All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan
Both end-stage renal disease and chronic kidney disease are increasing worldwide; however, the full effect of chronic kidney disease is unknown because mortality risks for all five stages are unavailable. We assessed prevalence and mortality risks for all stages of chronic kidney disease and quantif...
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| Published in | The Lancet (British edition) Vol. 371; no. 9631; pp. 2173 - 2182 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Elsevier Ltd
28.06.2008
Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Both end-stage renal disease and chronic kidney disease are increasing worldwide; however, the full effect of chronic kidney disease is unknown because mortality risks for all five stages are unavailable. We assessed prevalence and mortality risks for all stages of chronic kidney disease and quantified its attributable mortality in Taiwan.
The cohort consisted of 462 293 individuals aged older than 20 years who participated in a standard medical screening programme since 1994. As of Dec 31, 2006, we identified 14 436 deaths. Chronic kidney disease was determined by glomerular filtration rate and urinary protein. We estimated national prevalence in Taiwan from the cohort by adjusting age and educational levels. Hazard ratios (HRs) were calculated with Cox proportionate hazards model. We calculated mortality attributable to chronic kidney disease for national population and for low socioeconomic status.
The national prevalence of chronic kidney disease was 11·93% (95% CI 11·66–12·28), but only 3·54% (3·37–3·68) of participants in the cohort were aware of their disorder. Prevalence was substantially higher in the group with low socioeconomic status than in the high status group (19·87% [19·84–19·91]
vs 7·33% [7·31–7·35]). 56 977 (12%) of cohort participants had chronic kidney disease; those with disease had 83% higher mortality for all cause (HR 1·83 [1·73–1·93]) and 100% higher for cardiovascular diseases (2·00 [1·78–2·25]), in a cohort that was observed for 13 years with median follow-up of 7·5 years (IQR 4·0–10·1). 10·3% (95% CI 9·57–11·03) of deaths in the entire population were attributable to chronic kidney disease, but 17·5% (16·27–18·67) of deaths in the low socioeconomic status population. 2350 (39%) deaths occurred before 65 years of age in those with chronic kidney disease. Regular users of Chinese herbal medicines had a 20% (odds ratio 1·20 [1·16–1·24]) increased risk of developing chronic kidney disease.
The high prevalence of chronic kidney disease and its associated all-cause mortality, especially in people with low socioeconomic status, make reduction of this disorder a public-health priority. Promotion of its recognition through the general public knowing their glomerular filtration rate and testing their urine is crucial to reduce premature deaths from all causes and to attenuate this global epidemic.
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| AbstractList | Both end-stage renal disease and chronic kidney disease are increasing worldwide; however, the full effect of chronic kidney disease is unknown because mortality risks for all five stages are unavailable. We assessed prevalence and mortality risks for all stages of chronic kidney disease and quantified its attributable mortality in Taiwan.
The cohort consisted of 462 293 individuals aged older than 20 years who participated in a standard medical screening programme since 1994. As of Dec 31, 2006, we identified 14 436 deaths. Chronic kidney disease was determined by glomerular filtration rate and urinary protein. We estimated national prevalence in Taiwan from the cohort by adjusting age and educational levels. Hazard ratios (HRs) were calculated with Cox proportionate hazards model. We calculated mortality attributable to chronic kidney disease for national population and for low socioeconomic status.
The national prevalence of chronic kidney disease was 11·93% (95% CI 11·66–12·28), but only 3·54% (3·37–3·68) of participants in the cohort were aware of their disorder. Prevalence was substantially higher in the group with low socioeconomic status than in the high status group (19·87% [19·84–19·91]
vs 7·33% [7·31–7·35]). 56 977 (12%) of cohort participants had chronic kidney disease; those with disease had 83% higher mortality for all cause (HR 1·83 [1·73–1·93]) and 100% higher for cardiovascular diseases (2·00 [1·78–2·25]), in a cohort that was observed for 13 years with median follow-up of 7·5 years (IQR 4·0–10·1). 10·3% (95% CI 9·57–11·03) of deaths in the entire population were attributable to chronic kidney disease, but 17·5% (16·27–18·67) of deaths in the low socioeconomic status population. 2350 (39%) deaths occurred before 65 years of age in those with chronic kidney disease. Regular users of Chinese herbal medicines had a 20% (odds ratio 1·20 [1·16–1·24]) increased risk of developing chronic kidney disease.
The high prevalence of chronic kidney disease and its associated all-cause mortality, especially in people with low socioeconomic status, make reduction of this disorder a public-health priority. Promotion of its recognition through the general public knowing their glomerular filtration rate and testing their urine is crucial to reduce premature deaths from all causes and to attenuate this global epidemic.
