Why carry out this study?
|
In 2012, the Kidney Disease: Improving Global Outcomes (KDIGO) organisation issued a set of guidelines recommending that chronic kidney disease (CKD) be classified by both the level of glomerular filtration rate (GFR) and albuminuria. |
We conducted a systematic review to explore the uptake of the guidelines (i.e. how many studies use this classification system) and the epidemiology of CKD according to these guidelines (i.e. the prevalence of patients within the GFR/albuminuria-defined risk groups). |
What was learnt from the study?
|
A substantial proportion of the general population have CKD, but only a small fraction of patients have severely increased albuminuria or fall within the high-risk or very high-risk groups defined by the KDIGO 2012 guidelines. |
These groups, however, have a high prevalence of diabetes, cardiovascular disease and hypertension, especially among those with higher levels of albuminuria. |
Testing for albuminuria is therefore valuable for CKD prognosis and management. |
Digital Features
Introduction
Methods
Category | Inclusion criteria | Exclusion criteria |
---|---|---|
Population | Adult patients with CKD stages 2, 3a, 3b, 4, 5/ESRD, categorised according to the KDIGO 2012 classification or similar Mixed populations, if the outcomes are reported separately for the population of interest | Population does not include patients with CKD of a relevant stage or classification, or does not report results separately for this subgroup Animal/in vitro studies |
Intervention/comparator | Any or none | N/A |
Outcomes | Country or regional-level prevalence, incidence or mortality reported for the following health states, including but not limited to: CKD albuminuria categories, with albuminuria measured by methods including but not limited to: UACR PCR AER PER Protein reagent strip Level of overlap between CKD, T2DM and heart failure† Cardiovascular complications (e.g. MI, stroke, angina, MACE, hospitalisation for heart failure) Hypertension | No relevant epidemiological outcomes |
Study type | Non-interventional studies, e.g. observational studies or population surveys of any design, including cohort studies, cross-sectional surveys, case–control studies, registry studies, chart reviews etc. Meta-analyses of relevant study designs | Any other study type, e.g. RCTs, case reports/series |
Publication type | Original research studies Conference abstracts SRs of relevant primary publications (these were considered relevant at the title/abstract review stage and hand-searched for relevant primary studies, but excluded during the full-text review stage) | Irrelevant publication types including narrative reviews, commentaries, editorials |
Other criteria | Studies conducted in the USA, China or EU5 country (France, Germany, Italy, Spain, UK) Studies published in or after 2012 Conference abstracts published in or after 2017 Full text in English | Studies conducted in any other geographical location Studies published before 2012 Conference abstracts published before 2017 Full text in any other language |
Compliance with Ethics Guidelines
Results
Study Selection
Study Characteristics
Study | Registry, database or cohort | Country | Study design | Study setting | Data collection period | Sample size | GFR categories | Measure of eGFR | Albuminuria categories | Measure of albuminuria |
---|---|---|---|---|---|---|---|---|---|---|
Odden [26] | NHANES 1988–1994 and NHANES 1999–2002 | USA | Cross-sectional survey | General population | 1988–1994 and 1999–2002 | 10,956 | G4 and G5 merged; G2 split into 60–74 and 75–89 mL/min/1.73 m2; G3a and G3b subcategories presented | CKD-EPI equation | A1 split into < 10 and 10–29 mg/g subcategories | UACR |
Pani [31] | SardiNIA | Italy | Prospective cohort study | General population | Start 2001; average follow-up 7 years | 4842 | KDIGO 2012 | CKD-EPI and MDRD equation | KDIGO 2012 | Urinary protein and albumin levels |
Wang [30] | NHANES 2009–2010 and China National Survey of CKD 2009–2010 | USA and China | Cross-sectional survey | General population | 2009–2010 | 5557 (USA); 46,949 (China) | KDIGO 2012 | CKD-EPI equation | KDIGO 2012 | UACR |
Levin [25] | NHANES 1999–2006 | USA | Cross-sectional survey | General population | 1999–2006 | 18,026 | KDIGO 2012 | CKD-EPI equation | KDIGO 2012 | UACR |
ARIC | USA | Prospective cohort study | General population | 1996–1998 (visit 4); 2011–2013 (visit 5) | 11,060 | KDIGO categories but G4 and G5 merged | CKD-EPI equation | KDIGO 2012 | UACR | |
CKD-REIN | France | Prospective cohort study | Outpatient nephrology care (GFR category G3–4 at census; GFR category G2–5 at inclusion) | 3033 | KDIGO 2012 | CKD-EPI equation | A3 split into 300–1999 and ≥ 2000 mg/g subcategories | UACR (30% of patients); PCR, AER or PER (all other patients) | ||
