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      Chronic Kidney Disease: A Public Health Problem That Needs a Public Health Action Plan

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          Abstract

          For a health problem or condition to be considered a public health issue, four criteria must be met: 1) the health condition must place a large burden on society, a burden that is getting larger despite existing control efforts; 2) the burden must be distributed unfairly (i.e., certain segments of the population are unequally affected); 3) there must be evidence that upstream preventive strategies could substantially reduce the burden of the condition; and 4) such preventive strategies are not yet in place. Chronic kidney disease meets these criteria for a public health issue. Therefore, as a complement to clinical approaches to controlling it, a broad and coordinated public health approach will be necessary to meet the burgeoning health, economic, and societal challenges of chronic kidney disease.

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          Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population.

          Hans Hillege, Vaclav Fidler, Gilles F. H. Diercks … (2002)
          For the general population, the clinical relevance of an increased urinary albumin excretion rate is still debated. Therefore, we examined the relationship between urinary albumin excretion and all-cause mortality and mortality caused by cardiovascular (CV) disease and non-CV disease in the general population. In the period 1997 to 1998, all inhabitants of the city of Groningen, the Netherlands, aged between 28 and 75 years (n=85 421) were sent a postal questionnaire collecting information about risk factors for CV disease and CV morbidity and a vial to collect an early morning urine sample for measurement of urinary albumin concentration (UAC). The vital status of the cohort was subsequently obtained from the municipal register, and the cause of death was obtained from the Central Bureau of Statistics. Of these 85 421 subjects, 40 856 (47.8%) responded, and 40 548 could be included in the analysis. During a median follow-up period of 961 days (maximum 1139 days), 516 deaths with known cause were recorded. We found a positive dose-response relationship between increasing UAC and mortality. A higher UAC increased the risk of both CV and non-CV death after adjustment for other well-recognized CV risk factors, with the increase being significantly higher for CV mortality than for non-CV mortality (P=0.014). A 2-fold increase in UAC was associated with a relative risk of 1.29 for CV mortality (95% CI 1.18 to 1.40) and 1.12 (95% CI 1.04 to 1.21) for non-CV mortality. Urinary albumin excretion is a predictor of all-cause mortality in the general population. The excess risk was more attributable to death from CV causes, independent of the effects of other CV risk factors, and the relationship was already apparent at levels of albuminuria currently considered to be normal.
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            Nephropathy in diabetes.

            Mark Molitch, Ralph A. DeFronzo, Marion Franz … (2004)
            Article 0 comments Cited 219 times – based on 0 reviews     Review now
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              Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000.

              Josef Coresh, Danita D. Byrd-Holt, Brad C. Astor … (2005)
              The incidence of kidney failure treatment in the United States increased 57% from 1991 to 2000. Chronic kidney disease (CKD) prevalence was 11% among U.S. adults surveyed in 1988 to 1994. The objective of this study was to estimate awareness of CKD in the U.S. population during 1999 to 2000 and to determine whether the prevalence of CKD in the United States increased compared with 1988 to 1994. Analysis was conducted of nationally representative samples of noninstitutionalized adults, aged 20 yr and older, in two National Health and Nutrition Examination Surveys conducted in 1988 to 1994 (n = 15,488) and 1999 to 2000 (n = 4101) for prevalence +/- SE. Awareness of CKD is self-reported. Kidney function (GFR), kidney damage (microalbuminuria or greater), and stages of CKD (GFR and albuminuria) were estimated from calibrated serum creatinine, spot urine albumin to creatinine ratio (ACR), age, gender, and race. GFR was estimated using the simplified Modification of Diet in Renal Disease Study equation. Self-reported awareness of weak or failing kidneys in 1999 to 2000 was strongly associated with decreased kidney function and albuminuria but was low even in the presence of both conditions. Only 24.3 +/- 6.4% of patients at GFR 15 to 59 ml/min per 1.73 m(2) and albuminuria were aware of CKD compared with 1.1 +/- 0.3% at GFR of 90 ml/min per 1.73 m(2) or greater and no microalbuminuria. At moderately decreased kidney function (GFR 30 to 59 ml/min per 1.73 m(2)), awareness was much lower among women than men (2.9 +/- 1.6 versus 17.9 +/- 5.9%; P = 0.008). The prevalence of moderately or severely decreased kidney function (GFR 15 to 59 ml/min per 1.73 m(2)) remained stable over the past decade (4.4 +/- 0.3% in 1988 to 1994 and 3.8 +/- 0.4% in 1999 to 2000; P = 0.23). At the same time, the prevalence of albuminuria (ACR >/= 30 mg/g) in single spot urine increased from 8.2 +/- 0.4% to 10.1 +/- 0.7% (P = 0.01). Overall CKD prevalence was similar in both surveys (9% using ACR > 30 mg/g for persistent microalbuminuria; 11% in 1988 to 1994 and 12% in 1999 to 2000 using gender-specific ACR cutoffs). Despite a high prevalence, CKD awareness in the U.S. population is low. In contrast to the dramatic increase in treated kidney failure, overall CKD prevalence in the U.S. population has been relatively stable.
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                Author and article information

                Contributors
                :
                Section of Hypertension/Nephrology, Dartmouth–Hitchcock Medical Center
                ,
                anton.c.schoolwerth@hitchcock.orgOne Medical Center Dr, 2M, Lebanon, NH 03756603-653-3830
                :
                Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Ga
                :
                Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Ga
                :
                Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Ga
                :
                National Kidney Disease Education Program, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md
                :
                National Kidney Foundation, New York, NY
                :
                Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Ga
                :
                Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
                Journal
                Journal ID (nlm-ta): Prev Chronic Dis
                Title: Preventing Chronic Disease
                Publisher: Centers for Disease Control and Prevention
                ISSN (Electronic): 1545-1151
                Publication date Collection: April 2006
                Publication date (Electronic): 15 March 2006
                Volume: 3
                Issue: 2
                Electronic Location Identifier: A57
                Affiliations
                Section of Hypertension/Nephrology, Dartmouth–Hitchcock Medical Center
                Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Ga
                Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Ga
                Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Ga
                National Kidney Disease Education Program, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md
                National Kidney Foundation, New York, NY
                Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Ga
                Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
                Article
                Publisher ID: PCDv32_05_0105
                PMC ID: 1563984
                PubMed ID: 16539798
                SO-VID: 1a28b9f1-d05b-453d-a3e5-cd356a5e615e
                Copyright statement: Copyright @ 2006
                History
                Categories
                Subject: Special Topic
                Series title: PEER REVIEWED

                ScienceOpen disciplines: Health & Social care
                Data availability:
                ScienceOpen disciplines: Health & Social care

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