None. Summary Background Both end-stage renal disease and chronic kidney disease are increasing worldwide; however, the full effect of chronic kidney disease is unknown because mortality risks for all five stages are unavailable. We assessed prevalence and mortality risks for all stages of chronic kidney disease and quantified its attributable mortality in Taiwan. Methods The cohort consisted of 462 293 individuals aged older than 20 years who participated in a standard medical screening programme since 1994. As of Dec 31, 2006, we identified 14 436 deaths. Chronic kidney disease was determined by glomerular filtration rate and urinary protein. We estimated national prevalence in Taiwan from the cohort by adjusting age and educational levels. Hazard ratios (HRs) were calculated with Cox proportionate hazards model. We calculated mortality attributable to chronic kidney disease for national population and for low socioeconomic status. Findings The national prevalence of chronic kidney disease was 11·93% (95% CI 11·66–12·28), but only 3·54% (3·37–3·68) of participants in the cohort were aware of their disorder. Prevalence was substantially higher in the group with low socioeconomic status than in the high status group (19·87% [19·84–19·91] vs 7·33% [7·31–7·35]). 56 977 (12%) of cohort participants had chronic kidney disease; those with disease had 83% higher mortality for all cause (HR 1·83 [1·73–1·93]) and 100% higher for cardiovascular diseases (2·00 [1·78–2·25]), in a cohort that was observed for 13 years with median follow-up of 7·5 years (IQR 4·0–10·1). 10·3% (95% CI 9·57–11·03) of deaths in the entire population were attributable to chronic kidney disease, but 17·5% (16·27–18·67) of deaths in the low socioeconomic status population. 2350 (39%) deaths occurred before 65 years of age in those with chronic kidney disease. Regular users of Chinese herbal medicines had a 20% (odds ratio 1·20 [1·16–1·24]) increased risk of developing chronic kidney disease. Interpretation The high prevalence of chronic kidney disease and its associated all-cause mortality, especially in people with low socioeconomic status, make reduction of this disorder a public-health priority. Promotion of its recognition through the general public knowing their glomerular filtration rate and testing their urine is crucial to reduce premature deaths from all causes and to attenuate this global epidemic. Funding None. Both end-stage renal disease and chronic kidney disease are increasing worldwide; however, the full effect of chronic kidney disease is unknown because mortality risks for all five stages are unavailable. We assessed prevalence and mortality risks for all stages of chronic kidney disease and quantified its attributable mortality in Taiwan.BACKGROUNDBoth end-stage renal disease and chronic kidney disease are increasing worldwide; however, the full effect of chronic kidney disease is unknown because mortality risks for all five stages are unavailable. We assessed prevalence and mortality risks for all stages of chronic kidney disease and quantified its attributable mortality in Taiwan.The cohort consisted of 462 293 individuals aged older than 20 years who participated in a standard medical screening programme since 1994. As of Dec 31, 2006, we identified 14 436 deaths. Chronic kidney disease was determined by glomerular filtration rate and urinary protein. We estimated national prevalence in Taiwan from the cohort by adjusting age and educational levels. Hazard ratios (HRs) were calculated with Cox proportionate hazards model. We calculated mortality attributable to chronic kidney disease for national population and for low socioeconomic status.METHODSThe cohort consisted of 462 293 individuals aged older than 20 years who participated in a standard medical screening programme since 1994. As of Dec 31, 2006, we identified 14 436 deaths. Chronic kidney disease was determined by glomerular filtration rate and urinary protein. We estimated national prevalence in Taiwan from the cohort by adjusting age and educational levels. Hazard ratios (HRs) were calculated with Cox proportionate hazards model. We calculated mortality attributable to chronic kidney disease for national population and for low socioeconomic status.The national prevalence of chronic kidney disease was 11.93% (95% CI 11.66-12.28), but only 3.54% (3.37-3.68) of participants in the cohort were aware of their disorder. Prevalence was substantially higher in the group with low socioeconomic status than in the high status group (19.87% [19.84-19.91] vs 7.33% [7.31-7.35]). 56 977 (12%) of cohort participants had chronic kidney disease; those with disease had 83% higher mortality for all cause (HR 1.83 [1.73-1.93]) and 100% higher for cardiovascular diseases (2.00 [1.78-2.25]), in a cohort that was observed for 13 years with median follow-up of 7.5 years (IQR 4.0-10.1). 10.3% (95% CI 9.57-11.03) of deaths in the entire population were attributable to chronic kidney disease, but 17.5% (16.27-18.67) of deaths in the low socioeconomic status population. 