USRDS [27] | NHANES 2013–2016 | USA | Cross-sectional survey | General population | 2013–2016 | NR | KDIGO 2012 | CKD-EPI equation | KDIGO 2012 | UACR |
Tanner [28] | REGARDS | USA | Prospective cohort study | General population (analysis restricted to hypertensive patients) | 2003–2007 | 10,700 | G1 and G2 merged; G3a omitted; G3b, G4 and G5 merged | CKD-EPI equation | A1 split into < 10 and 10–29 mg/g subcategories | UACR |
Ruiz-Hurtado [32] | Spanish ABPM Registry Cohort | Spain | Cross-sectional registry analysis | Primary care setting (93% hypertension patients) | 2009–2014 | 16,546 | G2 omitted; G3a, G3b, G4 and G5 merged | CKD-EPI equation | KDIGO 2012 | UACR |
Lin [29] | Zhejiang Province | China | Cross-sectional survey | General population | 2009–2012 | 10,384 | KDIGO categories but G4 and G5 merged | Simplified MDRD equation | KDIGO 2012 | UACR |
Patient Demographics, Aetiology and Baseline Comorbidities
Study | Age mean (SD)† | Gender % male | Race/ethnicity % | SES (income, educational level) | Geolocation (urban vs rural) | Inclusion criteria | Exclusion criteria |
---|---|---|---|---|---|---|---|
Odden [26] | 46.8 (0.7) | 49.4 | 77.9% white, 11.2% black, 10.9% other | Reports educational level (< high school, high school, > high school) stratified by gender and uric acid level | NR | Adults aged ≥ 20 years | Pregnant participants. Participants who did not complete both the interview and examination |
Pani [31] | 49.7 (16.3) | 42.3 | NR | NR | NR | NR | NR |
Wang [30] | 47.2 (SE 0.51) (USA); 42.6 (SE 0.15) (China) | 49.0 (USA); 50.0 (China) | 10.6% black (USA); NR (China) | ≥ high school: 81.2% (USA); 31.4% (China) | Equal number of urban and rural locations | NR | Participants with missing data on serum creatinine or albuminuria, < 20 years of age or reported as being pregnant at the time of the study |
Levin [25] | NR‡ | NR‡ | NR‡ | NR‡ | NR‡ | NR‡ | NR‡ |
62.8 (5.7) | NR | 78% white, 22% black, 0% Hispanic, 0% Asian | NR | NR | Adults aged 45–64 at baseline | Participants reporting race other than white or black, or missing values of either kidney measure or covariates | |
66.2 (12.9) | 65 | NR | Educational level: < 9 years, 15%; 9–12 years, 49%; ≥ 12 years, 36% | The study encompassed rural and urban regions (numbers NR) | eGFR < 60 mL/min/1.73 m2 for at least 1 month. No prior chronic dialysis or transplantation. Written signed consent form | Age < 18 years old. Pregnant patients. Patients that planned to move. Patients that were unable to give informed consent or declined to participate | |
USRDS [27] | NR | NR | NR | Reports income and educational level stratified by presence of CKD, GFR status and albuminuria status | NR | Adults aged ≥ 20 years | NR |
Tanner [28] | 67.5 (8.7) | NR | 50.1% black | Income < 20,000 and less than high school education reported stratified by presence of treatment resistant hypertension | NR | Adults aged ≥ 45 years. Individuals with hypertension who were taking ≥ 1 class of antihypertensive medication | Individuals missing serum creatinine, urine albumin or urine creatinine, BP data or information from the pill bottle review. Participants who reported being on dialysis at baseline or were missing information on dialysis status. Participants with uncontrolled BP on one or two antihypertensive medication classes |
Ruiz-Hurtado [32] | 59.6 (13.6) | NR | NR | NR | NR | Patients included in the registry with valid ABPM readings and complete information for the determination of albuminuria, diabetes and CKD status | NR |
Lin [29] | 52.9 (14.5) | 43 | NR | NR | Equal number of urban and rural locations | Adults aged ≥ 18 years from the Zhejiang province who completed the required questionnaire, physical examination and laboratory examination | NR |
Study | Hypertension % | Diabetes† % | SBP (mmHg) mean (SD)‡ | BMI (kg/m2) mean (SD)‡ | History of CVD/CVD events % | History of MI % | History of stroke % | History of HF % |
---|---|---|---|---|---|---|---|---|
Odden [26] | 24.5 | 6.2 | 123.9 (0.8) | 27.8 (0.3) | NR | 3.4 | 1.9 | 2.3 |
Pani [31] | 32 | 9.1 | NR | 25.9 (4.7) | 5.6 | NR | NR | NR |
Wang [30] | 35.1 (USA); 30.4 (China) | 10.7 (USA); 5.0 (China) | 120.3 (SE 0.51) (USA); 125.2 (SE 0.18) (China) | 28.7 (SE 0.13) (USA); 23.5 (SE 0.03) (China) | 5.2 (USA); 2.0 (China) | NR | NR | NR |
Levin [25] | NR | NR | NR | NR | NR | NR | NR | NR |
47.4 | 16.6 | 127.6 (19) | 28.8 (5.6) | 13.9 | NR | NR | NR | |
91 | 43 | 142 (20) | 29 (6) | 53 | NR | NR | NR | |
USRDS [27] | NR | NR | NR | NR | NR | NR | NR | NR |
Tanner [28] | NR | 34.7 | 132.9 (14.1) | NR | NR | 19.3 | 10.7 | NR |
Ruiz-Hurtado [32] | 93 | 25.3 | NR | 29.3 (4.9) | 12.4 | NR | NR | NR |
Lin [29] | NR | NR | 133.4 (24.1) | 23.1 (3.99) | NR | NR | NR | NR |