四川地区慢性肾脏病发病情况及危险因素分析
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摘要
背景和目的
慢性肾脏病(CKD)是严重威胁人类生命和健康的常见慢性进展性疾病,具有患病率高、知晓率低、治疗困难、医疗费用大等特点。目前已成为全球关注的重要的公共卫生问题。世界上各国报道CKD患病率高,而目前我国尚缺乏完整的CKD流行病学资料,西南地区特别是四川省尚未有CKD的流行病学资料。因此,尽快筛查并了解CKD在我四川省不同地区、不同年龄人群的患病率及其高危因素,已成为制定合理的公共卫生政策和有效的干预措施的迫切需要。代谢综合征患病率逐年升高,研究提示其与CKD密切相关,不同代谢综合征组分对CKD的影响不尽相同,探索研究代谢综合征及其相关性疾病与CKD的关系,有利于控制和预防CKD的发生和进展。
本研究通过选取四川地区具有代表性人群,对其进行CKD筛查,分析四川地区成年人群中CKD的患病率、影响患病的危险因素,并进一步探讨代谢综合征及其各组分与CKD的关系,为制定CKD的预防和控制规划提供科学依据。
研究设计与方法
本研究结合四川本地的实际情况,应用多阶段整群随机抽样方法,在四川省内抽取有代表性的18岁以上成人人群作为研究对象。按照设计要求,应查3300人实际调查3024人,应答率为91.6%,当前分析的范围限定为年龄在18岁以上且完成调查的3024人。研究内容包括问卷调查(人口学特征、慢性疾病史、既往史、家族史、行为危险因素和膳食调查)、体格检查(身高、体重、腰围、臀围和血压)和血液(血糖、血脂、尿酸、血肌酐)及尿液检测(尿常规+沉渣镜检,尿微量白蛋白、尿肌酐)。采用现况研究,应用eGFR下降(<60ml/min/1.73m2)、白蛋白尿、蛋白尿、血尿等指标诊断慢性肾脏病,代谢综合征诊断根据2005年IDF关于代谢综合征的诊断标准,并根据代谢综合征不同组分分为A-J11组。使用SPSS16.0软件进行所有数据的分析,了解四川省内18岁以上人群CKD的患病率、代谢综合征及相关性疾病的患病率,应用单因素分析和多因素logistic回归分析方法筛选相应的CKD独立危险因素。并进一步研究代谢综合征及其各组分与CKD的关系。
结果
(一)四川地区CKD的患病率：四川地区的CKD、血尿、白蛋白尿、蛋白尿、及eGFR下降患病率(标化患病率)分别为19.1%(16.48%),7.2%(6.74%)11.4%(9.49%),1.4%(1.11%)及2.9%(2.34%)。男性CKD的患病率低于女性(6.2%比15.1%,p<0.001)。男性血尿、微量白蛋白尿、显性白蛋白尿的患病率分别为3.3%、8.4%和1.0%,相应的女性患病率分别为11.2%、12.4%和1.1%,两者具有显著性差异(p<0.001)；男性蛋白尿、eGFR下降患病率分别为1.4%和2.4%,相应的女性患病率为1.3%和3.3%,两者无显著性差异。成都地区CKD患病率低于广汉CKD患病率(10.4%比19.1%,p<0.001),成都地区较广汉地区血尿、白蛋白尿、蛋白尿及eGFR下降患病率低(p<0.001)。CKD患病率、微量白蛋白尿患病率随年龄递增升高,在不同年龄组(18～39岁,40～49岁,50～59岁,60～69岁,70～95岁)CKD的患病率分别为11.6%,16.8%,19.9%,27.4%和41.3%,差异具有统计学意义(p<0.001)。不同年龄组微量白蛋白尿的患病率分别为5.6%、7.3%、11.5%、17.8%和24.3%,差异具有统计学意义(p<0.001)。血尿的患病率各年龄组无显著性差异(p>0.05)。CKD知晓率为7.9%。
(二)慢性病患病率：四川地区的高血压患病率为16.5%,标化患病率为11.99%,成都地区高血压患病率低于广汉(11.1%比22.0%,p<0.001)。男性高血压的患病率为17.2%,女性为15.9%,两者无显著性差异(p>0.05)。四川地区的糖尿病患病率为6.6%,标化患病率为5.1%。成都地区比广汉地区糖尿病患病率低(4.0%比9.2%,P<0.001)。男性糖尿病的患病率为6.9%,女性为6.4%,两者无显著性差异(P>0.05)。四川地区的高脂血症患病率为53.4%,标化患病率为50.76%。成都地区高脂血症患病率较广汉低(49.3%比57.5%,p<0.05)。男性高脂血症的患病率为56.2%,女性为50.6%,两者具有显著性差异(P<0.05)。四川地区的肥胖症患病率为60.0%,标化患病率为65.30%。成都地区肥胖症患病率比广汉高(65.8%比54.1%,p<0.001)。男性肥胖症的患病率为65.4%,女性为54.4%,两者具有显著性差异(P<0.001)。四川地区高尿酸血症患病率14.4%,标化患病率为15.13%。成都地区比广汉地区患病率高(18.3%比10.4%,p<0.001)；男性高尿酸血症患病率较女性高(19.8%比8.8%,P<0.001)。
(三)四川地区的代谢综合征患病率：四川地区代谢综合征患病率为10.0%,标化患病率为8.57%。成都地区代谢综合征患病率与广汉地区无显著性差异(9.9%比10.0%,p>0.05)。男性代谢综合征的患病率为6.1%,女性为13.8%,两者具有显著性差异(P<0.001)。不同MS分组：A、B、C、D、E及J组患病率分别为3.9%、2.3%、1.7%、0.8%、0.9%及0.3%；相应的标化患病率分别为4.13%、1.57%、1.31%、0.53%、0.75%及0.22%。相应的男性患病率为4.4%、0.4%、1.0%、0.3%、0%及0%,女性患病率为3.3%、4.3%、2.5%、1.3%、1.7%及0.6%。
