Elsevier

The Lancet

Volume 379, Issue 9818, 3–9 March 2012, Pages 815-822
The Lancet

Articles
Prevalence of chronic kidney disease in China: a cross-sectional survey

https://doi.org/10.1016/S0140-6736(12)60033-6Get rights and content

Summary

Background

The prevalence of chronic kidney disease is high in developing countries. However, no national survey of chronic kidney disease has been done incorporating both estimated glomerular filtration rate (eGFR) and albuminuria in a developing country with the economic diversity of China. We aimed to measure the prevalence of chronic kidney disease in China with such a survey.

Methods

We did a cross-sectional survey of a nationally representative sample of Chinese adults. Chronic kidney disease was defined as eGFR less than 60 mL/min per 1·73 m2 or the presence of albuminuria. Participants completed a lifestyle and medical history questionnaire and had their blood pressure measured, and blood and urine samples taken. Serum creatinine was measured and used to estimate glomerular filtration rate. Urinary albumin and creatinine were tested to assess albuminuria. The crude and adjusted prevalence of indicators of kidney damage were calculated and factors associated with the presence of chronic kidney disease analysed by logistic regression.

Findings

50 550 people were invited to participate, of whom 47 204 agreed. The adjusted prevalence of eGFR less than 60 mL/min per 1·73 m2 was 1·7% (95% CI 1·5–1·9) and of albuminuria was 9·4% (8·9–10·0). The overall prevalence of chronic kidney disease was 10·8% (10·2–11·3); therefore the number of patients with chronic kidney disease in China is estimated to be about 119·5 million (112·9–125·0 million). In rural areas, economic development was independently associated with the presence of albuminuria. The prevalence of chronic kidney disease was high in north (16·9% [15·1–18·7]) and southwest (18·3% [16·4–20·4]) regions compared with other regions. Other factors independently associated with kidney damage were age, sex, hypertension, diabetes, history of cardiovascular disease, hyperuricaemia, area of residence, and economic status.

Interpretation

Chronic kidney disease has become an important public health problem in China. Special attention should be paid to residents in economically improving rural areas and specific geographical regions in China.

Funding

The Ministry of Science and Technology (China); the Science and Technology Commission of Shanghai; the National Natural Science Foundation of China; the Department of Health, Jiangsu Province; the Sichuan Science and Technology Department; the Ministry of Education (China); the International Society of Nephrology Research Committee; and the China Health and Medical Development Foundation.

Introduction

In the past 10 years, chronic kidney disease has received increased attention as a leading public health problem. The burden of chronic kidney disease is not restricted to its effect on demands for renal replacement therapy; the disease has other major effects on the overall population. For example, in the general population, and in high-risk diabetic or hypertensive populations, outcomes, especially mortality and cardiovascular events, are strongly affected by kidney involvement.1, 2, 3 Therefore, through its effect on cardiovascular risk and outcomes as well as end-stage renal disease, chronic kidney disease directly affects the global burden of death caused by cardiovascular disease, the most common cause of premature morbidity and mortality worldwide.1

Chronic kidney disease is highly prevalent in developing countries.4, 5 Rapid increase in the prevalence of risk factors such as diabetes, hypertension, and obesity will result in an even greater burden of chronic kidney disease in the future, and is likely to have substantial socioeconomic and public health consequences in resource-poor countries.4 China is the world's largest developing country. Previous studies have indicated that the prevalence of chronic kidney disease differs substantially between geographical regions in China.6, 7, 8, 9 This heterogeneity might be related to variability in lifestyles and economic development, or differences in study methodology.6, 7, 8, 9 National surveys of chronic kidney disease prevalence in a developing country that incorporate estimated glomerular filtration rate (eGFR) and albuminuria, as well as the ethnic and economic heterogeneity seen in China, are rare.

The China National Survey of Chronic Kidney Disease, done from January, 2007, to October, 2010, was a cross-sectional study designed to provide reliable data for the prevalence of chronic kidney disease and associated factors in adults in China.

Section snippets

Participants

We used a multistage, stratified sampling method to obtain a representative sample of people aged 18 years or older in the general population. We selected 13 provinces (Beijing, Sichuan, Inner Mongolia Autonomous Region, Jiangsu, Xinjiang Uyghur Autonomous Region, Ningxia Hui Autonomous Region, Zhejiang, Guangxi Zhuang Autonomous Region, Guangdong, Shanghai, Hubei, Hunan, and Shandong) by probability proportional to size sampling (initially including 15, to allow for non-responders) from

Results

50 550 people were invited to participate and 47 204 completed the survey and examination. The response rate was 93% (93% for both men and women, 99% in the rural areas and 89% in the urban areas). Urinary creatinine was not measured in 1501 (3·2%) participants because of insufficient sample collection.

Participants with low eGFR or albuminuria were older, less educated, more likely to be women, and had higher prevalences of cardiovascular disease, hypertension, and diabetes, than did

Discussion

In this representative sample of Chinese adults, the prevalence of chronic kidney disease was 10·8%. 119·5 million adults aged 18 years or older have chronic kidney disease as defined in this study, and only 12·5% of them are aware of the condition. A major strength of our study is that it is a nationwide survey in a developing country with large economic heterogeneity and therefore provides a unique dataset with which to explore the effect of multiple demographic variables on the burden and

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