Detection of risk factors and early indicators of chronic kidney disease in an adult population during a kidney health campaign
Abstract
Introduction: Chronic kidney disease (CKD) in adults is a common condition and a major public health issue worldwide. There has been related to a high risk of End Stage Renal Disease (ESRD), cardiovascular disease and death. Given the increasing incidence of CKD and the availability of effective therapeutic measures, is of vital importance perform early detection of risk factors (RF), in order to delay or prevent progression to ESRD. The optimal cost-effective strategy seems to be an investigation aimed at patients with one or more risk factors for CKD. In order to detect early indicators of CKD and associated risk factors, we conducted a study in an adult population. Methods: In a cross-sectional study was evaluated BP, BMI, blood glucose, serum creatinine and albumin/creatinine ratio in urine sample in 608 people> 18 years. Participants were classified for stages of CKD according to the presence of albuminuria and / or estimated glomerular filtration rate (MDRD4, CKD-EPI and CG). For statistical analysis (Stata 11.0) we used Fisher’s exact test, Ttest and Cox regression to explore the association between variables. Effect measure RR and 95% CI, was considered significant when P <0.05. Results: Mean age 54.8 ± 15.4 years, 72% were females. 61.5% had one or more CKD RF. Presence of CKD RF: age> 55 years 52.8%, hypertension 39.3% obesity 36.8%, carbohydrate metabolism disorders (CHMD)21.2%, diabetes: 14.1% (DBT), smoking 12.31%, albuminuria 11%. CKD was found in 14% of participants, 40% were male, albuminuria in 78.8% and GFR <60 ml/m in 37.6%. The 95.2% of participants with CKD had RF. The following variables were associated with ERC (p <0.05): male gender, age> 55, hypertension, diabetes, obesity, smoking and educational level. In multivariate analysis remained significant: age> 55, obesity, hypertension, diabetes and educational level. The 21.8% of hypertensive patients, 37.3% of those with CHMD and 100% with albuminuria did not know that condition. Conclusion: In this population to be a male, to have> 55 years, hypertension, obesity and diabetes it increases the risk of developing CKD. We identified a high percentage (61.5%) of individuals with RF and ERC. The implementation of campaigns for early detection of RF and treatment would reduce the incidence and progression of CKD. We found a frequency of CKD and albuminuria similar to others international reports contributing to the understanding of this disease and its prevalence in Argentina.
References
Nwankwo E, Bello AK, El Nahas AM. Chronic kidney disease: stemming the global tide. Am J Kidney Dis. 2005;45(1):201-8.
Estados Unidos. Renal Data System. 2003 Annual Data Report: Atlas of End-Stage Renal Disease in the United States [Internet]. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2003. Disponible en: https://www.usrds.org/atlas03.aspx. [Consulta: oct. 2013].
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296-305.
Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298(17):2038-47.
Levey AS, Atkins R, Coresh J, Cohen EP, Collins AJ, Eckardt KU, et al. Chronic kidney disease as a global public health problem: approaches and initiatives - a position statement from Kidney Disease Improving Global Outcomes. Kidney Int. 2007;72(3):247-59.
Chadban SJ, Briganti EM, Kerr PG, Dunstan DW, Welborn TA, Zimmet PZ, et al. Prevalence of kidney damage in Australian adults: The AusDiab kidney study. J Am Soc Nephrol. 2003;14(7 Suppl 2):S131-8.
Singh NP, Ingle GK, Saini VK, Jami A, Beniwal P, Lal M, et al. Prevalence of low glomerular filtration rate, proteinuria and associated risk factors in North India using Cockcroft-Gault and Modification of Diet in Renal Disease equation: an observational, cross-sectional study. BMC Nephrol. 2009;10:4.
Iseki K. Chronic kidney disease in Japan. Intern Med. 2008;47(8):681-9.
Cusumano A, García García G, González Bedat MC. The Latin American Dialysis and Transplant Registry: report 2006. Ethn Dis. 2009;19(1 Suppl. 1):S1-3-6.
Marinovich S, Lavorato C, Celia E, Bisignano L, Soratti M, Hansen Krogh D, et al. Registro Argentino de Diálisis Crónica SAN-INCUCAI 2008. Nefrol Argent. 2011;9(Supl. 1, Parte 1):7-62.
Marinovich S, Lavorato C, Celia E, Bisignano L, Soratti M, Hansen Krogh D, et al. Registro Argentino de Diálisis Crónica SAN-INCUCAI 2008. Nefrol Argent. 2011;9(Supl. 1, Parte 2):71-126.
Howard K, White S, Salkeld G, McDonald S, Craig JC, Chadban S, et al. Cost-effectiveness of screening and optimal management for diabetes, hypertension, and chronic kidney disease: a modeled analysis. Value Health. 2010;13(2):196-208.
Boulware LE, Jaar BG, Tarver-Carr ME, Brancati FL, Powe NR. Screening for proteinuria in US adults: a cost-effectiveness analysis. JAMA. 2003;290(23):3101-14.