2350 (39%) deaths occurred before 65 years of age in those with chronic kidney disease. Regular users of Chinese herbal medicines had a 20% (odds ratio 1.20 [1.16-1.24]) increased risk of developing chronic kidney disease.FINDINGSThe national prevalence of chronic kidney disease was 11.93% (95% CI 11.66-12.28), but only 3.54% (3.37-3.68) of participants in the cohort were aware of their disorder. Prevalence was substantially higher in the group with low socioeconomic status than in the high status group (19.87% [19.84-19.91] vs 7.33% [7.31-7.35]). 56 977 (12%) of cohort participants had chronic kidney disease; those with disease had 83% higher mortality for all cause (HR 1.83 [1.73-1.93]) and 100% higher for cardiovascular diseases (2.00 [1.78-2.25]), in a cohort that was observed for 13 years with median follow-up of 7.5 years (IQR 4.0-10.1). 10.3% (95% CI 9.57-11.03) of deaths in the entire population were attributable to chronic kidney disease, but 17.5% (16.27-18.67) of deaths in the low socioeconomic status population. 2350 (39%) deaths occurred before 65 years of age in those with chronic kidney disease. Regular users of Chinese herbal medicines had a 20% (odds ratio 1.20 [1.16-1.24]) increased risk of developing chronic kidney disease.The high prevalence of chronic kidney disease and its associated all-cause mortality, especially in people with low socioeconomic status, make reduction of this disorder a public-health priority. Promotion of its recognition through the general public knowing their glomerular filtration rate and testing their urine is crucial to reduce premature deaths from all causes and to attenuate this global epidemic.INTERPRETATIONThe high prevalence of chronic kidney disease and its associated all-cause mortality, especially in people with low socioeconomic status, make reduction of this disorder a public-health priority. Promotion of its recognition through the general public knowing their glomerular filtration rate and testing their urine is crucial to reduce premature deaths from all causes and to attenuate this global epidemic. Both end-stage renal disease and chronic kidney disease are increasing worldwide; however, the full effect of chronic kidney disease is unknown because mortality risks for all five stages are unavailable. We assessed prevalence and mortality risks for all stages of chronic kidney disease and quantified its attributable mortality in Taiwan. The cohort consisted of 462 293 individuals aged older than 20 years who participated in a standard medical screening programme since 1994. As of Dec 31, 2006, we identified 14 436 deaths. Chronic kidney disease was determined by glomerular filtration rate and urinary protein. We estimated national prevalence in Taiwan from the cohort by adjusting age and educational levels. Hazard ratios (HRs) were calculated with Cox proportionate hazards model. We calculated mortality attributable to chronic kidney disease for national population and for low socioeconomic status. The national prevalence of chronic kidney disease was 11.93% (95% CI 11.66-12.28), but only 3.54% (3.37-3.68) of participants in the cohort were aware of their disorder. Prevalence was substantially higher in the group with low socioeconomic status than in the high status group (19.87% [19.84-19.91] vs 7.33% [7.31-7.35]). 56 977 (12%) of cohort participants had chronic kidney disease; those with disease had 83% higher mortality for all cause (HR 1.83 [1.73-1.93]) and 100% higher for cardiovascular diseases (2.00 [1.78-2.25]), in a cohort that was observed for 13 years with median follow-up of 7.5 years (IQR 4.0-10.1). 10.3% (95% CI 9.57-11.03) of deaths in the entire population were attributable to chronic kidney disease, but 17.5% (16.27-18.67) of deaths in the low socioeconomic status population. 2350 (39%) deaths occurred before 65 years of age in those with chronic kidney disease. Regular users of Chinese herbal medicines had a 20% (odds ratio 1.20 [1.16-1.24]) increased risk of developing chronic kidney disease. The high prevalence of chronic kidney disease and its associated all-cause mortality, especially in people with low socioeconomic status, make reduction of this disorder a public-health priority. Promotion of its recognition through the general public knowing their glomerular filtration rate and testing their urine is crucial to reduce premature deaths from all causes and to attenuate this global epidemic. Both end-stage renal disease and chronic kidney disease are increasing worldwide; however, the full effect of chronic kidney disease is unknown because mortality risks for all five stages are unavailable. We assessed prevalence and mortality risks for all stages of chronic kidney disease and quantified its attributable mortality in Taiwan. The cohort consisted of 462 293 individuals aged older than 20 years who participated in a standard medical screening programme since 1994. As of Dec 31, 2006, we identified 14 436 deaths. Chronic kidney disease was determined by glomerular filtration rate and urinary protein. We estimated national prevalence in Taiwan from the cohort by adjusting age and educational levels. Hazard ratios (HRs) were calculated with Cox proportionate hazards model. We calculated mortality attributable to chronic kidney disease for national population and for low socioeconomic status. The national prevalence of chronic kidney disease was 11.93% (95% CI 11.66-12.28), but only 3.54% (3.37-3.68) of participants in the cohort were aware of their disorder. Prevalence was substantially higher in the group with low socioeconomic status than in the high status group (19.87% [19.84-19.91] vs 7.33% [7.31-7.35]). 