Stanford University School of Medicine, 291 Campus Dr, Stanford, CA 94305, USA.
Global Health. 2014 Feb 20;10:9. doi: 10.1186/1744-8603-10-9.
The burden of chronic kidney disease (CKD) will rise in parallel with the growing prevalence of type two diabetes mellitus in South Asia but is understudied. Using a cross-sectional survey of adults living in a middle-income neighborhood of Dhaka, Bangladesh, we tested the hypothesis that the prevalence of CKD in this group would approach that of the U.S. and would be strongly associated with insulin resistance.
We enrolled 402 eligible adults (>30 years old) after performing a multi-stage random selection procedure. We administered a questionnaire, and collected fasting serum samples and urine samples. We used the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to estimate glomerular filtration rate, and sex-specific cut offs for albuminuria: > 1.9 mg/mmol (17 mg/g) for men, and >2.8 mg/mmol (25 mg/g) for women. We assessed health-related quality of life using the Medical Outcomes Study Short Form-12 (SF-12).
A total of 357 (89%) participants with serum samples comprised the analytic cohort. Mean age of was 49.5 (± 12.7) years. Chronic kidney disease was evident in 94 (26%). Of the participants with CKD, 58 (62%) had albuminuria only. A participant with insulin resistance had a 3.6-fold increase in odds of CKD (95% confidence interval 2.1 to 6.4). Participants with stage three or more advanced CKD reported a decrement in the Physical Health Composite score of the SF-12, compared with participants without CKD.
We found an alarmingly high prevalence of CKD--particularly CKD associated with insulin resistance-in middle-income, urban Bangladeshis.
随着南亚地区 2 型糖尿病患病率的不断上升，慢性肾脏病（CKD）的负担也将相应增加，但目前对这方面的研究还比较匮乏。本研究使用横断面调查方法，对孟加拉国达卡市一个中等收入社区的成年人进行了调查，旨在验证以下假设，即该人群的 CKD 患病率将接近美国水平，并与胰岛素抵抗密切相关。
我们通过多阶段随机抽样程序，选择了 402 名符合条件的成年人（年龄大于 30 岁）参与研究。我们通过问卷调查、采集空腹血清样本和尿液样本的方式，收集了参与者的相关信息。我们使用慢性肾脏病流行病学协作（CKD-EPI）方程来估计肾小球滤过率，并使用白蛋白尿的性别特异性切点值：男性>1.9mg/mmol（17mg/g），女性>2.8mg/mmol（25mg/g）。我们使用医疗结局研究短表 12 项（SF-12）评估了与健康相关的生活质量。
共有 357 名（89%）参与者提供了血清样本，构成了分析队列。参与者的平均年龄为 49.5（±12.7）岁。共有 94 名（26%）参与者患有 CKD。在患有 CKD 的参与者中，有 58 名（62%）仅有白蛋白尿。有胰岛素抵抗的参与者患 CKD 的几率增加了 3.6 倍（95%置信区间为 2.1 至 6.4）。与无 CKD 的参与者相比，患有更严重 CKD（三期及以上）的参与者的 SF-12 生理健康综合评分下降。
我们发现，在孟加拉国的中等收入城市居民中，CKD 的患病率——尤其是与胰岛素抵抗相关的 CKD 患病率——高得惊人。
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