Long-term trends in the prevalence of chronic kidney disease and the influence of cardiovascular risk factors in Norway
2016; Elsevier BV; Volume: 90; Issue: 3 Linguagem: Inglês
10.1016/j.kint.2016.04.012
ISSN1523-1755
AutoresStein Hallan, Marius Altern Øvrehus, Solfrid Romundstad, Dena E. Rifkin, Arnulf Langhammer, Paul E. Stevens, Joachim H. Ix,
Tópico(s)Chronic Disease Management Strategies
ResumoSurveillance of chronic kidney disease (CKD) prevalence over time and information on how changing risk factors influence this trend are needed to evaluate the effects of general practice and public health interventions. Because very few studies addressed this, we studied the total adult population of a demographically stable county representative of Norway using cross-sectional studies 10 years apart (Nord-Trøndelag Health Study (HUNT)2 and Nord-Trøndelag Health Study (HUNT)3, 65,237 and 50,586 participants, respectively). Thorough quality-control procedures and comparisons of methods over time excluded analytical drift, and multiple imputations of missing data combined with nonattendance weights contributed to unbiased estimates. CKD prevalence remained stable in Norway from 1995 through 1997 (11.3%) to 2006 through 2008 (11.1%). The association of survey period with CKD prevalence was modified by a strong decrease in blood pressure, more physical activity, and lower cholesterol levels. Without these improvements, a 2.8, 0.7, and 0.6 percentage points higher CKD prevalence could have been expected, respectively. In contrast, the prevalence of diabetes and obesity increased moderately, but the proportion of diabetic patients with CKD decreased significantly (from 33.4% to 28.6%). A CKD prevalence of 1 percentage point lower would have been expected without these changes. Thus, CKD prevalence remained stable in Norway for more than a decade in association with marked improvements in blood pressure, lipid levels, and physical activity and despite modest increases in diabetes and obesity. Surveillance of chronic kidney disease (CKD) prevalence over time and information on how changing risk factors influence this trend are needed to evaluate the effects of general practice and public health interventions. Because very few studies addressed this, we studied the total adult population of a demographically stable county representative of Norway using cross-sectional studies 10 years apart (Nord-Trøndelag Health Study (HUNT)2 and Nord-Trøndelag Health Study (HUNT)3, 65,237 and 50,586 participants, respectively). Thorough quality-control procedures and comparisons of methods over time excluded analytical drift, and multiple imputations of missing data combined with nonattendance weights contributed to unbiased estimates. CKD prevalence remained stable in Norway from 1995 through 1997 (11.3%) to 2006 through 2008 (11.1%). The association of survey period with CKD prevalence was modified by a strong decrease in blood pressure, more physical activity, and lower cholesterol levels. Without these improvements, a 2.8, 0.7, and 0.6 percentage points higher CKD prevalence could have been expected, respectively. In contrast, the prevalence of diabetes and obesity increased moderately, but the proportion of diabetic patients with CKD decreased significantly (from 33.4% to 28.6%). A CKD prevalence of 1 percentage point lower would have been expected without these changes. Thus, CKD prevalence remained stable in Norway for more than a decade in association with marked improvements in blood pressure, lipid levels, and physical activity and despite modest increases in diabetes and obesity. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are inextricably intertwined, and their development over the past decades has sometimes been characterized as an "epidemic."1Radhakrishnan J. Remuzzi G. Saran R. et al.Taming the chronic kidney disease epidemic: a global view of surveillance efforts.Kidney Int. 2014; 86: 246-250Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar ESRD has increased 3-fold since the 1980s,2National Institutes of Health. U.S. Renal Data System, Annual Data Reports (1994-2014). Available at: http://www.usrds.org/2014/view/Default.aspx. Accessed December 9, 2015.Google Scholar but CKD is more difficult to define and follow over time. The CKD prevalence is high worldwide (10%–13%),3Chadban S.J. Briganti E.M. Kerr P.G. et al.Prevalence of kidney damage in Australian adults: the AusDiab kidney study.J Am Soc Nephrol. 