Hsu Raymond K, Powe Neil R
aDivision of Nephrology bDepartment of Medicine, University of California, San Francisco cPriscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
Curr Opin Nephrol Hypertens. 2017 May;26(3):187-196. doi: 10.1097/MNH.0000000000000315.
We aim to review recent updates on the epidemiology of chronic kidney disease (CKD).
Recent analyses from the National Health and Nutritional Examination survey describe the temporal trend in CKD prevalence in US adults. The overall prevalence of estimated glomerular filtration rate less than 60 ml/min/1.73 m increased from 4.8% in 1988-1994 to 6.9% in 2003-2004, but has since stabilized at 6.4-6.9% up to 2011-2012. Prevalence of CKD stages 1-4 has also stabilized at ∼14% of adults since 2003-2004. The prevalence of diabetic kidney disease - defined as estimated glomerular filtration rate less than 60 ml/min/1.73 m and/or microalbuminuria among adults with diabetes - has similarly plateaued since the early to mid-2000s at ∼26-27%. There is continued rise in CKD and diabetic kidney disease prevalence among blacks and Mexican-Americans, however, in the last decade. Worldwide, a similar pattern of stable prevalence of CKD since the early 2000s is seen in England, Norway, and Korea. Despite these optimistic findings, there are several emerging at-risk populations. Rapid increases in diabetes and hypertension in China may signal an impending growth in CKD. In parts of Central America, there is emergence of very high CKD prevalence among agricultural workers - suspected to be due to occupational and environmental exposures.
Collective efforts to undermine risk factors, such as better control of hypertension and diabetes, have likely helped to abate the growth in CKD in several developed countries within the last decade. More worldwide high-quality and geographically granular data collection on CKD would help to monitor the epidemiology of CKD and potentially assist in identifying impactful interventions.
我们旨在回顾慢性肾脏病（CKD）流行病学的近期进展。
美国国家健康与营养检查调查的最新分析描述了美国成年人CKD患病率的时间趋势。估算肾小球滤过率低于60 ml/min/1.73 m²的总体患病率从1988 - 1994年的4.8%增至2003 - 2004年的6.9%，但此后至2011 - 2012年稳定在6.4% - 6.9%。自2003 - 2004年以来，CKD 1 - 4期的患病率在成年人中也稳定在约14%。糖尿病肾病的患病率（定义为糖尿病成年人中估算肾小球滤过率低于60 ml/min/1.73 m²和/或微量白蛋白尿）自21世纪初至中期以来同样趋于平稳，约为26% - 27%。然而，在过去十年中，黑人和墨西哥裔美国人的CKD及糖尿病肾病患病率持续上升。在全球范围内，自21世纪初以来，英国、挪威和韩国也出现了类似的CKD患病率稳定模式。尽管有这些乐观的发现，但仍有一些新兴的高危人群。中国糖尿病和高血压的快速增长可能预示着CKD即将增加。在中美洲部分地区，农业工人中出现了非常高的CKD患病率，怀疑是由于职业和环境暴露所致。
过去十年中，在一些发达国家，通过共同努力控制高血压和糖尿病等危险因素，可能有助于减缓CKD的增长。在全球范围内收集更多高质量且地理分布详细的CKD数据，将有助于监测CKD的流行病学情况，并可能有助于确定有效的干预措施。
