University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Am J Kidney Dis. 2013 Mar;61(3):395-403. doi: 10.1053/j.ajkd.2012.10.018. Epub 2012 Dec 8.
It is not known whether geographic differences in the prevalence of chronic kidney disease exist and are associated with end-stage renal disease (ESRD) incidence rates across the United States.
Cross-sectional and ecologic.
SETTING & PARTICIPANTS: White (n = 16,410) and black (n = 11,109) participants from across the continental United States in the population-based Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.
Geographic region, defined by the 18 networks of the US ESRD Network Program.
OUTCOMES & MEASUREMENTS: Albuminuria, defined as albumin-creatinine ratio ≥30 mg/g, and decreased estimated glomerular filtration rate (eGFR), defined as <60 mL/min/1.73 m(2), were measured in the REGARDS Study. ESRD incidence rates were obtained from the US Renal Data System.
For whites, the network-specific prevalence of albuminuria ranged from 8.4% (95% CI, 3.3%-13.5%) in Network 15 to 14.8% (95% CI, 8.0%-21.6%) in Network 3, and decreased eGFR ranged from 4.3% (95% CI, 2.0%-6.6%) in Network 4 to 16.7% (95% CI, 12.7%-20.7%) in Network 7. For blacks, the prevalence of albuminuria ranged from 12.1% (95% CI, 8.7%-15.5%) in Network 5 to 26.5% (95% CI, 16.7%-36.3%) in Network 4, and decreased eGFR ranged from 6.7% (95% CI, 5.0%-8.4%) in Network 17/18 to 13.4% (95% CI, 7.8%-19.1%) in Network 12. Spearman correlation coefficients for the prevalence of albuminuria and decreased eGFR with network-specific ESRD incidence rates were 0.49 and 0.24, respectively, for whites and 0.29 and 0.25, respectively, for blacks.
There were few cases of albuminuria and decreased eGFR in some geographic regions.
In the United States, substantial geographic variations in the prevalence of albuminuria and decreased eGFR exist, but were correlated only modestly with ESRD incidence, suggesting the chronic kidney disease burden may not explain the geographic variation in ESRD incidence.
目前尚不清楚美国各地慢性肾脏病的流行率是否存在地域差异，以及这些差异是否与终末期肾病（ESRD）的发病率有关。
横断面和生态学研究。
来自美国各地的白人（n = 16410 人）和黑人（n = 11109 人），他们均为基于人群的“美国地理和种族差异中风原因（REGARDS）研究”的参与者。
地理区域，由美国 ESRD 网络计划的 18 个网络定义。
对于白人，网络特异性白蛋白尿的患病率范围从第 15 网络的 8.4%（95%可信区间，3.3%-13.5%）到第 3 网络的 14.8%（95%可信区间，8.0%-21.6%），eGFR 降低的范围从第 4 网络的 4.3%（95%可信区间，2.0%-6.6%）到第 7 网络的 16.7%（95%可信区间，12.7%-20.7%）。对于黑人，白蛋白尿的患病率范围从第 5 网络的 12.1%（95%可信区间，8.7%-15.5%）到第 4 网络的 26.5%（95%可信区间，16.7%-36.3%），eGFR 降低的范围从第 17/18 网络的 6.7%（95%可信区间，5.0%-8.4%）到第 12 网络的 13.4%（95%可信区间，7.8%-19.1%）。白蛋白尿和 eGFR 降低的流行率与网络特异性 ESRD 发病率之间的斯皮尔曼相关系数分别为 0.49 和 0.24，白人的相关系数分别为 0.29 和 0.25，黑人的相关系数分别为 0.29 和 0.25。
在一些地理区域，白蛋白尿和 eGFR 降低的病例数较少。
在美国，白蛋白尿和 eGFR 降低的流行率存在显著的地域差异，但与 ESRD 发病率的相关性仅为中等程度，这表明慢性肾脏病的负担可能无法解释 ESRD 发病率的地域差异。