2003; 14: S131-S138Crossref PubMed Google Scholar, 4Coresh J. Selvin E. Stevens L.A. et al.Prevalence of chronic kidney disease in the United States.JAMA. 2007; 298: 2038-2047Crossref PubMed Scopus (3894) Google Scholar, 5Hallan S.I. Coresh J. Astor B.C. et al.International comparison of the relationship of chronic kidney disease prevalence and ESRD risk.J Am Soc Nephrol. 2006; 17: 2275-2284Crossref PubMed Scopus (538) Google Scholar, 6Stevens P.E. Levin A. Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group MembersEvaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline.Ann Intern Med. 2013; 158: 825-830Crossref PubMed Scopus (1716) Google Scholar, 7Zhang L. Wang F. Wang L. et al.Prevalence of chronic kidney disease in China: a cross-sectional survey.Lancet. 2012; 379: 815-822Abstract Full Text Full Text PDF PubMed Scopus (1511) Google Scholar but few have studied prevalence trends over time. The topic therefore remains uncertain and is intensely debated because the increased ESRD incidence could be caused by an increased progression rate or improved delivery and availability of ESRD treatment in addition to an increased number of CKD patients. It is also unclear how management of risk factors affects CKD prevalence, but there are some encouraging results from intervention trials as well as public health initiatives.8Judd E. Calhoun D.A. Management of hypertension in CKD: beyond the guidelines.Adv Chronic Kidney Dis. 2015; 22: 116-122Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar, 9Levin A. Stevens P.E. Early detection of CKD: the benefits, limitations and effects on prognosis.Nat Rev Nephrol. 2011; 7: 446-457Crossref PubMed Scopus (51) Google Scholar, 10Ruggenenti P. Cravedi P. Remuzzi G. Mechanisms and treatment of CKD.J Am Soc Nephrol. 2012; 23: 1917-1928Crossref PubMed Scopus (187) Google Scholar, 11Stevens P.E. de Lusignan S. Farmer C.K. Tomson C.R. Engaging primary care in CKD initiatives: the UK experience.Nephrol Dial Transplant. 2012; 27: iii5-iii11Crossref PubMed Scopus (26) Google Scholar The National Health and Nutrition Examination Survey showed that total CKD prevalence increased by 30% in the US population between 1991 and 2001.4Coresh J. Selvin E. Stevens L.A. et al.Prevalence of chronic kidney disease in the United States.JAMA. 2007; 298: 2038-2047Crossref PubMed Scopus (3894) Google Scholar Later studies from Europe and Asia have shown both increasing12Juutilainen A. Kastarinen H. Antikainen R. et al.Trends in estimated kidney function: the FINRISK surveys.Eur J Epidemiol. 2012; 27: 305-313Crossref PubMed Scopus (17) Google Scholar, 13Nagata M. Ninomiya T. Doi Y. et al.Trends in the prevalence of chronic kidney disease and its risk factors in a general Japanese population: the Hisayama study.Nephrol Dial Transplant. 2010; 25: 2557-2564Crossref PubMed Scopus (96) Google Scholar and stable14Capuano V. Lamaida N. Borrelli M.I. et al.[Chronic kidney disease prevalence and trends (1998-2008) in an area of southern Italy. The data of the VIP project].G Ital Nefrol. 2012; 29: 445-451Google Scholar, 15Gifford F.J. Methven S. Boag D.E. et al.Chronic kidney disease prevalence and secular trends in a UK population: the impact of MDRD and CKD-EPI formulae.QJM. 2011; 104: 1045-1053Crossref Scopus (21) Google Scholar trends. Furthermore, recent data from England have shown decreasing CKD prevalence from 2003 through 2010, a period with a high priority for preventive kidney medicine.16Aitken G.R. Roderick P.J. Fraser S. et al.Change in prevalence of chronic kidney disease in England over time: comparison of nationally representative cross-sectional surveys from 2003 to 2010.BMJ Open. 2014; 4: e005480Crossref Scopus (51) Google Scholar These conflicting results may represent true regional differences, perhaps due to different risk profiles, or may be artifacts caused by technical and analytical challenges in measuring CKD prevalence over time. Many developed countries have achieved substantial blood pressure improvements,17Lackland D.T. Roccella E.J. Deutsch A.F. et al.Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 315-353Crossref PubMed Scopus (537) Google Scholar, 18Lopez-Jimenez F. Batsis J.A. Roger V.L. et al.Trends in 10-year predicted risk of cardiovascular disease in the United States, 1976 to 2004.Circ Cardiovasc Qual Outcomes. 2009; 2: 443-450Crossref PubMed Scopus (43) Google Scholar, 19Ulmer H. Kelleher C.C. Fitz-Simon N. et al.Secular trends in cardiovascular risk factors: an age-period cohort analysis of 698,954 health examinations in 181,350 Austrian men and women.J Intern Med. 2007; 261: 566-576Crossref PubMed Scopus (43) Google Scholar, 20Vartiainen E. Laatikainen T. Peltonen M. et al.Thirty-five-year trends in cardiovascular risk factors in Finland.Int J Epidemiol. 2010; 39: 504-518Crossref PubMed Scopus (397) Google Scholar but the prevalence of hypertension is increasing in developing countries and is now the leading risk factor for global disease burden.21Celermajer D.S. Chow C.K. Marijon E. et al.Cardiovascular disease in the developing world: prevalences, patterns, and the potential of early disease detection.J Am Coll Cardiol. 2012; 60: 1207-1216Abstract Full Text Full Text PDF PubMed Scopus (329) Google Scholar, 22Lim S.S. Vos T. Flaxman A.D. et al.A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2224-2260Abstract Full Text Full Text PDF PubMed Scopus (8632) Google Scholar, 23Siegel K.R. Patel S.A. Ali M.K. Non-communicable diseases in South Asia: contemporary perspectives.Br Med Bull. 2014; 111: 31-44Crossref Scopus (73) Google Scholar Furthermore, recent guidelines and randomized clinical trials disagree on the blood pressure treatment goals,24James P.A. Oparil S. Carter B.L. et al.2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).JAMA. 2014; 311: 507-520Crossref PubMed Scopus (5873) Google Scholar, 25Wright J.T. Williamson J.D. Whelton P.K. et al.A randomized trial of intensive versus standard blood-pressure control.N Engl J Med. 2015; 373: 2103-2116Crossref PubMed Scopus (3938) Google Scholar and other risk factors such as physical inactivity, obesity, and diabetes mellitus are increasing worldwide.21Celermajer D.S. Chow C.K. Marijon E. et al.Cardiovascular disease in the developing world: prevalences, patterns, and the potential of early disease detection.J Am Coll Cardiol. 2012; 60: 1207-1216Abstract Full Text Full Text PDF PubMed Scopus (329) Google Scholar, 26Global Burden of Disease Project 2013: Data Visualization Tools. Available at: http://vizhub.healthdata.org/gbd-compare/. Accessed December 14, 2015.Google Scholar, 27Murray C.J. Barber R.M. Foreman K.J. et al.Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition.Lancet. 2015; 386: 2145-2191Abstract Full Text Full Text PDF PubMed Scopus (1347) Google Scholar In sum, this creates a setting that could fuel CKD progression and worsen CKD as a public health problem. The Global Burden of Disease Study 2013 estimated that the global disability–adjusted life-years caused by CKD increased by 17.1% from 2005 to 2013,27Murray C.J. Barber R.M. Foreman K.J. et al.Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition.Lancet. 2015; 386: 2145-2191Abstract Full Text Full Text PDF PubMed Scopus (1347) Google Scholar but the estimates are uncertain because the field has substantial data shortages. Thus, we analyzed changes in estimated glomerular filtration rate (eGFR), albuminuria, CKD stages, and relevant risk factors over a 10-year period in Norway. We also compared the prevalence results and their relationship to individual risk factors and national-level public health and predialysis care measures with corresponding data from England and the United States. The cross-sectional Nord-Trøndelag Health Study (HUNT)-2 survey (1995–1997) had a 70% participation rate (N = 65,237), whereas the HUNT-3 survey (2006–2008) had a 54% participation rate (N = 50,586). Table 1 shows demographics and characteristics of the participants; HUNT-3 participants were older and had a higher body mass index, and more subjects had diabetes