Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
BMC Nephrol. 2014 Jun 13;15:90. doi: 10.1186/1471-2369-15-90.
Chronic kidney disease (CKD) is increasing being recognized as a global public health problem. However, there is dearth of information on the prevalence, determinants, and management of CKD from low- and middle-income countries. The objectives of the study were to determine the 1) prevalence of CKD; 2) socio-demographic and clinical factors associated with CKD; and 3) the existing management of these patients with regards to blood pressure control, and use of antihypertensive medications.
We conducted a cross-sectional study on 2873 participants aged ≥ 40 years in 12 representative communities in Karachi, Pakistan. The primary outcome was clinically significant CKD defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 estimated by CKD-EPI (CKD Epidemiology Collaboration) Pakistan equation (0.686 × CKD-EPI1.059) or urinary albumin to creatinine ratio ≥ 3 mg/mmol (i.e. KDOQI CKD stage G3, A2 or worse).
The overall prevalence (95% CI) of CKD was 12.5% (11.4 - 13.8%). The factors independently associated with CKD were older age, hypertension, diabetes, elevated systolic blood pressure, raised fasting plasma glucose, raised triglycerides, and history of stroke (p<0.05 for each). About 267 (74.4%, 69.5 - 78.8%) adults with CKD had concomitant hypertension. Of these, 130 (48.7%, 42.6 - 54.9%) were on antihypertensive medications, and less than 20% had their BP controlled to conventional target of ≤ 140/90 mm Hg, and only 16.9% (12.6 - 21.9%) were on blockers of renin-angiotensin system alone or in combination with other drugs.
Clinically significant CKD is common among Pakistani adults. The conventional risk factors for CKD and poor control of blood pressure among patients with CKD highlight the need to integrate CKD prevention and management in the primary care infrastructure in Pakistan, and possibly neighbouring countries.
慢性肾脏病（CKD）日益被认为是一个全球性公共卫生问题。然而，来自中低收入国家的 CKD 患病率、决定因素和管理信息却十分匮乏。本研究的目的是确定：1）CKD 的患病率；2）与 CKD 相关的社会人口学和临床因素；3）这些患者在血压控制以及抗高血压药物使用方面的现有管理情况。
我们在巴基斯坦卡拉奇的 12 个具有代表性的社区中对 2873 名年龄≥40 岁的参与者进行了横断面研究。主要结局为临床显著 CKD，定义为通过 CKD-EPI（CKD 流行病学合作）巴基斯坦方程（0.686×CKD-EPI1.059）估计肾小球滤过率（eGFR）<60mL/min/1.73m2（即 KDOQI CKD 分期 G3、A2 或更差）或尿白蛋白与肌酐比值≥3mg/mmol。
CKD 的总体患病率（95%CI）为 12.5%（11.4-13.8%）。与 CKD 独立相关的因素为年龄较大、高血压、糖尿病、收缩压升高、空腹血糖升高、甘油三酯升高和中风史（每项 p<0.05）。约 267 名（74.4%，69.5-78.8%）CKD 患者合并高血压。其中，130 名（48.7%，42.6-54.9%）正在服用抗高血压药物，不到 20%的患者血压控制达到传统目标≤140/90mmHg，只有 16.9%（12.6-21.9%）单独或联合使用肾素-血管紧张素系统阻滞剂。
临床显著 CKD 在巴基斯坦成年人中很常见。CKD 的常规危险因素以及 CKD 患者血压控制不佳，突出表明需要将 CKD 预防和管理纳入巴基斯坦的初级保健基础设施中，并且可能需要纳入邻国。
