Ma Yao, Wang Xiang, Zhao Weihong
Division of Nephrology, Department of Geriatrics, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China.
Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China.
PLoS One. 2025 Aug 25;20(8):e0328653. doi: 10.1371/journal.pone.0328653. eCollection 2025.
The Global Burden of Disease (GBD) study provides updated epidemiological descriptions of chronic kidney disease (CKD), yet the discrepancies between its estimates and those from other sources remain unclear. Furthermore, attention is required due to the specificity of standard and computational tool for glomerular filtration rate (GFR). We aimed to evaluate CKD burden from various sources, definitions, and equations.
This study analyzed CKD prevalence among US adults from 1999 to 2018, using data from the GBD study 2021 and the National Health and Nutrition Examination Survey (NHANES). We calculated average prevalence and estimated annual percentage change (EAPC) for the total population and by sex. The analysis was repeated using different definitions and equations. Additionally, a literature review was conducted to extend the comparison to a global scale.
Among US adults, the annual average estimates from the GBD and NHANES were similar, while long-term trends diverged, with disparities becoming more evident in sex-specific subgroups. Removal of racial coefficients led to an increase in the estimated CKD prevalence in Black individuals, while a decrease was observed in White individuals. The EKFC equation yielded the highest average and single-cycle CKD prevalence. Applying age-adapted thresholds reduced the prevalence of low estimated GFR (eGFR<threshold(s)) by approximately 50%, with numbers of older women reclassified into non-CKD categories.
This study highlights the differences in estimated CKD prevalence across various sources. Age-adjusted thresholds and the flexible EKFC equation hold promise for future applications in both epidemiological research and clinical practice.
全球疾病负担（GBD）研究提供了慢性肾脏病（CKD）的最新流行病学描述，但其估计值与其他来源的估计值之间的差异仍不明确。此外，由于肾小球滤过率（GFR）标准和计算工具的特殊性，需要予以关注。我们旨在评估来自不同来源、定义和方程的CKD负担。
本研究利用2021年GBD研究和美国国家健康与营养检查调查（NHANES）的数据，分析了1999年至2018年美国成年人中的CKD患病率。我们计算了总人口和按性别划分的平均患病率以及估计的年度百分比变化（EAPC）。使用不同的定义和方程重复进行分析。此外，还进行了文献综述，以将比较扩展到全球范围。
在美国成年人中，GBD和NHANES的年度平均估计值相似，但长期趋势有所不同，在特定性别的亚组中差异变得更加明显。去除种族系数导致黑人个体的CKD估计患病率增加，而白人个体的患病率则下降。EKFC方程得出的平均和单周期CKD患病率最高。应用年龄适应性阈值可使低估计GFR（eGFR<阈值）的患病率降低约50%，许多老年女性被重新分类为非CKD类别。
本研究强调了不同来源估计的CKD患病率之间的差异。年龄调整阈值和灵活的EKFC方程在未来的流行病学研究和临床实践中都有应用前景。
