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

Emerging Threats

In many parts of the developing world, the epidemiology of CKD is not well elucidated, due to the lack of resources for large-scale health examination surveys and the inconsistent quality of data and application of methods for assessing kidney disease.[32] Another barrier is that GFR-estimating equations have not been well validated in many of these populations. In low-income and middle-income countries, the burden of CKD may be growing as a result of rapid urbanization, exposure to environmental toxins, infectious disease burdens, and increasing rates of noncommunicable diseases such as hypertension and diabetes.[32]

In China, the most populous country in the world with an estimated 1.4 billion population, there have been a few recent ominous snapshots on the epidemiology of CKD. Zhang et al.[33] performed the first comprehensive study exploring prevalence of CKD in China using a multistage, stratified survey sampling methodology involving adults from 13 provinces in China, allowing for nationally representative inferences to be made. GFR was estimated using a modified version[34] of the Modification of Diet in Renal Disease equation adapted for the Chinese population. The study reported an overall prevalence of CKD (defined as eGFR < 60 ml/min/1.73 m2 or ACR ≥ 30 mg/g) of 10.8% (equivalent to nearly 120 million individuals) during the survey period of 2009–2010. Interestingly, most of the patients classified as having CKD in China were diagnosed because of the presence of albuminuria (adjusted prevalence 9.4%), whereas relatively fewer were diagnosed because of diminished eGFR less than 60 ml/min/1.73 m2 (1.7% prevalence). This suggests that the reported results may represent the onset of an evolving CKD boom, with later stages of CKD (including ESRD) expected to increase in the years to come.[35] In a more recent analysis,[36] the same research group reported that CKD related to diabetes has become more common than CKD related to glomerulonephritis in both the general population and in a hospitalized urban population. The findings from these large population studies in China, coupled with a well described rise in the prevalence of diabetes in China,[37,38] signal a strong forewarning of a growing epidemic of CKD to come in China in the upcoming years to decades, perhaps analogous to trends seen in the United States from the 1980s to early 2000s.[5]

Lastly, in the coastal pacific regions of Central America, an alarmingly epidemic of CKD and ESRD has emerged among rural agricultural communities within the past 2 decades.[39] Young male agricultural workers – particularly sugarcane cutters – in these coastal regions of Nicaragua, El Salvador, and to some extent Costa Rica and Guatemala have exhibited high rates of progressive CKD that were disproportionate to known risk factors such as diabetes and hypertension.[39,40] Community-based cross-sectional surveys have reported prevalence rates of CKD (decreased eGFR of <60 ml/min/1.73 m2) to be upward of more than 15–20% range among young agricultural male workers.[41–44] This entity, now named Mesoamerican nephropathy[39,40] or chronic interstitial nephritis in agricultural communities,[45] is characterized by tubulointerstitial nephritis on kidney biopsy and is hypothesized to be triggered by occupational and environmental toxins in these agricultural communities, along with heat stress and repeated episodes of dehydration.

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