Recent Trends in the Prevalence of Chronic Kidney Disease

Not the Same Old Song

Raymond K. Hsu; Neil R. Powe

Disclosures

Curr Opin Nephrol Hypertens. 2017;26(3):187-196. 

In This Article

International Updates in Temporal Trends in Chronic Kidney Disease Prevalence

Several countries with established health examination survey systems have also updated their CKD prevalence trends in recent years. Below, we review studies with nationally representative data similar to NHANES published within the last 3 years. Figure 1 illustrates the trends in prevalence across these international populations.[10,20–22]

England

Aitken et al.[20] recently reported the temporal trend in CKD prevalence in England from 2003 to 2010. Using data from the Health Surveys for England (HSEs) – a nationally representative survey of individuals aged 16 years or more – the investigators found a national prevalence of CKD (defined as CKD-EPI[11] derived eGFR < 60 ml/min/1.73 m2) to be 5.7% in 2003 and 5.2% in 2009–2010 (Fig. 1). The prevalence of CKD fell in all age and sex subgroups with the exception of men aged 65–74 years in whom there was a slight increase in prevalence. This slight decline in national prevalence of CKD occurred despite a concurrent increase in prevalence of obesity and diabetes, and persisted after adjustment for demographic and clinical factors. Hypertension prevalence decreased, and BP control improved during the period, but these factors did not appear to fully explain the fall in CKD prevalence. The lack of albuminuria measurements from the 2003 HSE precluded the comparison of CKD prevalence defined using both albuminuria and eGFR.[20]

Norway

In a study published in 2016, Hallan et al.[21] reported the trend in prevalence of CKD in a demographically stable county representative of Norway. Using the cross-sectional Nord-TrØndelag Health Study survey data from two periods about a decade apart, the investigators found a stable prevalence of CKD stages 1 through 5 (11.3% in 1995–1997 and 11.1% in 2006–2008, P = 0.42). There was a slight increase in the prevalence of eGFR less than 60 ml/min/1.73 m2 from 4.5% in 1995–1997 to 4.8% in 2006–2008 (P = 0.033) (Fig. 1) but a slight decrease in prevalence of albuminuria (ACR ≥ 30 mg/g) from 7.9 to 7.4%. With analysis of potential risk factors acting as modifiers of CKD prevalence, the authors found that lowered BP over time was the most significant modifier of the lowered CKD prevalence over time. More specifically, it was postulated that better hypertension control and greater use of RAS-inhibitors are factors that probably contributed to the decrease in prevalence of albuminuria but increase in prevalence of eGFR less than 60 ml/min/1.73 m2.[30] Despite an increase in the prevalence of diabetes and obesity during this decade, the proportion of diabetic patients with CKD decreased from 33.4 to 28.6%.[21]

Korea

Kang et al.[31] recently reported the temporal trend in CKD prevalence in adults in South Korea using multiple phases of the nationally representative Korean NHANES. In men, the prevalence of eGFR less than 60 ml/min/1.73 m2 was 1.0% in 1998, 5.4% in 2001, 3.1% in 2005, and 2.6% in 2007–2009; in women, prevalence of eGFR less than 60 ml/min/1.73 m2 was 3.4% in 1998, 9.7% in 2001, 10.2% in 2005, and 4.6% in 2007–2009. Using only urine dipstick measurements to assess proteinuria and defining CKD as eGFR less than 60 ml/min/1.73 m2 or dipstick proteinuria at least 1+, there was a similar trend of decreased CKD prevalence since 2001 for men and since 2005 for women. This study was limited by the lack of more quantitative proteinuria measurements and the lack of explanation for potential in serum creatinine assay drift. Figure 1 includes data points from an earlier Korean study[22] comparing the overall prevalence in eGFR less than 60 ml/min/1.73 m2 showing declining overall prevalence from the 2005–2007 surveys (as the more recent study by Kang et al.[31] only provided sex-specific prevalence rates).

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