A population-based study measuring the prevalence of chronic kidney disease among adults in West Malaysia

Hooi, Lai Seong; Ong, Loke Meng; Ahmad, Ghazali; Bavanandan, Sunita; Ahmad, Noor Ani; Naidu, Balkish Mahadir; Mohamud, Wan Nazaimoon Wan; Yusoff, Muhammad Fadhli Mohd

doi:10.1038/ki.2013.220

Cited by 83 publications

(83 citation statements)

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“…Furthermore, CKD is also related to both a higher prevalence of cardiovascular disease and premature death [1], [2]. The estimated proportion of patients with CKD in the general population is approximately 10% in the United States, 7% in the United Kingdom, 9−10% in Asian countries and 19% in Japan [3]–[7]. The prevalence of CKD has been increasing significantly with time [8], [9].…”

Section: Introductionmentioning

confidence: 99%

Waist to Height Ratio Is an Independent Predictor for the Incidence of Chronic Kidney Disease

et al. 2014

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ObjectiveObesity is a risk factor for chronic kidney disease (CKD) and cardiovascular disease. The association between waist to height ratio (WheiR) and CKD is unclear. This study evaluated the association between WheiR and CKD.Design and MethodsIn this longitudinal cohort study, 4841 Japanese workers (3686 males, 1155 females) 18 to 67 years of age in 2008 were followed up until 2011. CKD was defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m2 (by the Modification of Diet in Renal Disease equation for Japanese) or dipstick proteinuria (≥1+). Cox proportional hazards models were used to examine the relationship between WheiR and development of CKD.ResultsA total of 384 (7.9%) participants (300 men and 84 women) were found to have new CKD. The incidence of CKD was 13.7, 24.2, 37.9 and 43.7 per 1000 person-years of follow-up in the lowest, second, third and highest quartiles of WheiR, respectively. After adjustment for potential confounders, the adjusted hazard ratios (95% confidence interval) for CKD were 1.00 (reference), 1.23 (0.85, 1.78), 1.59 (1.11, 2.26) and 1.62 (1.13, 2.32) through the quartiles of WheiR, respectively. WheiR had a significant predictive value for the incidence of both proteinuria and low estimated glomerular filtration rate. After subdivision according to gender, the relationship between WheiR and the incidence of CKD was statistically significant in the unadjusted model. However, after adjusting for potential confounders, WheiR was significantly associated with the incidence of CKD in females, whereas it was not significant in males.ConclusionsWheiR, which is commonly used as an index of central obesity, is associated with CKD. There was a significant gender difference in the relationship between CKD and WheiR.

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Section: Introductionmentioning

confidence: 99%

Waist to Height Ratio Is an Independent Predictor for the Incidence of Chronic Kidney Disease

et al. 2014

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“…Many factors can influence albumin excretion, including obesity, age, sex, distant inflammation, high blood pressure, infection and drug use [29], resulting in wide fluctuations and hence false positivity of albuminuria. Several authors found a high percentage (>50%) of false-positive albuminuria at low values [urinary UACR 30–50 mg/g; dipstick proteinuria +], but less at higher values or dipstick ++ and +++ [11, 30, 31]. In the same way, CV I or repeatability of UACR is very high (>50%), and this variability is higher in low UACR ranges (>100%) [32].…”

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confidence: 99%

Epidemiology of chronic kidney disease: think (at least) twice!

Delanaye

Glassock²,

Broe

2017

Clinical Kidney Journal

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The introduction of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines has substantially contributed to the early detection of different stages of chronic kidney disease (CKD). Several recent studies from different parts of the world mention a CKD prevalence of between 8 and 13%. There are several reasons the CKD prevalence found in a study of a particular population is clearly overestimated. The structure of the population pyramid (young or older age) of the study sample may result in high or low CKD prevalence. The absence of using an isotope dilution mass spectrometry creatinine assay can be the source of high bias in CKD prevalence. In addition, using an arbitrary single threshold of estimated glomerular filtration rate (eGFR; <60 mL/min/1.73 m2) for classifying CKD leads to a substantial ‘overdiagnosis’ (false positives) in the elderly (>65 years of age), particularly in those without albuminuria (or proteinuria), haematuria or hypertension. It also results in a significant ‘underdiagnosis’ (false negatives) in younger individuals with an eGFR >60 mL/min/1.73 m2 and below the third percentile for their age/gender category. The use of third percentile eGFR rates as a cut-off based on age/gender-specific reference values of eGFR allows the detection of these false positives and negatives. In the present article, we focus on an important and frequently omitted criterion in epidemiological studies: chronicity. Indeed, the two most important factors introducing a high number (up to 50%) of false positives are lack of confirming proteinuria and the absence of proof of chronicity of the eGFR found at first screening. There is an urgent need for quality studies of the prevalence of CKD using representative randomized samples of the population, applying the KDIGO guidelines correctly.