(四)代谢综合征与慢性肾脏病：301例MS患者中CKD患病率为26.2%,比非MS人群(18.4%)高(p<0.001), CKD多因素分析：按照α=0.05水准,与CKD有关的因素有：C组(OR=1.955,95.0%CI=1.075-3.557)、D组(OR=2.432, 95.0%CI=1.068-5.540)。
(五)CKD的危险因素：Logistic多因素回归提示：男性(OR=0.496, 95.0%CI=0.379-0.648).高文化程度(OR=0.839,95.0%CI=0.738-0.955)、高经济收入(OR=0.804,95.0%CI=0.727-0.889)是CKD的保护因素,高血压(OR=1.933,95.0%CI=1.506-2.482)、糖尿病(OR=4.528,95.0%CI=3.239-6.329)、高尿酸(OR=1.644,95.0%CI=1.233-2.192)及肾病史(OR=1.682, 95.0%CI=1.137-2.487)是CKD的独立危险因素。
结论
(一)四川地区成年人群CKD总的患病率水平较高,农村比城市人群CKD患病率高。
(二)四川地区成年人群代谢综合征及相关性疾病总的患病率水平较高,城乡代谢综合征无明显差异,中心性肥胖患病率城市高于农村人群,高血压、糖尿病、高脂血症患病率农村高于城市。四川地区女性人群代谢综合征患病率高于男性。
(三)四川地区代谢综合征患者CKD患病率高于非代谢综合征人群,代谢综合征合并CKD与非代谢综合征人群合并CKD比较,其CKD分期更高,预示病情更重。
(四)中心性肥胖合并甘油三酯升高及糖代谢异常的患者,中心性肥胖合并高密度脂蛋白降低及高血压的患者可能是代谢综合征中CKD患病的相对高危组。函需对MS进行筛查及控制,以减少肾脏病的发生。
(五)女性、高血压、糖尿病、高尿酸血症、肾病史、低收入和低文化为CKD的独立危险因素。
(六)四川省CKD知晓率低,函需在CKD高危人群中开展CKD的筛检计划,提高知晓率,并加强病人的管理,改善病人的治疗和控制现状。
Backgroud and objectives
Chronic kidney disease(CKD) is a common disease that threatening life and health of human being with its high prevalence, low awareness, difficult treatment and high medical expense. It has became a worldwide public health problem. Many countries have reported the high prevalence rate, while a complete national epidemiology of CKD is absent in China. There were several reports about CKD epidimology in other regions of China except the southwest region. The prevalence of CKD in different area, different gender and different age groups in Sichuan is still unknown. Therefore, screening for CKD in Sichuan Province will allow us to acquire the epidemiology of CKD in this area, and to establish an effective, applicable strategy for CKD prevention and manangement. The incidence of metabolic syndrome(MS) is increasing, and researches have revealed its intimated relationship with CKD. But the influence of CKD by different components of MS is still unclear, so it is important to uncover this relation for establishing effective policy for CKD prevention and management.
In this research, people from Sichuan province were enrolled for CKD screening, the prevalence and risk factors were analysed, and the relation between CKD and metabolic syndrome was studied at the same time.
Study design and methods