mellitus. By contrast, there were fewer current smokers; participants were more physically active and more likely to be receiving antihypertensive treatment. These factors were accompanied by lower systolic blood pressure, lower prevalence of cardiovascular disease, and better self-reported general health. Estimates corrected for nonparticipation describe the total adult population. Selected healthy subgroups with identical risk profiles (Supplementary Table S1) had identical mean eGFRs (105.9 vs. 106.2 ml/min per 1.73 m2, P = 0.63) and mean urinary albumin to creatinine ratio (ACR) (10.0 vs. 10.2 mg/g, P = 0.92) in the HUNT-2 and HUNT-3, respectively, indicating no analytical drift of kidney measures between the 2 surveys.Table 1Demographics and characteristics of the HUNT-2 (1995–1997) and HUNT-3 (2006–2008) surveysParticipantsGeneral populationHUNT-2 (N = 65,252)HUNT-3 (N = 50,586)HUNT-2 (N = 94,094)HUNT-3 (N = 93,482)Age, yr50.3 (0.07)53.2 (0.06)48.8 (0.08)50.2 (0.09)Sex (% male)46.8 (0.2)45.3 (0.2)49.6 (0.2)49.5 (0.2)Education (% attended college/university)20.1 (0.2)26.4 (0.2)21.1 (0.2)27.3 (0.2)Living in rural area (%)68.2 (0.2)60.7 (0.2)66.6 (0.2)61.9 (0.2)General health (%) Poor1.9 (0.05)1.4 (0.05)1.8 (0.05)1.4 (0.05) Fair25.6 (0.2)24.7 (0.2)24.6 (0.2)23.1 (0.2) Good57.1 (0.2)58.1 (0.2)56.8 (0.2)58.2 (0.2) Excellent15.4 (0.2)15.8 (0.2)16.8 (0.2)17.4 (0.2)Cardiovascular disease (%)8.0 (0.1)7.7 (0.1)8.0 (0.1)7.1 (0.1)Confirmed diabetes mellitus (DM) (%)3.4 (0.1)4.7 (0.1)3.3 (0.1)4.2 (0.1)Probable survey discovered DM (%)3.5 (0.1)4.7 (0.1)3.3 (0.1)4.4 (0.1)Pre-DM (%)14.5 (0.1)17.7 (0.2)14.0 (0.1)17.0 (0.2)High DM risk score (%)17.6 (0.1)21.5 (0.2)16.1 (0.1)18.5 (0.2)Former smoker (%)25.0 (0.2)31.0 (0.2)23.6 (0.2)28.6 (0.2)Current smoker (%)29.2 (0.2)21.0 (0.2)28.7 (0.2)21.0 (0.2)Systolic blood pressure (mm Hg)137.7 (0.1)130.4 (0.1)137.3 (0.1)129.6 (0.1)Diastolic blood pressure (mm Hg)80.1 (0.1)73.2 (0.1)79.4 (0.05)72.7 (0.06)Antihypertensive medication (%)13.7 (0.1)20.9 (0.2)13.1 (0.1)18.4 (0.2)Hypertension (%)44.3 (0.2)38.7 (0.2)43.2 (0.2)35.5 (0.2)Body mass index (kg/m2)26.4 (0.02)27.2 (0.02)26.3 (0.02)27.0 (0.02)Obesity (%)16.4 (0.2)22.5 (0.2)16.1 (0.2)21.6 (0.2)Physical inactivity (%)73.1 (0.2)58.1 (0.2)72.3 (0.2)58.9 (0.2)Total cholesterol (mg/dl)227.8 (0.2)212.3 (0.2)224.7 (0.2)209.2 (0.2)HDL cholesterol (mg/dl)53.4 (0.1)52.2 (0.001)52.6 (0.002)51.4 (0.002)Data are mean and percentage (SE). General population data were weighted for nonresponse, and missing values were imputed.DM, diabetes mellitus; HDL, high-density lipoprotein. Open table in a new tab Data are mean and percentage (SE). General population data were weighted for nonresponse, and missing values were imputed. DM, diabetes mellitus; HDL, high-density lipoprotein. Kidney function was shifted toward lower eGFR values, especially within the normal range (Figure 1). The mean eGFR was 99.1 ml/min per 1.73 m2 in the HUNT-2 and 97.8 ml/min per 1.73 m2 in the HUNT-3 (P < 0.001), and corresponding eGFRs <60 ml/min per 1.73 m2 were 4.5% and 4.8% (P = 0.033). In contrast, the ACR distribution based on 3 urine samples changed minimally, but mean urinary ACR decreased from 15.7 mg/g to 14.1 mg/g (P < 0.001) due to fewer participants with increased albuminuria (7.9% in the HUNT-2 and 7.4% in the HUNT-3, P = 0.034). Severely increased albuminuria (ACR >300 mg/g, formerly termed macroalbuminuria) was 0.3% versus 0.1% (P < 0.001), and moderately increased albuminuria (ACR 30–300 mg/mmol, formerly termed microalbuminuria) was 7.6% versus 7.3% (P = 0.26). CKD was risk stratified by 6 eGFR categories × 3 ACR categories (Figure 2). Total CKD prevalence did not differ across the 2 surveys (11.3% vs. 11.1%, P = 0.42), and the majority of cases were classified as CKD with a moderately increased risk of complications (9.3% vs. 9.0%, P = 0.20). The prevalence of high-/very high risk CKD was also stable (2.0%–2.1%, P = 0.35). eGFR categories of 15 to 44 ml/min per 1.73 m2 with normoalbuminuria were significantly increased, whereas the prevalence of severely increased albuminuria was lower at each eGFR stage. Among subjects older than 75 years of age, the prevalence of high