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Original article | Published 6 May 2016, doi:10.4414/smw.2016.14313 Cite this as: Swiss Med Wkly. 2016;146:w14313
Prevalence and determinants of chronic kidney disease in the Swiss population Valentina Forni Ognaa, Adam Ognab, Belen Pontec,d, Luca Gabuttib, Isabelle Binete, David Conenf, Paul Erneg, Augusto Gallinoh, Idris Guessousc,i, Daniel Hayozj, Franco Mugglik, Fred Paccaudc, Antoinette Péchère-Bertchil, Paolo M. Suterm, Murielle Bochudc, Michel Burniera a
Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Switzerland
b
Department of Internal Medicine and Nephrology, Ospedale La Carità, Locarno, Switzerland
c
Division of Chronic Disease, Institute of Social and Preventive Medicine, Lausanne University Hospital, Switzerland
d
Service of Nephrology, Geneva University Hospitals, Switzerland
e
Service of Nephrology/Transplantation Medicine, Kantonsspital, St. Gallen, Switzerland
f
Department of Medicine, University Hospital Basel, Switzerland
g
Hypertension Centre, Luzern, Switzerland
h i
Cardiology Department, Ospedale San Giovanni, Bellinzona, Switzerland Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva
University Hospitals, Switzerland j
Department of Internal Medicine and Angiology, Hôpital Cantonal, Fribourg, Switzerland
k
Internal Medicine Praxis, Vezia, Switzerland
l
Unit of Hypertension, Departments of Specialties of Medicine and Community Medicine and Primary Care and Emergency Medicine, Geneva University
Hospitals, Switzerland m
Clinic and Policlinic of Internal Medicine, University Hospital of Zurich, Switzerland
Summary QUESTIONS UNDER STUDY: The prevalence of chronic kidney disease (CKD) is increasing worldwide, corresponding to an increased risk of cardiovascular disease. The latest study on prevalence of CKD involving the three linguistic regions of Switzerland dates back to 2002–2003 and definitions have changed since then. We aimed to assess the current prevalence and determinants of CKD in the Swiss general population. METHODS: We analysed the data of 1353 participants from a cross-sectional population-based survey performed in 2010–2012 in the three linguistic regions of Switzerland. The prevalence of CKD and the derived cardiovascular risk categories were assessed according to the Kidney Disease – Improving Global Outcomes (KDIGO) 2012 classification, using estimated glomerular filtration rate (GFR; CKDEpidemiological Collaboration equation) and albuminuria level. Multivariate logistic regression was used to analyse factors associated with CKD. RESULTS: We included 660 men and 693 women, equally distributed in four age categories (15–29, 30–44, 45–59 and over 60 years). The overall prevalence of CKD was 10.4%. The prevalence in the low, moderate, high and very high risk KDIGO categories were 89.6%, 8.4%, 1.6% and 0.5%, respectively. The prevalence of CKD was similar in all linguistic regions. In multivariate analysis, female gender, older age, diabetes and uric acid were independently associated with CKD in persons ≥45 y. In younger
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participants, diabetes and lower educational level were associated with CKD. CONCLUSIONS: In the general Swiss population, CKD affects one in ten adults. Subjects older than 60 years, as well as patients with diabetes and hypertension, show a high prevalence of CKD. Systematic screening may be recommended in this population. Key words: chronic kidney disease; KDIGO 2012 classification; CKD-EPI equation; albuminuria; Switzerland
Introduction The prevalence of chronic kidney disease (CKD) is increasing worldwide, amounting to an epidemic outbreak, which parallels the population aging and the increasing prevalence of hypertension, diabetes and obesity [1]. CKD is clearly associated with an increased risk of cardiovascular morbidity and mortality. Indeed, CKD patients are more likely to die from a cardiovascular event than to have deteriorating kidney function and start dialysis [2]. To better account for the prognostic impact of CKD stages in term of cardiovascular and renal prognosis, a revised CKD staging system was proposed by the Kidney Disease –Improving Global Outcomes (KDIGO) group [3]. In fact, the previous Kidney Disease Outcomes Quality Initiative (KDOQI) CKD classification guidelines (2002) [4] have been questioned, in particular with regard to their tendency
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Original article
Swiss Med Wkly. 2016;146:w14313
to overestimate CKD prevalence and fail to predict accurately prognosis and risk [5–7]. According to KDOQI (2002), CKD is defined, from a two-dimensional algorithm, as either kidney damage (identified by albuminuria in the presence of an albumin-to-creatinine ratio [ACR] >30 mg/g) with or without impaired estimated glomerular filtration rate (eGFR), or impaired eGFR