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“…Many of them indicated that they would like to take part in the 2-day scenario in the first month if it was allowed. In another population-based study in West Malaysia, only 52.2% of respondents with albuminuria agreed to be retested in the following weeks [8]. This research was a sub-study of another large-scale cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the DAY-1 + DAY-2 strategy was excluded from the cost-effectiveness analysis due to the increased time costs associated with it. The gold standard (DAY-1 + MONTH-2 + MONTH-3) was eliminated from the cost-effectiveness analysis for the following reasons: 1) The study initially defined the gold standard for purposes of validity assessment of various strategies and was not concerned with its practicality [8]. Secondly, both the sensitivity and specificity of a gold standard should be 100%.…”

Section: Methodsmentioning

confidence: 99%

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Strategies and cost-effectiveness evaluation of persistent albuminuria screening among high-risk population of chronic kidney disease

et al. 2017

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BackgroundScreening for persistent albuminuria among the high-risk population is important for early detection of CKD while studies regarding screening protocol and related cost-effectiveness analysis are limited. This study explored a feasible and cost-efficient screening strategy for detecting persistent albuminuria among the high-risk population.MethodsA cohort study including 157 clinically stable outpatients with a risk factor of CKD and whose laboratory tests revealed an albumin-creatinine-ratio (ACR) between 30 and 300 mg/g of creatinine during the previous 12 months was conducted to assess the validity of alternative screening strategies. Each participant collected three first morning urine samples in three consecutive months. These samples were labeled as DAY-1, MONTH-2 and MONTH-3. In the first month, a random spot sample in the afternoon of the first day and another morning sample on the second day were collected and labeled as Random and DAY-2. Persistent albuminuria was defined by abnormal ACR (≥30 mg/g creatinine) for DAY-1, MONTH-2 and MONTH-3. Alternative strategies were DAY-1; Random; DAY-1 + Random; DAY-1 + DAY-2; and DAY-1 + Random + DAY-2. To evaluate the economic performance of those alternative strategies, a hybrid decision tree/Markov model was developed based on the cohort study to simulate both clinical and cost-effectiveness outcomes. Sensitivity analyses were conducted to investigate assumptions of the model and to examine the model’s robustness.ResultsAltogether, 82 patients exhibited persistent albuminuria. All of the five strategies had sensitivity higher than 90%. Of these strategies, Random had the lowest specificity (46.7%), and DAY-1 + Random + DAY-2 had the highest specificity (81.3%). Estimated cost for each quality adjusted life year (QALYs) gained were ¥112,335.88 for DAY-1 + Random, ¥8134.69 for Random and ¥10,327.99 for DAY-1 + Random + DAY-2. When compared with DAY-1 strategy, the sensitivity and specificity of which were 100.0 and 69.3%, respectively. DAY-1 + Random + DAY-2 had the highest effectiveness and incremental effectiveness of 11.87 and 0.73 QALYs. At a willingness-to-pay threshold of ¥100,000 per QALY, DAY-1 + Random + DAY-2 had the highest acceptability of 91.0%. Sensitivity analyses demonstrated the robustness of the results.ConclusionsIn order to make a quick diagnosis of persistent albuminuria among high-risk population, the strategy of combining two first morning urine samples and one randomized spot urine sample in two consecutive days is accurate, saves time, and is cost-effective.

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A population-based study measuring the prevalence of chronic kidney disease among adults in West Malaysia

Cited by 83 publications

References 16 publications

Waist to Height Ratio Is an Independent Predictor for the Incidence of Chronic Kidney Disease

Waist to Height Ratio Is an Independent Predictor for the Incidence of Chronic Kidney Disease

Epidemiology of chronic kidney disease: think (at least) twice!

Strategies and cost-effectiveness evaluation of persistent albuminuria screening among high-risk population of chronic kidney disease

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