and very high risk CKD was significantly higher in the HUNT-3 compared with the HUNT-2 (10.2% vs. 11.9%, P = 0.020 and 19.6% vs. 24.3%, P = 0.03, respectively), whereas moderate-risk CKD was stable (Table 2). For younger subjects, there were no changes in the prevalence of any CKD risk groups. Furthermore, patients with confirmed diabetes mellitus in the HUNT-3 had a substantially lower CKD prevalence compared with those in the HUNT-2 (33.4% vs. 28.6%, P = 0.002), whereas a similar pattern was not found in patients with undiagnosed diabetes. Several indicators reflecting intensified preventive treatment over time (e.g., much lower blood pressure, cholesterol, and urine albumin; further data shown in Supplementary Table S2) and slightly younger age in the HUNT-3 diabetics could explain this. Obese subjects in the HUNT-3 also had a lower CKD prevalence compared with those in the HUNT-2.Table 2Stratified CKD prevalence 1995–1997 compared with 2006–2008CKD total (%)CKD with high/very high risk (%)HUNT-2 (1995–1997)HUNT-3 (2006–2008)P valueHUNT-2 (1995–1997)HUNT-3 (2006–2008)P valueAge, yr 18–445.104.730.240.080.060.50 45–648.348.160.600.580.500.35 65–7418.6417.610.143.543.310.48 75–8433.7035.710.0810.2111.930.020 85+48.4853.730.0519.5724.290.030 Overall11.3011.110.422.012.110.35 Overall, age-adjusted to US 2000 standard population8.998.770.111.171.220.33Diabetes mellitus None9.419.050.211.411.410.97 Probable undiagnosed19.6418.680.534.344.600.72 Confirmed33.4128.570.00211.288.830.016Obesity BMI <3010.3610.320.891.671.860.06 BMI ≥3016.1713.94<0.0013.803.000.007BMI, body mass index; CKD, chronic kidney disease. Open table in a new tab BMI, body mass index; CKD, chronic kidney disease. Possible mediation by risk factors on the association of survey period with CKD prevalence is displayed in Table 3. If we assumed no decrease in systolic blood pressure during the study period, the total CKD prevalence would be 2.8 percentage points higher in the HUNT-3 than observed (P < 0.001). Lower cholesterol and higher physical activity also contributed significantly to the stable CKD prevalence. If none of these risk improvements had taken place, the CKD prevalence would have increased by 3.8 percentage points (P < 0.001). Correspondingly, without the concurrent increase in prediabetes, diabetes mellitus, and obesity, CKD prevalence could potentially have been 1.0 percentage points lower (P < 0.001). Sensitivity analysis using ordinary logistic regression gave very similar results, and analysis of predicted HUNT-3 prevalence substituting various risk factors with mean HUNT-2 values showed less but still significant influence of blood pressure and physical activity improvements (Supplementary Table S3).Table 3Predicted changes in CKD prevalence from HUNT-2 (1995–1997) to HUNT-3 (2006–2008) if modifiable kidney risk factors remained at 1995–1997 leveleGFR 30 mg/gCKD totalCKD high/very high riskObserved prevalence 1995–1997 (%)4.497.9311.302.01Improved variables Predicted CKD change if no change in(Absolute prevalence change [percentage points], 2006–2008 vs. 1995–1997)Systolic BP+2.06***+1.11***+2.77***+0.91***CVD+0.49**−0.43−0.01+0.18Cholesterol+1.01***−0.23+0.58*+0.36**Physical inactivity+0.93***−0.13+0.69*+0.37**Smoking+0.19−0.34−0.15−0.06None of these risk factors+3.41***+1.36***+3.78***+1.43***Worsened variables Predicted CKD change if no change inPrediabetes/diabetes+0.03-0.83**−0.73**−0.06BMI+0.04−0.74**−0.65*−0.02None of these risk factors−0.12−0.95***−1.00***−0.13Note: Asterisks indicate that change from HUNT-2 to HUNT-3 is significantly different from 0 (*P < 0.05, **P < 0.01, ***P < 0.001). Data are based on generalized estimation equation analysis, an extension of logistic regression for clustered data. For example, with CKD total as a dependent variable and time period (HUNT-2 or HUNT-3) and systolic BP as independent variables, time period has an odds ratio of 1.245: CKD prevalence in HUNT3 would be 1.245 times higher if systolic blood pressure remained unchanged (1.245 × 11.3 − 11.3 = 2.77% [percentage points] higher CKD prevalence could have been expected).ACR, albumin to creatinine ratio; BMI, body mass index; BP, blood