智利18岁及以上成年人的慢性肾脏病：2009 - 2010年和2016 - 2017年智利全国卫生横断面调查结果
Chronic kidney disease in adults aged 18 years and older in Chile: findings from the cross-sectional Chilean National Health Surveys 2009-2010 and 2016-2017.
作者信息
Walbaum Magdalena, Scholes Shaun, Pizzo Elena, Paccot Melanie, Mindell Jennifer S
机构信息
Department of Epidemiology and Public Health, University College London Research, London, UK.
Applied Health Research, University College London, London, UK.
出版信息
BMJ Open. 2020 Sep 3;10(9):e037720. doi: 10.1136/bmjopen-2020-037720.
OBJECTIVES
This study estimates the prevalence of chronic kidney disease (CKD) among Chilean adults and examines its associations with sociodemographic characteristics, health behaviours and comorbidities.
DESIGN
Analysis of cross-sectional data from the two most recent large nationally representative Chilean Health Surveys (Encuesta Nacional de Salud, ENS) 2009-2010 and 2016-2017.
PARTICIPANTS
Adults aged 18+ years with serum creatine data (ENS 2009-2010: n=4583; ENS 2016-2017: n=5084).
PRIMARY AND SECONDARY OUTCOME MEASURES
Reduced kidney function (CKD stages 3a-5) based on the estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m) was the primary outcome measure. Using the urine albumin-to-creatinine ratio (ACR ≥30 mg/g), increased albuminuria was ascertained among adults aged 40+ years with diabetes and/or hypertension. Both outcomes were analysed using logistic regression with results summarised using OR. CKD prevalence (stages 1-5) among adults aged 40+ years was estimated including participants with an eGFR of >60 mL/min/1.73 m but with increased albuminuria (stages 1-2).
RESULTS
Overall, 3.2% (95% CI: 2.4% to 3.8%) of adults aged 18+ in ENS 2016-2017 had reduced kidney function. After full adjustment, participants with hypertension (OR: 2.37; 95% CI: 1.19 to 4.74) and those with diabetes (OR: 1.66; 95% CI: 1.03 to 2.66) had significantly higher odds of reduced kidney function. In ENS 2016-2017, 15.5% (13.5% to 17.8%) of adults aged 40+ years with diabetes and/or hypertension had increased albuminuria. Being obese versus normal-weight (OR: 1.66; 95% CI: 1.08 to 2.54) and having both diabetes and hypertension versus having diabetes alone (OR: 2.30; 95% CI: 1.34 to 3.95) were significantly associated with higher odds of increased albuminuria in fully-adjusted analyses. At least 15.4% of adults aged 40+ years in ENS 2016-2017 had CKD (stages 1-5), including the 9.6% of adults at CKD stages 1-2.
CONCLUSIONS
Prevention strategies and Chilean guidelines should consider the high percentage of adults aged 40 years and older at CKD stages 1-2.
目的
本研究估算智利成年人慢性肾脏病（CKD）的患病率，并探讨其与社会人口学特征、健康行为及合并症之间的关联。
设计
对智利最近两次具有全国代表性的大型健康调查（2009 - 2010年全国健康调查，ENS；2016 - 2017年全国健康调查，ENS）的横断面数据进行分析。
参与者
年龄在18岁及以上且有血清肌酐数据的成年人（2009 - 2010年ENS：n = 4583；2016 - 2017年ENS：n = 5084）。
主要和次要结局指标
基于估算的肾小球滤过率（eGFR <60 mL/min/1.73 m²）得出的肾功能下降（CKD 3a - 5期）为主要结局指标。对于40岁及以上患有糖尿病和/或高血压的成年人，使用尿白蛋白与肌酐比值（ACR≥30 mg/g）来确定蛋白尿增加情况。两个结局指标均采用逻辑回归分析，结果以OR汇总。估算40岁及以上成年人中CKD（1 - 5期）的患病率，包括eGFR >60 mL/min/1.73 m²但蛋白尿增加（1 - 2期）的参与者。
结果
总体而言，2016 - 2017年ENS中18岁及以上成年人中有3.2%（95%CI：2.4%至3.8%）肾功能下降。经过全面调整后，患有高血压的参与者（OR：2.37；95%CI：1.19至4.74）和患有糖尿病的参与者（OR：1.66；95%CI：1.03至2.66）肾功能下降的几率显著更高。在2016 - 2017年ENS中，40岁及以上患有糖尿病和/或高血压的成年人中有15.5%（13.5%至17.8%）蛋白尿增加。在全面调整分析中，肥胖与正常体重相比（OR：1.66；95%CI：1.08至2.54）以及同时患有糖尿病和高血压与仅患有糖尿病相比（OR：2.30；95%CI：1.34至3.95）与蛋白尿增加几率显著相关。2016 - 2017年ENS中至少15.4%的40岁及以上成年人患有CKD（1 - 5期），其中9.6%为CKD 1 - 2期成年人。
结论
预防策略和智利指南应考虑40岁及以上处于CKD 1 - 2期的成年人的高比例情况。
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