Chronic kidney disease: the underrecognized epidemic

Chronic kidney disease: the underrecognized epidemic

Chronic kidney disease, CKD, is not well known in the public. However, its high prevalence and associated mortality should make the condition a public health priority, according to an article released on June 26, 2008 in The Lancet.

CKD, sometimes also called chronic renal disease, involves a progressive decline in function of the kidneys. IT is believed to be preventable, as well as treatable in its earlier stages. This process can be painful, and is associated with many causes of increased mortality. However, the effects of CKD on public health worldwide have not been well researched -- in most countries, the chronic kidney disease data are as of yet unavailable or at best unassembled. As a result, there is a need for analysis of the magnitude of this disorder.

To examine this question, Dr Chi-Pang Wen, National Health Research Institutes, Taiwan, and colleagues examined a cohort of almost half a million patients in Taiwan, focusing on the frequency and risk of mortality for CKD at all stages. The patients were classified as CKD patients by their glomerular filtration rate, a measure of the filtered flow through the kidney, and by the levels of protein in the urine. All 462,293 patients were more than 20 years old and had been screened in a standard program in 1994. As of December 31, 2006, the researchers found 14,436 deaths. The group was observed for 13 years, with a median follow up of 7.5 years.

The researchers found several important trends in this data related to the frequency of the disease. Nationally, CKD was classified in almost 12% of the population, a frequency similar to that of the United States. However, only 3.54% of these patients were aware of their disorder, in comparison to 10% of their counterparts in the US. The disease was more frequent in patients of lower socioeconomic status (19.87%) in comparison with those with higher status (7.33%). People who took Chinese herbal medicines regularly had a 20% increased risk of developing CKD.

Additionally, some conclusions about mortality were made. Those who had the condition had an 83% higher mortality for all causes of death, and twice the risk (200%) of mortality for cardiovascular reasons.  Of all deaths in the population, 10.3% were connected to CKD, but, when this was compared within subjects of low socioeconomic status, this proportion increased. In patients with CKD, almost 40% of deaths occurred before the age of 65.

According to the authors, the frequency of CKD is several times that of diabetes, and more than half that of those affected by high blood pressure. They indicate that the underdiagnosis and undertreament of CKD is common in every country, and there is a global need for increased awareness. "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."

All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462293 adults in Taiwan

Chi Pang Wen, Ting Yuan David Cheng, Min Kuang Tsai, Yen Chen Chang, Hui Ting Chan, Shan Pou Tsai, Po Huang Chiang, Chih Cheng Hsu, Pei Kun Sung, Yi Hua Hsu, Sung Feng Wen

Lancet 2008; 371: 2173-82

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