pressure; CKD, chronic kidney disease; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate. Open table in a new tab Note: Asterisks indicate that change from HUNT-2 to HUNT-3 is significantly different from 0 (*P < 0.05, **P < 0.01, ***P < 0.001). Data are based on generalized estimation equation analysis, an extension of logistic regression for clustered data. For example, with CKD total as a dependent variable and time period (HUNT-2 or HUNT-3) and systolic BP as independent variables, time period has an odds ratio of 1.245: CKD prevalence in HUNT3 would be 1.245 times higher if systolic blood pressure remained unchanged (1.245 × 11.3 − 11.3 = 2.77% [percentage points] higher CKD prevalence could have been expected). ACR, albumin to creatinine ratio; BMI, body mass index; BP, blood pressure; CKD, chronic kidney disease; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate. Finally we compared Norwegian, US, and British population level data that could contribute to changes in CKD prevalence beyond the individual level risk factors analyzed in previous text. Relevant information from national kidney registries, published studies, governmental and international organizations, and other sources was collected to describe the risk factors and clinical setting in which these 3 major CKD prevalence studies were conducted (Supplementary Table S4, Supplementary Figure S1). Because the studies describe different time periods, we also display relevant information estimated by the Global Burden of Disease project for the total 1990 through 2010 period for all 3 countries (Supplementary Table S5, Supplementary Figure S2). Paying special attention to design and analytical problems in prevalence trend studies, we found that total CKD prevalence was stable in Norway over a 10-year period. Improved treatment of hypertension and hypercholesterolemia and higher physical activity might have contributed to this favorable situation despite increasing diabetes and obesity prevalence. Coresh et al.4Coresh J. Selvin E. Stevens L.A. et al.Prevalence of chronic kidney disease in the United States.JAMA. 2007; 298: 2038-2047Crossref PubMed Scopus (3894) Google Scholar reported that the CKD prevalence in the US adult population increased from 10.0% in the period 1988 through 1994 to 13.1% in the period 1999 through 2004, which was partly explained by trends in diabetes and hypertension. Others have questioned these findings due to a possible drift in serum creatinine measurements across National Health and Nutrition Examination Survey exams.28Foley R.N. Temporal trends in the burden of chronic kidney disease in the United States.Curr Opin Nephrol Hypertens. 2010; 19: 273-277Crossref PubMed Scopus (14) Google Scholar, 29Hsu R.K. Hsu C.Y. Temporal trends in prevalence of CKD: the glass is half full and not half empty.Am J Kidney Dis. 2013; 62: 214-216Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar A conservative trend analysis, that is, adjusting for the assumption that no eGFR change should take place in healthy young subjects without known CKD risk factors, showed a more modest change in CKD prevalence (10.0% to 11.3%).4Coresh J. Selvin E. Stevens L.A. et al.Prevalence of chronic kidney disease in the United States.JAMA. 2007; 298: 2038-2047Crossref PubMed Scopus (3894) Google Scholar However, moving past creatinine calibration, a recent analysis based on well-calibrated cystatin C measurements found that the prevalence of eGFR <60 ml/min per 1.73 m2 had increased significantly.30Grams M.E. Juraschek S.P. Selvin E. et al.Trends in the prevalence of reduced GFR in the United States: a comparison of creatinine- and cystatin C-based estimates.Am J Kidney Dis. 2013; 62: 253-260Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar It is therefore most likely that CKD prevalence indeed increased in the United States in the 1990s, whereas more recent National Health and Nutrition Examination Survey reports indicate stabilization thereafter.31Centers for Disease Control and Prevention (CDC). Chronic Kidney Disease (CKD) Surveillance Project: prevalence of CKD stages 1-4 by year and stage. Available at: http://nccd.cdc.gov/CKD/detail.aspx?Qnum=Q372. 