| Backgroud and objectivesChronic kidney disease(CKD) is a common disease that threatening life and health of human being with its high prevalence, low awareness, difficult treatment and high medical expense. It has became a worldwide public health problem. Many countries have reported the high prevalence rate, while a complete national epidemiology of CKD is absent in China. There were several reports about CKD epidimology in other regions of China except the southwest region. The prevalence of CKD in different area, different gender and different age groups in Sichuan is still unknown. Therefore, screening for CKD in Sichuan Province will allow us to acquire the epidemiology of CKD in this area, and to establish an effective, applicable strategy for CKD prevention and manangement. The incidence of metabolic syndrome(MS) is increasing, and researches have revealed its intimated relationship with CKD. But the influence of CKD by different components of MS is still unclear, so it is important to uncover this relation for establishing effective policy for CKD prevention and management.In this research, people from Sichuan province were enrolled for CKD screening, the prevalence and risk factors were analysed, and the relation between CKD and metabolic syndrome was studied at the same time.Study design and methodsThis research was based on the situation of Sichuan province,3024 people older than 18 years were enrolled by cluster random sampling. Acording to the design,3300 people should be enrolled, the actual investigated people were 3024 with a responsed rate of 91.6%. This rearch included a questionnaire (demographic characteristics, history of chronic disease, past history, family history, behavior and diet status, etc.), physical exminations (body height, weight, waist circumference, hip circumference and blood pressure) and laboratory examinations (urine routine and sediment, urine albumin and urine creatinine). CKD was diagnosed by decreased eGFR(<60ml/min/1.73m2) or presentation of microalbuminuria, macroalbuminuria, proteinuria or hematuria. MS was diagnosed according to International Diabetes Federation guidelines. A cross-secitonal study was adopted to investigate the Sichuan adults about the prevalence, awareness rate, and current status of treatment of CKD, metabolic syndrome. Multivariate analysis were applied to study the risk factors of CKD,. The relationship between CKD and metabolic syndrome was also studied.Results1. Prevalence of CKD in Sichuan province:The overall prevalence and age-and-sex-standardized prevalence of CKD in Sichuan was 19.1% and 16.48% respectively. The prevalence of hematuria, albuminuria, proteinuria and decreased eGFR was 7.2%,11.4%,1.4% and 2.9%; and the standardized prevalence was 6.74%, 9.49%,1.11% and 2.34%, respectively. Prevalence of CKD, hematuria, microalbuminuria and macroalbuminuria was 15.1%,11.2%,12.4% and 1.1% in female, and it was lower in male population with the corresponding prevalence of 6.2%,3.3%,8.4% and 1.0%(p<0.001). There was no difference in prevalence of proteinuria or decreased eGFR between male and female population. Prevalence of CKD in Chengdu was lower than in Guanghan(10.4% vs 19.1%, p<0.001). And prevalence of hematuria, proteinuria, albuminuria and decreased eGFR was also lower in Chengdu than in Guanghan(p<0.001). Prevalence of CKD and microalbuminuria increased with age. In different age groups(18～39,40～49,50～59, 60～69,70～95), the prevalence of CKD was 11.6%,16.8%,19.9%,27.4%和41.3%; and the prevalence of microalbuminuria was 5.6%,7.3%,11.5%,17.8% and 24.3% respectively. There was no difference of prevalence of hematuria in different age groups. The awareness rate of CKD was 7.9%.2. Prevalence of other chronic diseases in Sichuan province:The prevalence and age-and-sex-standardized prevalence of hypertension was 16.5% and 11.9% respectively with a higher prevalence in Guanghan than in Chengdu(22.0% vs 11.0%, p<0.001). There was no difference in the prevalence between male and female(17.2% vs 15.9%, p>0.05). The prevalence and age-and-sex-standardized prevalence of diabetes was 6.6% and 5.1% respectively with a higher prevalence in Guanghan than in Chengdu(9.2% vs 4.0%, p<0.001), there was no difference in the prevalence between male and female(6.9% vs 6.4%, p>0.05). The prevalence and age-and-sex-standardized prevalence of hyperlipidemia was 53.4% and 50.76% respectively with a higher prevalence in Guanghan than in Chengdu(57.5% vs 49.3%, p<0.05), it was higher in male than in female(56.2% vs 50.6%%, p<0.05). The prevalence and age-and-sex-standardized prevalence of obesity was 60.0% and 65.30% respectively with a higher prevalence in Chengdu than in Guanghan (65.8% vs 54.1%, p<0.001), it was higher in male than in female(65.4% vs54.4%, p<0.001). The prevalence and age-and-sex-standardized prevalence of hyperuricemia was 14.4% and 15.13% respectively with a higher prevalence in Chengdu than in Guanghan (18.3 vs 10.4%, p<0.001), it was higher in male than in female(19.8% vs 8.8%, p<0.001).3. Prevalence of metabolic syndrome and its components in Sichuan province:The prevalence and age-and-sex-standardized prevalence of metabolic syndrome was 10.0% and 8.57% respectively without difference in Chengdu and Guanghan (9.9% vs 10.0%, p>0.05), it was higher in female than in male(13.8% vs 6.1%, p<0.001). Different group of MS:prevalence of group A, B, C, D, E and J was 3.9%,2.3%, 1.7%,0.8%,0.9% and 0.3%. And the corresponding age-and-sex-standardized prevalence was 4.13%,1.57%,1.31%,0.53%,0.75% and 0.22%。4. Relationship between MS and CKD:In the diagnosed MS patients, the prevalence of CKD was higher than non-MS people (26.2% vs 18.4, p<0.001). Group C (OR=1.955,95.0%CI=1.075-3.557) and D (OR=2.432,95.0%CI=1.068-5.540) was associated with increased prevalence of CKD。 5. Risk factors of CKD:The logistic regression analysis showed that hypertension(OR =1.933,95.0%CI:1.506-2.482), diabetes(OR=4.528,95.0%CI:3.239-6.329), hyperuricemia(OR=1.644,95.0%CI:1.233-2.192) and past history of reral disease (OR=1.682,95.0%CI:1.137-2.487) was risk factors of CKD. And male(OR=0.496, 95.0%CI:0.379-0.648), high degree of education(OR=0.839,95.0%CI:0.738-0.955), and high income(OR=0.804,95.0%CI:0.727-0.889) was negative associated with CKD.Conclusions1. The prevalence of CKD in Sichuan province is relatively high in China with a higher prevalence in rural population than in urban population.2. The prevalence of metabolic syndrome and its components is high in Sichuan Province. There is no difference in MS prevalence between rural and urban populations. Prevalence of centric obesity is higher in urban population while prevalence of other components are higher in rural population.3. Prevalence and stages of CKD are higher in MS patients than in general population in Sichuan,4. Centric obesity accompanied with hypertriglyceridemia and glycometabolism disorders, obesity accompanied with decreased HDL-C and hypertension may be more at high risk of developing CKD.5. Female gender, hypertension, hyperuricemia, diabetes, past history of renal disease, low degree of education and low income are risk factors of CKD.6. Screening plan for CKD in populations with high risk is urgent to increase the awareness, to enhance patients' management, and to improve the current status of treatment and control of CKD. |