This research was based on the situation of Sichuan province,3024 people older than 18 years were enrolled by cluster random sampling. Acording to the design,3300 people should be enrolled, the actual investigated people were 3024 with a responsed rate of 91.6%. This rearch included a questionnaire (demographic characteristics, history of chronic disease, past history, family history, behavior and diet status, etc.), physical exminations (body height, weight, waist circumference, hip circumference and blood pressure) and laboratory examinations (urine routine and sediment, urine albumin and urine creatinine). CKD was diagnosed by decreased eGFR(<60ml/min/1.73m2) or presentation of microalbuminuria, macroalbuminuria, proteinuria or hematuria. MS was diagnosed according to International Diabetes Federation guidelines. A cross-secitonal study was adopted to investigate the Sichuan adults about the prevalence, awareness rate, and current status of treatment of CKD, metabolic syndrome. Multivariate analysis were applied to study the risk factors of CKD,. The relationship between CKD and metabolic syndrome was also studied.
Results
1. Prevalence of CKD in Sichuan province:The overall prevalence and age-and-sex-standardized prevalence of CKD in Sichuan was 19.1% and 16.48% respectively. The prevalence of hematuria, albuminuria, proteinuria and decreased eGFR was 7.2%,11.4%,1.4% and 2.9%; and the standardized prevalence was 6.74%, 9.49%,1.11% and 2.34%, respectively. Prevalence of CKD, hematuria, microalbuminuria and macroalbuminuria was 15.1%,11.2%,12.4% and 1.1% in female, and it was lower in male population with the corresponding prevalence of 6.2%,3.3%,8.4% and 1.0%(p<0.001). There was no difference in prevalence of proteinuria or decreased eGFR between male and female population. Prevalence of CKD in Chengdu was lower than in Guanghan(10.4% vs 19.1%, p<0.001). And prevalence of hematuria, proteinuria, albuminuria and decreased eGFR was also lower in Chengdu than in Guanghan(p<0.001). Prevalence of CKD and microalbuminuria increased with age. In different age groups(18～39,40～49,50～59, 60～69,70～95), the prevalence of CKD was 11.6%,16.8%,19.9%,27.4%和41.3%; and the prevalence of microalbuminuria was 5.6%、7.3%、11.5%、17.8% and 24.3% respectively. There was no difference of prevalence of hematuria in different age groups. The awareness rate of CKD was 7.9%.
