Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York.
Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York.
Clin J Am Soc Nephrol. 2023 Jun 1;18(6):739-747. doi: 10.2215/CJN.0000000000000175. Epub 2023 Apr 18.
BACKGROUND: CKD is a major cause of morbidity and mortality in lower-income countries. However, population-based studies characterizing the epidemiology of CKD in these settings are lacking. The study objective was to describe the epidemiology of CKD in a population-based cohort in urban Haiti, including estimates of the prevalence by CKD stage, the magnitude of associated factors with CKD, and the proportion on guideline-recommended treatment. METHODS: We assessed the prevalence of CKD and associated risk factors in the population-based Haiti Cardiovascular Disease Cohort. We analyzed cross-sectional data from 2424 adults who completed a clinical examination, risk factor surveys, and laboratory measurements for serum creatinine, urinary albumin, and urinary creatinine. We compared our results with US estimates from the National Health and Nutrition Examination Survey. CKD was defined as either a reduced eGFR <60 ml/min per 1.73 m 2 or urinary albumin-to-creatinine ratio ≥30 mg/g according to the Kidney Disease Improving Global Outcomes guidelines. Multivariable logistic regression identified associated factors with CKD. RESULTS: The mean age was 42 years, 57% of participants were female, and 69% lived in extreme poverty on ≤1 US dollar per day. The age-standardized prevalence of CKD was 14% (95% confidence interval [CI], 12% to 15%). The age-standardized prevalence of reduced eGFR and elevated urinary albumin-to-creatinine ratio was 3% (95% CI, 2% to 4%) and 11% (95% CI, 10% to 13%), respectively. Diabetes (adjusted odds ratio, 4.1; 95% CI, 2.7 to 6.2) and hypertension (adjusted odds ratio, 2.9; 95% CI, 2.0 to 4.2) were significantly associated with CKD. Only 12% of participants with CKD and albuminuria were on guideline-recommended agents, such as angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. CONCLUSIONS: In a large population-based cohort of Haitian adults, CKD was highly associated with both diabetes and hypertension. The proportion of participants with CKD on treatment was low, underscoring the need for strengthening clinical management and nephrology care health infrastructure in Haiti. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: A Longitudinal Cohort Study to Evaluate Cardiovascular Risk Factors and Disease in Haiti, NCT03892265 .
背景：CKD 是低收入国家发病率和死亡率的主要原因。然而，缺乏这些环境下描述 CKD 流行病学的基于人群的研究。本研究的目的是描述海地城市人群中 CKD 的流行病学，包括 CKD 各阶段的患病率估计、与 CKD 相关的因素的严重程度，以及指南推荐的治疗方法的比例。
方法：我们评估了基于人群的海地心血管疾病队列中 CKD 的患病率和相关风险因素。我们分析了 2424 名成年人的横断面数据，这些成年人完成了临床检查、风险因素调查以及血清肌酐、尿白蛋白和尿肌酐的实验室测量。我们将结果与美国全国健康和营养检查调查的估计值进行了比较。根据肾脏病改善全球结局指南，CKD 定义为 eGFR<60 ml/min/1.73m 2 或尿白蛋白/肌酐比值≥30 mg/g。多变量逻辑回归确定了与 CKD 相关的因素。
结果：平均年龄为 42 岁，57%的参与者为女性，69%的人生活在每天 1 美元以下的极端贫困中。CKD 的年龄标准化患病率为 14%（95%可信区间[CI]，12%至 15%）。eGFR 降低和尿白蛋白/肌酐比值升高的年龄标准化患病率分别为 3%（95%CI，2%至 4%）和 11%（95%CI，10%至 13%）。糖尿病（调整后的优势比，4.1；95%可信区间，2.7 至 6.2）和高血压（调整后的优势比，2.9；95%可信区间，2.0 至 4.2）与 CKD 显著相关。只有 12%的 CKD 和白蛋白尿患者使用了指南推荐的药物，如血管紧张素转换酶抑制剂和血管紧张素 II 受体阻滞剂。
结论：在海地成年人的大型基于人群的队列中，CKD 与糖尿病和高血压密切相关。接受 CKD 治疗的参与者比例较低，这突显了加强海地临床管理和肾脏病保健基础设施的必要性。
临床试验注册名称和注册号：一项评估心血管危险因素和疾病的海地纵向队列研究，NCT03892265。
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