Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands.
J Epidemiol Glob Health. 2024 Sep;14(3):740-764. doi: 10.1007/s44197-024-00209-5. Epub 2024 Apr 8.
Chronic kidney disease (CKD) etiology varies greatly between developed and developing countries. In addition, differences in underlying pathogenesis and therapeutic options affect the progression towards advanced-CKD. This meta-analysis aims to identify the etiology of advanced-CKD in Southeast Asia.
A systematic search in four electronic-databases and complementary search on national kidney registries and repository libraries was conducted until July 20, 2023. The risk of bias was assessed using Newcastle-Ottawa Scale for observational studies and Version-2 of Cochrane for intervention studies. A random-effects model was used to estimate pooled prevalence. The protocol is registered in the International Prospective Register of Systematic Reviews PROSPERO; Registration ID:CRD42022300786.
We analyzed 81 studies involving 32,834 subjects. The pooled prevalence of advanced-CKD etiologies are diabetic kidney disease (DKD) 29.2% (95%CI 23.88-34.78), glomerulonephritis 20.0% (95%CI 16.84-23.38), hypertension 16.8% (95%CI 14.05-19.70), other 8.6% (95%CI 6.97-10.47), unknown 7.5% (95%CI 4.32-11.50), and polycystic kidney disease 0.7% (95%CI 0.40-1.16). We found a significant increase in DKD prevalence from 21% (9.2%, 95%CI 0.00-33.01) to 30% (95%CI 24.59-35.97) before and after the year 2000. Among upper-middle-income and high-income countries, DKD is the most prevalent (26.8%, 95%CI 21.42-32.60 and 38.9%, 95%CI 29.33-48.79, respectively), while glomerulonephritis is common in lower-middle-income countries (33.8%, 95%CI 15.62-54.81).
The leading cause of advanced-CKD in Southeast Asia is DKD, with a substantial proportion of glomerulonephritis. An efficient screening program targeting high-risk populations (diabetes mellitus and glomerulonephritis) is needed, with the aim to delay CKD progression.
慢性肾脏病（CKD）的病因在发达国家和发展中国家之间存在很大差异。此外，潜在发病机制和治疗选择的差异会影响 CKD 向晚期发展的进程。本荟萃分析旨在确定东南亚晚期 CKD 的病因。
在四个电子数据库中进行系统检索，并在国家肾脏登记处和存储库库中进行补充检索，检索截止日期为 2023 年 7 月 20 日。使用纽卡斯尔-渥太华量表对观察性研究和 Cochrane 版本 2 对干预性研究进行偏倚风险评估。使用随机效应模型估计汇总患病率。该方案已在国际前瞻性系统评价注册库 PROSPERO 中注册；注册号：CRD42022300786。
我们分析了 81 项涉及 32834 名受试者的研究。晚期 CKD 病因的汇总患病率为：糖尿病肾病（DKD）29.2%（95%CI 23.88-34.78）、肾小球肾炎 20.0%（95%CI 16.84-23.38）、高血压 16.8%（95%CI 14.05-19.70）、其他 8.6%（95%CI 6.97-10.47）、原因不明 7.5%（95%CI 4.32-11.50）和多囊肾病 0.7%（95%CI 0.40-1.16）。我们发现，2000 年前和 2000 年后 DKD 的患病率分别从 21%（9.2%，95%CI 0.00-33.01）显著增加到 30%（95%CI 24.59-35.97）。在上中等收入和高收入国家中，DKD 是最常见的病因（26.8%，95%CI 21.42-32.60 和 38.9%，95%CI 29.33-48.79），而肾小球肾炎在中低等收入国家中更为常见（33.8%，95%CI 15.62-54.81）。
东南亚晚期 CKD 的主要病因是 DKD，其中相当一部分是肾小球肾炎。需要针对高危人群（糖尿病和肾小球肾炎）制定有效的筛查计划，以延缓 CKD 的进展。
