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Title: Chronic Kidney Disease on the Rise, Yet Often Undiagnosed
URL: http://www.pslgroup.com/dg/2245FA.htm
Doctor's Guide
June 26, 2008

NEW YORK -- June 26, 2008 -- The high and increasing prevalence of chronic kidney disease (CKD) in the general population and its associated all-cause mortality should make the condition a public-health priority, according to authors of an article published in this week's edition of The Lancet.

According to background information from the article, CKD is associated with a wide range of causes of increased mortality, but the public-health effect of this has not been fully assessed. At earlier stages, CKD is believed to be treatable and preventable. But in most countries, national prevalence of CKD data is not yet established or the data have just been assembled, further complicating the full magnitude of the disorder.

Chi-Pang Wen, MD, National Health Research Institutes, Taiwan, Republic of China, and colleagues, have taken advantage of the availability of a cohort of almost half a million patients in Taiwan to assess the prevalence and mortality risks for all stages of CKD and quantify its attributable mortality.

The cohort consisted of 462,293 people aged over 20 years who participated in a standard medical screening programme from 1994. As of December 31, 2006, a total of 14,436 deaths were counted. CKD was calculated using the glomerular filtration rate (GFR) and urinary protein levels.

The national prevalence of CKD was almost 12% (similar to that in the United States), but only 3.54% of the cohort were aware of their disorder (compared with 10% in the United States). Prevalence was substantially higher in the group with low socioeconomic status (19.87%) than in the high-status group (7.33%).

A total of 56,777 (12%) within the cohort had CKD. Those with the condition had an 83% higher mortality for all causes, and a 100% or higher mortality for cardiovascular causes. The cohort was observed for 13 years with a median follow-up of 7.5 years. Of the deaths in the entire population, 10.3% were attributable to CKD, but this proportion increased to 17.5% in the low socioeconomic status group. Almost 40% of deaths occurred before age 65 in people with CKD.

The authors say that the number of people affected by CKD was several times more than that for diabetes, and more than half the number affected by high blood pressure. They add that the underdiagnosis and undertreatment of CKD is universal, and that the lack of awareness of the problem and the lost opportunities for prevention are global.

"The high prevalence and its associated all-cause mortality, especially in people with low socioeconomic status, make reduction of CKD a public-health priority. Promotion of its recognition through the general public knowing their GFR and testing their urine is crucial to reduce premature deaths from all causes and to attenuate this global epidemic," the authors wrote.

SOURCE: The Lancet

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