2. Prevalence of other chronic diseases in Sichuan province:The prevalence and age-and-sex-standardized prevalence of hypertension was 16.5% and 11.9% respectively with a higher prevalence in Guanghan than in Chengdu(22.0% vs 11.0%, p<0.001). There was no difference in the prevalence between male and female(17.2% vs 15.9%, p>0.05). The prevalence and age-and-sex-standardized prevalence of diabetes was 6.6% and 5.1% respectively with a higher prevalence in Guanghan than in Chengdu(9.2% vs 4.0%, p<0.001), there was no difference in the prevalence between male and female(6.9% vs 6.4%, p>0.05). The prevalence and age-and-sex-standardized prevalence of hyperlipidemia was 53.4% and 50.76% respectively with a higher prevalence in Guanghan than in Chengdu(57.5% vs 49.3%, p<0.05), it was higher in male than in female(56.2% vs 50.6%%, p<0.05). The prevalence and age-and-sex-standardized prevalence of obesity was 60.0% and 65.30% respectively with a higher prevalence in Chengdu than in Guanghan (65.8% vs 54.1%, p<0.001), it was higher in male than in female(65.4% vs54.4%, p<0.001). The prevalence and age-and-sex-standardized prevalence of hyperuricemia was 14.4% and 15.13% respectively with a higher prevalence in Chengdu than in Guanghan (18.3 vs 10.4%, p<0.001), it was higher in male than in female(19.8% vs 8.8%, p<0.001).
3. Prevalence of metabolic syndrome and its components in Sichuan province:The prevalence and age-and-sex-standardized prevalence of metabolic syndrome was 10.0% and 8.57% respectively without difference in Chengdu and Guanghan (9.9% vs 10.0%, p>0.05), it was higher in female than in male(13.8% vs 6.1%, p<0.001). Different group of MS:prevalence of group A, B, C, D, E and J was 3.9%,2.3%, 1.7%,0.8%,0.9% and 0.3%. And the corresponding age-and-sex-standardized prevalence was 4.13%,1.57%,1.31%,0.53%,0.75% and 0.22%。
4. Relationship between MS and CKD:In the diagnosed MS patients, the prevalence of CKD was higher than non-MS people (26.2% vs 18.4, p<0.001). Group C (OR=1.955,95.0%CI=1.075-3.557) and D (OR=2.432,95.0%CI=1.068-5.540) was associated with increased prevalence of CKD。
5. Risk factors of CKD:The logistic regression analysis showed that hypertension(OR =1.933,95.0%CI:1.506-2.482), diabetes(OR=4.528,95.0%CI:3.239-6.329), hyperuricemia(OR=1.644,95.0%CI:1.233-2.192) and past history of reral disease (OR=1.682,95.0%CI:1.137-2.487) was risk factors of CKD. And male(OR=0.496, 95.0%CI:0.379-0.648), high degree of education(OR=0.839,95.0%CI:0.738-0.955), and high income(OR=0.804,95.0%CI:0.727-0.889) was negative associated with CKD.
Conclusions
1. The prevalence of CKD in Sichuan province is relatively high in China with a higher prevalence in rural population than in urban population.
2. The prevalence of metabolic syndrome and its components is high in Sichuan Province. There is no difference in MS prevalence between rural and urban populations. Prevalence of centric obesity is higher in urban population while prevalence of other components are higher in rural population.
3. Prevalence and stages of CKD are higher in MS patients than in general population in Sichuan,
4. Centric obesity accompanied with hypertriglyceridemia and glycometabolism disorders, obesity accompanied with decreased HDL-C and hypertension may be more at high risk of developing CKD.
5. Female gender, hypertension, hyperuricemia, diabetes, past history of renal disease, low degree of education and low income are risk factors of CKD.
6. Screening plan for CKD in populations with high risk is urgent to increase the awareness, to enhance patients' management, and to improve the current status of treatment and control of CKD.