2014. Accessed December 15, 2015.Google Scholar Other studies present conflicting results on CKD prevalence trends over time. Nagata et al.13Nagata M. Ninomiya T. Doi Y. et al.Trends in the prevalence of chronic kidney disease and its risk factors in a general Japanese population: the Hisayama study.Nephrol Dial Transplant. 2010; 25: 2557-2564Crossref PubMed Scopus (96) Google Scholar described a smaller but well-characterized Japanese population followed from 1974 to 2002. CKD stages 3 through 5 increased 3-fold in men (4.8% to 15.7%) and doubled in women (5.8% to 11.7%). In contrast, Kang et al.32Kang H.T. Lee J. Linton J.A. et al.Trends in the prevalence of chronic kidney disease in Korean adults: the Korean National Health and Nutrition Examination Survey from 1998 to 2009.Nephrol Dial Transplant. 2013; 28: 927-936Crossref Scopus (27) Google Scholar concluded that the CKD prevalence decreased in South Korea between 1998 and 2009, but there were more missing data and no information regarding the potential for analytical drift in serum creatinine values over time. A 1.5-fold higher risk of an eGFR <60 ml/min per 1.73 m2 was reported in Finland between 2002 and 2007,12Juutilainen A. Kastarinen H. Antikainen R. et al.Trends in estimated kidney function: the FINRISK surveys.Eur J Epidemiol. 2012; 27: 305-313Crossref PubMed Scopus (17) Google Scholar whereas a laboratory-based study from Scotland reported stable CKD prevalence between 2004 and 2009.15Gifford F.J. Methven S. Boag D.E. et al.Chronic kidney disease prevalence and secular trends in a UK population: the impact of MDRD and CKD-EPI formulae.QJM. 2011; 104: 1045-1053Crossref Scopus (21) Google Scholar Furthermore, in one of the best methodological studies on this topic, Aitken et al.16Aitken G.R. Roderick P.J. Fraser S. et al.Change in prevalence of chronic kidney disease in England over time: comparison of nationally representative cross-sectional surveys from 2003 to 2010.BMJ Open. 2014; 4: e005480Crossref Scopus (51) Google Scholar reported a significant decrease in CKD stage 3–4 in England from 2003 to 2010. Using nationally representative samples adjusted for nonresponse, the investigators found that an eGFR <60 ml/min per 1.73 m2 decreased from 5.7% to 5.2% based on well-calibrated serum creatinine values. The total CKD prevalence was 13% in 2010, but, unfortunately, albuminuria data were not available for the 2003 survey. The Global Burden of Disease project, which is an enormous undertaking with excellent opportunities to describe the ongoing epidemiologic transition, has recently estimated that the impact of CKD increased steadily in both high-income and developing countries during the period 1990 through 2010 (459–549 and 339–438 disability–adjusted life-years/100.000, respectively).26Global Burden of Disease Project 2013: Data Visualization Tools. Available at: http://vizhub.healthdata.org/gbd-compare/. Accessed December 14, 2015.Google Scholar A study on the future burden of CKD in the United States estimates that the prevalence will increase from 13.2% currently to 16.7% in 2030,33Hoerger T.J. Simpson S.A. Yarnoff B.O. et al.The future burden of CKD in the United States: a simulation model for the CDC CKD Initiative.Am J Kidney Dis. 2015; 65: 403-411Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar and projections also indicate that CKD will move up 4 places in the global mortality rankings.34Mathers C.D. Loncar D. Projections of global mortality and burden of disease from 2002 to 2030.PLoS Med. 2006; 3: e442Crossref PubMed Scopus (7566) Google Scholar In our study, although total CKD prevalence remained stable in Norway, there were some worrisome changes in the eGFR distribution in the adult population. First, a low eGFR (<60 ml/min per 1.73 m2) showed a small but significant increase, but this was, at least temporarily, offset by a decrease in albuminuria, most likely caused by better blood pressure control and a 3-fold increased prescription of angiotensin-converting enzyme inhibitors. Second, there was a large shift in the normal eGFR range with fewer subjects with an eGFR
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