/or dysglycemia groups (P < 0.05).


Prevalence of chronic kidney disease across levels of glycemia among adults in Pudong New Area, Shanghai, China.

Zhou Y, Echouffo-Tcheugui JB, Gu JJ, Ruan XN, Zhao GM, Xu WH, Yang LM, Zhang H, Qiu H, Narayan KM, Sun Q - BMC Nephrol (2013)

Comparison of age-adjusted prevalence of CKD with estimation of the GFR by the MDRD Study equation and the CKD-EPI equation, stratified by hypertension or hyperglycemic status. CKD prevalence expressed as mean ± SD. All P values less than 0.05 for ANOVA tests across all four groups. HTN refers to the self-reported patients, those with the use of antihypertensive drugs, or detected with undiagnosed hypertension; DM refers to self-reported type 2 diabetes or elevated FPG (FPG ≥ 100 mg/dL). Abbreviations: MDRD Modification of diet in renal disease, CKD-EPI Chronic kidney disease epidemiology collaboration, FPG Fasting plasma glucose, HTN Hypertension.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4225706&req=5

Figure 1: Comparison of age-adjusted prevalence of CKD with estimation of the GFR by the MDRD Study equation and the CKD-EPI equation, stratified by hypertension or hyperglycemic status. CKD prevalence expressed as mean ± SD. All P values less than 0.05 for ANOVA tests across all four groups. HTN refers to the self-reported patients, those with the use of antihypertensive drugs, or detected with undiagnosed hypertension; DM refers to self-reported type 2 diabetes or elevated FPG (FPG ≥ 100 mg/dL). Abbreviations: MDRD Modification of diet in renal disease, CKD-EPI Chronic kidney disease epidemiology collaboration, FPG Fasting plasma glucose, HTN Hypertension.
Mentions: Figure 1 shows data on the relative contribution of dysglycemia (diabetes or prediabetes) and hypertension to the burden of CKD, through a comparison of the age-adjusted prevalence of CKD among individuals with only hypertension, only dysglycemia, both, and neither of these conditions. Regardless of the equation used to derive eGFR, the highest age-adjusted CKD prevalence was consistently observed in those with hypertension and dsyglycemia (19.4% in men and 23.5% in women using the MDRD Study equation; 18.5% in men and 23.8% in women using the CKD-EPI equation). Those with only hypertension or only dysglycemia had a lower prevalence of CKD, and those with neither of these conditions had the lowest prevalence (P < 0.05). Women had a higher prevalence of CKD than men, in any of the hypertension and/or dysglycemia groups (P < 0.05).

Bottom Line: The prevalence of albuminuria, decreased kidney function and CKD each increased with higher glycemic levels (P < 0.001).In a multivariable analysis, the factors associated with CKD were hypertension (Odds ratio [OR] 1.70, 95% confidence interval [CI]: 1.42-2.03), dysglycemia (OR 1.65, 95% CI: 1.39-1.95), female gender (OR 1.48, 95% CI: 1.25-1.75), higher triglycerides (OR 1.14, 95% CI: 1.08-1.20 per mmol/L), higher body mass index (OR 1.08, 95% CI: 1.05-1.10 per kg/m2), and older age (OR 1.02, 95% CI: 1.01 -1.03 per year).As much as 30% of the CKD burden may be associated with dysglycemia among Chinese adults, independent of age, gender and hypertension status.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pudong New Area Center for Disease Control and Prevention, 3039 Zhang Yang Road, Shanghai 200136, China. sunqiao163@hotmail.com.

ABSTRACT

Background: Few population-based studies have examined the relationship between glycemic status and chronic kidney disease (CKD) in China. We examined the prevalence of CKD across categories of glycemia [diagnosed diabetes, undiagnosed diabetes (fasting plasma glucose [FPG] ≥ 126 mg/dL), prediabetes (FPG 100-126 mg/dL) and normal glycemia (FPG <100 mg/dL)] among Chinese adults and assessed the relative contribution of dysglycemia (prediabetes and/or diabetes) to the burden of CKD.

Methods: 5,584 Chinese adults aged 20-79 years were selected from the Pudong New Area of Shanghai through a multistage random sampling. Demographic and lifestyle characteristics, anthropometry and blood pressure were measured. Biochemical assays included FPG, serum creatinine and lipids, urinary creatinine and albumin. Prevalence of albuminuria [urine albumin-to-creatinine ratio (ACR) ≥ 30 mg/g], decreased kidney function and CKD (either decreased kidney function or albuminuria) across levels of glycemia were estimated.

Results: The prevalence of albuminuria, decreased kidney function and CKD each increased with higher glycemic levels (P < 0.001). Based on the MDRD Study equation, the unadjusted CKD prevalence was 30.9%, 28.5%, 14.1% and 9.2% in those with diagnosed diabetes, undiagnosed diabetes, prediabetes and normoglycemia, respectively. The corresponding age-, gender- and hypertension-adjusted CKD prevalence were 25.8%, 25.0%, 12.3% and 9.1%, respectively. In a multivariable analysis, the factors associated with CKD were hypertension (Odds ratio [OR] 1.70, 95% confidence interval [CI]: 1.42-2.03), dysglycemia (OR 1.65, 95% CI: 1.39-1.95), female gender (OR 1.48, 95% CI: 1.25-1.75), higher triglycerides (OR 1.14, 95% CI: 1.08-1.20 per mmol/L), higher body mass index (OR 1.08, 95% CI: 1.05-1.10 per kg/m2), and older age (OR 1.02, 95% CI: 1.01 -1.03 per year). The population attributable risks (PARs) associated with diabetes, prediabetes, dysglycemia (diabetes and prediabetes) and hypertension were 18.4%, 19.7%, 30.3% and 44.5% for CKD as defined by the MDRD study equation, and 15.8%, 24.4%, 29.2% and 10.0% with the CKD-EPI equation. Estimates of prevalence and ORs of the relative contribution of various risk factors to CKD obtained with the CKD-EPI equation were similar.

Conclusions: As much as 30% of the CKD burden may be associated with dysglycemia among Chinese adults, independent of age, gender and hypertension status. Prevention and control of diabetes and prediabetes should be a high priority in reducing the CKD burden in China.

Show MeSH
Related in: MedlinePlus