Analysis Of The Feature And Risk Factors Of Reduced Renal Function In The Middle-aged And Old People Who Have Not Been Diagnosed With CKD In Shandong Province

BackgroundThe number of patients with chronic kidney disease (CKD) is increasing on a worldwide scale and it has become a global public health challenge. Glomerular filtration rate (GFR) serves not only as a diagnostic element, but also the staging criteria of reduced renal function. Reduced renal function is an important component of CKD and having specific clinical value. More and more attention has been paid to glomerular filtration rate (GFR) which is not only an important part of the diagnostic criteria for reduced renal function, but also the foundation for staging of reduced renal function. Some studies had reported the prevalence and risk factors about the reduced renal function in developed countries. But the data were different in different studies. It is worth note that, the awareness rate of CKD is very low.The prevalence of metabolic syndrome is increasing in worldwide scale, and it s components can be harmful to renal function. The most common cause of ESRD requiring dialysis is DM. Prediabetes is a state in which the glucose is higher than normal and do not meet the diagnostic criteria of diabetes. Prediabetes can preserve for a long time, or develop to diabetes. But it is still unclear whether prediabetes is an independent risk factor for reduced renal function.In current study, we sought to investigate the feature of reduced renal function and explore the risk factors of reduced renal function in the middle-aged and old people who have not been diagnosed with CKD in China. MethodsFour communities in Shandong province were selected by chester sampling in2012to carry out the community-based survey. The residents aged40years or older were selected and invited to participate in our survey. Finally,9578subjects were eligible for the analysis. All participants were asked to complete a questionnaire consists information on general data, past medical history, family history and personal eating and living habits. During the clinical examination, specially trained investigators measured height, weight, waist circumference, hip circumference and blood pressure with standardized protocols and techniques. A venous blood sample was drawn after12h fasting for measurement of serum creatinine(was measured by the modified kinetic Jaffe reaction), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG) and fasting insulin concentration (FIns). Then an oral glucose-tolerance test (OGTT) was done and2hours blood sample was drawn for measurement of2h serum glucose.Results1. The prevalence of mildly reduced kidney function and moderately to severely reduced kidney function was11.54%and0.66%respectively. The prevalence was16.4%and1.0%in male; the prevalence was9.0%and0.5%in female.2. Age, glycosylated hemoglobin, fasting insulin level, low density lipoprotein cholesterol and triglyceride were negatively correlated with glomerular filtration rate in the multiple linear regression. The regression coefficient were-0.649、-1.232、-0.207、-1.524and-0.881respectively.3. The ORs for reduced renal function of prediabetes, diabetes, hypertriglyceridemia, overweight and obesity were1.479(95%CI1.167-1.875),1.776(95%CI1.467-2.151),1.460(95%CI1.216-1.753),1.464(95%CI1.159-1.850),1.469(95%CI1.140-1.894) respectively after adjustment for age and gender.4. The OR values was by1.521(1.181-1.958) and1.703(1.234-2.351) respectively in status of impaired fasting glucose (IFG), IFG and Impaired glucose tolerance (IGT) after adjustment for age, gender, triglyceride and BMI. The OR values of IGT was1.129(0.829-1.538) without statistical significance.ConclusionAn alarmingly large portion of the aged population with reduced renal function remained undiagnosed. Age, male, hyperglycemia, hypertension, dyslipidemia, overweight and obesity were important risk factors associated with reduced renal function in our study. Although diabetic nephropathy is characterized by increased glomerular filtration rate in early stage, our study has revealed that prediabetes is also an independent risk factor for the reduced renal function. These data rings the alarm for screening and management of CKD in Chinese aged adults.