56 977 (12%) of cohort participants had chronic kidney disease; those with disease had 83% higher mortality for all cause (HR 1.83 [1.73-1.93]) and 100% higher for cardiovascular diseases (2.00 [1.78-2.25]), in a cohort that was observed for 13 years with median follow-up of 7.5 years (IQR 4.0-10.1). 10.3% (95% CI 9.57-11.03) of deaths in the entire population were attributable to chronic kidney disease, but 17.5% (16.27-18.67) of deaths in the low socioeconomic status population. 2350 (39%) deaths occurred before 65 years of age in those with chronic kidney disease. Regular users of Chinese herbal medicines had a 20% (odds ratio 1.20 [1.16-1.24]) increased risk of developing chronic kidney disease. The high prevalence of chronic kidney disease and its associated all-cause mortality, especially in people with low socioeconomic status, make reduction of this disorder a public-health priority. Promotion of its recognition through the general public knowing their glomerular filtration rate and testing their urine is crucial to reduce premature deaths from all causes and to attenuate this global epidemic. None. |
| Author | Sung, Pei Kun Chan, Hui Ting Wen, Chi Pang Hsu, Chih Cheng Tsai, Min Kuang Wen, Sung Feng Cheng, Ting Yuan David Tsai, Shan Pou Hsu, Yi Hua Chiang, Po Huang Chang, Yen Chen |
| Author_xml | – sequence: 1 givenname: Chi Pang surname: Wen fullname: Wen, Chi Pang email: cwengood@nhri.org.tw organization: Center for Health Policy Research and Development, National Health Research Institutes, Zhunan, Taiwan – sequence: 2 givenname: Ting Yuan David surname: Cheng fullname: Cheng, Ting Yuan David organization: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA – sequence: 3 givenname: Min Kuang surname: Tsai fullname: Tsai, Min Kuang organization: Center for Health Policy Research and Development, National Health Research Institutes, Zhunan, Taiwan – sequence: 4 givenname: Yen Chen surname: Chang fullname: Chang, Yen Chen organization: Center for Health Policy Research and Development, National Health Research Institutes, Zhunan, Taiwan – sequence: 5 givenname: Hui Ting surname: Chan fullname: Chan, Hui Ting organization: Center for Health Policy Research and Development, National Health Research Institutes, Zhunan, Taiwan – sequence: 6 givenname: Shan Pou surname: Tsai fullname: Tsai, Shan Pou organization: University of Texas, School of Public Health, Houston, TX, USA – sequence: 7 givenname: Po Huang surname: Chiang fullname: Chiang, Po Huang organization: Center for Health Policy Research and Development, National Health Research Institutes, Zhunan, Taiwan – sequence: 8 givenname: Chih Cheng surname: Hsu fullname: Hsu, Chih Cheng organization: Center for Health Policy Research and Development, National Health Research Institutes, Zhunan, Taiwan – sequence: 9 givenname: Pei Kun surname: Sung fullname: Sung, Pei Kun organization: MJ Health Management Institution, Taipei, Taiwan – sequence: 10 givenname: Yi Hua surname: Hsu fullname: Hsu, Yi Hua organization: MJ Health Management Institution, Taipei, Taiwan – sequence: 11 givenname: Sung Feng surname: Wen fullname: Wen, Sung Feng organization: Nephrology Section, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/18586172$$D View this record in MEDLINE/PubMed |
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| Snippet | Both end-stage renal disease and chronic kidney disease are increasing worldwide; however, the full effect of chronic kidney disease is unknown because... Summary Background Both end-stage renal disease and chronic kidney disease are increasing worldwide; however, the full effect of chronic kidney disease is... |
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| SubjectTerms | Adult Age Distribution Awareness Cardiovascular disease Cardiovascular diseases Chronic Disease Cohort Studies Creatinine - blood Death Certificates Deaths Female Glomerular Filtration Rate Health risks Herbal medicine Humans Internal Medicine Kidney diseases Kidney Diseases - classification Kidney Diseases - epidemiology Kidney Diseases - mortality Kidney Failure, Chronic - epidemiology Kidney Failure, Chronic - mortality Kidneys Male Mass Screening - methods Medical Records Systems, Computerized Medical research Medical tests Medicine Middle Aged Mortality Mortality risk Physical examinations Prevalence Public health Risk Sample size Severity of Illness Index Social Class Socioeconomics Students, Public Health Taiwan - epidemiology |
| Title | All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan |
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