慢性肾脏病(CKD)是严重威胁人类生命和健康的常见慢性进展性疾病,具有患病率高、知晓率低、治疗困难、医疗费用大等特点。目前已成为全球关注的重要的公共卫生问题。世界上各国报道CKD患病率高,而目前我国尚缺乏完整的CKD流行病学资料,西南地区特别是四川省尚未有CKD的流行病学资料。因此,尽快筛查并了解CKD在我四川省不同地区、不同年龄人群的患病率及其高危因素,已成为制定合理的公共卫生政策和有效的干预措施的迫切需要。代谢综合征患病率逐年升高,研究提示其与CKD密切相关,不同代谢综合征组分对CKD的影响不尽相同,探索研究代谢综合征及其相关性疾病与CKD的关系,有利于控制和预防CKD的发生和进展。
本研究通过选取四川地区具有代表性人群,对其进行CKD筛查,分析四川地区成年人群中CKD的患病率、影响患病的危险因素,并进一步探讨代谢综合征及其各组分与CKD的关系,为制定CKD的预防和控制规划提供科学依据。
研究设计与方法
本研究结合四川本地的实际情况,应用多阶段整群随机抽样方法,在四川省内抽取有代表性的18岁以上成人人群作为研究对象。按照设计要求,应查3300人实际调查3024人,应答率为91.6%,当前分析的范围限定为年龄在18岁以上且完成调查的3024人。研究内容包括问卷调查(人口学特征、慢性疾病史、既往史、家族史、行为危险因素和膳食调查)、体格检查(身高、体重、腰围、臀围和血压)和血液(血糖、血脂、尿酸、血肌酐)及尿液检测(尿常规+沉渣镜检,尿微量白蛋白、尿肌酐)。采用现况研究,应用eGFR下降(<60ml/min/1.73m2)、白蛋白尿、蛋白尿、血尿等指标诊断慢性肾脏病,代谢综合征诊断根据2005年IDF关于代谢综合征的诊断标准,并根据代谢综合征不同组分分为A-J11组。使用SPSS16.0软件进行所有数据的分析,了解四川省内18岁以上人群CKD的患病率、代谢综合征及相关性疾病的患病率,应用单因素分析和多因素logistic回归分析方法筛选相应的CKD独立危险因素。并进一步研究代谢综合征及其各组分与CKD的关系。
结果
(一)四川地区CKD的患病率：四川地区的CKD、血尿、白蛋白尿、蛋白尿、及eGFR下降患病率(标化患病率)分别为19.1%(16.48%),7.2%(6.74%)11.4%(9.49%),1.4%(1.11%)及2.9%(2.34%)。男性CKD的患病率低于女性(6.2%比15.1%,p<0.001)。男性血尿、微量白蛋白尿、显性白蛋白尿的患病率分别为3.3%、8.4%和1.0%,相应的女性患病率分别为11.2%、12.4%和1.1%,两者具有显著性差异(p<0.001)；男性蛋白尿、eGFR下降患病率分别为1.4%和2.4%,相应的女性患病率为1.3%和3.3%,两者无显著性差异。成都地区CKD患病率低于广汉CKD患病率(10.4%比19.1%,p<0.001),成都地区较广汉地区血尿、白蛋白尿、蛋白尿及eGFR下降患病率低(p<0.001)。CKD患病率、微量白蛋白尿患病率随年龄递增升高,在不同年龄组(18～39岁,40～49岁,50～59岁,60～69岁,70～95岁)CKD的患病率分别为11.6%,16.8%,19.9%,27.4%和41.3%,差异具有统计学意义(p<0.001)。不同年龄组微量白蛋白尿的患病率分别为5.6%、7.3%、11.5%、17.8%和24.3%,差异具有统计学意义(p<0.001)。血尿的患病率各年龄组无显著性差异(p>0.05)。CKD知晓率为7.9%。