Collins AJ, Vassalotti JA, Wang C, Li S, Gilbertson DT, Liu J, et al. Who should be targeted for CKD screening? Impact of diabetes, hypertension, and cardiovascular disease. Am J Kidney Dis. 2009;53(3 Suppl 3):S71-7.
Hallan SI, Dahl K, Oien CM, Grootendorst DC, Aasberg A, Holmen J, et al. Screening strategies for chronic kidney disease in the general population: follow-up of cross sectional health survey. BMJ. 2006;333(7577):1047.
World Health Organization-International Society of Hypertension (WHO/ISH) Guidelines for the Management of Hypertension. Disponible en: http://www.who.int/cardiovascular_diseases/guidelines/hypertension/en. [Consulta: oct. 2013].
American College of Endocrinology Consensus Statement on Quidelines for glycemic control. Endocr Pract. 2002;8(Suppl. 1):6-11.
A desktop guide to Type 2 diabetes mellitus. European Diabetes Policy Group 1999. Diabet Med. 1999;16(9):716-30.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461-70.
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-12.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-72.
Alcázar R, Egocheaga MI, Orte L, Lobos JM, González Parra E, Alvarez Guisasola F, et al. Documento de consenso SEN-semFYC sobre la enfermedad renal crónica. Nefrologia. 2008;28(3):273-82.
American Diabetes Association. Standards of Medical Care in Diabetes 2010. Diabetes Care. 2010;33(Suppl. 1):S11-S61.
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.
Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: a position
statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005;67(6):2089-100.
Levey AS, De Jong PE, Coresh J, El Nahas M, Astor BC, Matsushita K, et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney Int. 2011;80(1):17-28.
Argentina. Ministerio de Salud. Segunda Encuesta Nacional Factores de Riesgo (ENFR) para Enfermedades No transmisibles 2009 [Internet]. 7 p. Disponible en: http://www.bvs.org.ar/pdf/enfr2009.pdf. [Consulta: oct. 2013].
Inserra F, Cornelio C, Daverio S, Dielh S, Samarelli N, Díaz A. Estratificación de la función renal de la población con cobertura social en la ciudad de Buenos Aires. Nefrol Argent. 2003,1:44.
Argentina. Instituto Nacional de Estadística y Censos. Dirección Nacional de Estadísticas Sociales y de Población. Estimaciones y proyecciones de población. Total del país 1950-2015. Buenos Aires: 2004, 33 p. (Análisis Demográfico; no. 30). Disponible en: https://ipiec.tierradelfuego.gob.ar/wp-content/uploads/2013/11/Estimaciones_Proyecciones_Pa%C3%ADs_1950_2015.pdf. [Consulta: oct. 2013].
Jones CA, McQuillan GM, Kusek JW, Eberhardt MS, Herman WH, Coresh J, et al. Serum creatinine levels in the US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis. 1998;32(6):992-9.
Garg AX, Kiberd BA, Clark WF, Haynes RB, Clase CM. Albuminuria and renal insufficiency prevalence guides population screening: results from the NHANES III. Kidney Int. 2002;61(6):2165-75.
Altobelli V, Elbert A, Pastore R, Gianzanti C, Galli B, Samson R, et al. Factores de riesgo de enfermedad renal crónica y cardiovascular en Salta. Libro de resúmenes Congreso Argentino de Nefrología (14° : Puerto Iguazú, Misiones : 21-24 abr. 2005).
Inserra F, Cornelio C, Daverio S, Samarelli N, Díaz A. Frecuencias relativas de diabetes, creatininas elevadas y proteinuria en análisis clínicos de Buenos Aires. Libro de resúmenes Congreso Argentino de Nefrología (13° : San Miguel de Tucumán : 2-5 abr. 2003).
Inserra F, De La Llave G, Alpino M. Castagna R, De La Fuente I, Dorado E, et al. Relevamiento de factores de riesgo y de enfermedad renal en familiares de pacientes en diálisis. Medicina (B. Aires). 2007;67(1):8-18.
Marini A, Bacqué MC, De los Santos R, Dorado E, Wikinski R, Robaina J, et al. Relevamiento de factores de riesgo e indicadores de daño renal y cardiovascular en estudiantes de medicina. Nefrol Dial Traspl. 2009;29(4):153-61.
Centers for Disease Control and Prevention (CDC). Prevalence of chronic kidney disease and associated risk factors--United States, 1999-2004. MMWR Morb Mortal Wkly Rep. 2007;56(8):161-5.
Argentina. Ministerio de Salud, Dirección de Calidad de los Servicios de Salud. Guía de Práctica Clínica sobre prevención y detección precoz de la enfermedad renal crónica en adultos en el primer nivel de atención. Buenos Aires: Programa Nacional de Garantía de Calidad de la Atención Médica, 2010. 83 p.
Robaina J, Leguizamón L, Forlano C, Puchulu F, Pandolfo M, Marini A, et al. Relevamiento de factores de riesgo de enfermedad renal crónica en la población estudiada durante la semana del riñón. Libro de resúmenes Congreso Argentino de Nefrología (12° : Córdoba, Argentina : 14-17 sept. 2011).
