Prevalence and risk factors of chronic kidney disease: a population study in the Tibetan population

Abstract

This is the first population-based epidemiological study of CKD in the Tibetan population. We found a higher prevalence of CKD and associated high prevalence of albuminuria, hypertension, hyperuricaemia and high haematocrit in the Tibetan population. The present study indicates the urgent need to develop comprehensive strategies targeted at reducing the CKD burden in this area and may lead to a better understanding of CKD in high-altitude populations.

High Altitude Renal Syndrome (HARS)

“…47 A large epidemiologic study in Tibet also found a significant increased prevalence of hyperuricemia in Tibetans compared with prior studies performed among Han Chinese people living in Guangzhou. 46 Moreover, subjects living at high altitude also have a low fractional excretion of uric acid despite the high serum levels of uric acid 47 ; similar findings have been described in congenital cyanotic heart disease. 65 Interestingly, the higher prevalence of hyperuricemia associates with both the presence of microalbuminuria and systemic hypertension.…”

“…65 Interestingly, the higher prevalence of hyperuricemia associates with both the presence of microalbuminuria and systemic hypertension. 46 For example, in our study of Tibetans, 38% of subjects had hypertension, 29% had hyperuricemia, and 16% had albuminuria (including microalbuminuria). However, reduced GFR (defined as estimated GFR Ͻ60 ml/min per 1.73 m 2 ) was observed in only 2% of these subjects.…”

“…However, reduced GFR (defined as estimated GFR Ͻ60 ml/min per 1.73 m 2 ) was observed in only 2% of these subjects. 46 Multivariate analysis showed that hyperuricemia, polycythemia, and hypertension were independent predictors of albuminuria. These findings expand on the laboratory finding that experimental hyperuricemia can induce systemic and glomerular hypertension and microalbuminuria in animals.…”

“…45 For example, in a recent study in Tibet, we found that 15% of Tibetans had microalbuminuria. 46 Proteinuria increases with higher hematocrit. In one study, 6/27 (22%) of CMS patients had proteinuria Ͼ1 g/24 h. 47 The pathogenesis of the proteinuria may relate to a variety of factors, including the effects of tissue hypoxia within kidney parenchyma, glomerular capillary hypertension, hyperviscosity, and elevated right heart pressures.…”

“…The proteinuria may also relate to the hyperuricemia commonly observed at high altitude (see below). 46 Treatment with angiotensin converting enzyme (ACE) inhibitors is beneficial in reducing proteinuria in subjects living at high altitude. In a study in Bolivia, high altitude residents administered an ACE inhibitor showed significant reductions in proteinuria and hemoglobin.…”