(二)慢性病患病率：四川地区的高血压患病率为16.5%,标化患病率为11.99%,成都地区高血压患病率低于广汉(11.1%比22.0%,p<0.001)。男性高血压的患病率为17.2%,女性为15.9%,两者无显著性差异(p>0.05)。四川地区的糖尿病患病率为6.6%,标化患病率为5.1%。成都地区比广汉地区糖尿病患病率低(4.0%比9.2%,P<0.001)。男性糖尿病的患病率为6.9%,女性为6.4%,两者无显著性差异(P>0.05)。四川地区的高脂血症患病率为53.4%,标化患病率为50.76%。成都地区高脂血症患病率较广汉低(49.3%比57.5%,p<0.05)。男性高脂血症的患病率为56.2%,女性为50.6%,两者具有显著性差异(P<0.05)。四川地区的肥胖症患病率为60.0%,标化患病率为65.30%。成都地区肥胖症患病率比广汉高(65.8%比54.1%,p<0.001)。男性肥胖症的患病率为65.4%,女性为54.4%,两者具有显著性差异(P<0.001)。四川地区高尿酸血症患病率14.4%,标化患病率为15.13%。成都地区比广汉地区患病率高(18.3%比10.4%,p<0.001)；男性高尿酸血症患病率较女性高(19.8%比8.8%,P<0.001)。
(三)四川地区的代谢综合征患病率：四川地区代谢综合征患病率为10.0%,标化患病率为8.57%。成都地区代谢综合征患病率与广汉地区无显著性差异(9.9%比10.0%,p>0.05)。男性代谢综合征的患病率为6.1%,女性为13.8%,两者具有显著性差异(P<0.001)。不同MS分组：A、B、C、D、E及J组患病率分别为3.9%、2.3%、1.7%、0.8%、0.9%及0.3%；相应的标化患病率分别为4.13%、1.57%、1.31%、0.53%、0.75%及0.22%。相应的男性患病率为4.4%、0.4%、1.0%、0.3%、0%及0%,女性患病率为3.3%、4.3%、2.5%、1.3%、1.7%及0.6%。
(四)代谢综合征与慢性肾脏病：301例MS患者中CKD患病率为26.2%,比非MS人群(18.4%)高(p<0.001), CKD多因素分析：按照α=0.05水准,与CKD有关的因素有：C组(OR=1.955,95.0%CI=1.075-3.557)、D组(OR=2.432, 95.0%CI=1.068-5.540)。
(五)CKD的危险因素：Logistic多因素回归提示：男性(OR=0.496, 95.0%CI=0.379-0.648).高文化程度(OR=0.839,95.0%CI=0.738-0.955)、高经济收入(OR=0.804,95.0%CI=0.727-0.889)是CKD的保护因素,高血压(OR=1.933,95.0%CI=1.506-2.482)、糖尿病(OR=4.528,95.0%CI=3.239-6.329)、高尿酸(OR=1.644,95.0%CI=1.233-2.192)及肾病史(OR=1.682, 95.0%CI=1.137-2.487)是CKD的独立危险因素。
结论
(一)四川地区成年人群CKD总的患病率水平较高,农村比城市人群CKD患病率高。
(二)四川地区成年人群代谢综合征及相关性疾病总的患病率水平较高,城乡代谢综合征无明显差异,中心性肥胖患病率城市高于农村人群,高血压、糖尿病、高脂血症患病率农村高于城市。四川地区女性人群代谢综合征患病率高于男性。
(三)四川地区代谢综合征患者CKD患病率高于非代谢综合征人群,代谢综合征合并CKD与非代谢综合征人群合并CKD比较,其CKD分期更高,预示病情更重。
(四)中心性肥胖合并甘油三酯升高及糖代谢异常的患者,中心性肥胖合并高密度脂蛋白降低及高血压的患者可能是代谢综合征中CKD患病的相对高危组。函需对MS进行筛查及控制,以减少肾脏病的发生。
(五)女性、高血压、糖尿病、高尿酸血症、肾病史、低收入和低文化为CKD的独立危险因素。
(六)四川省CKD知晓率低,函需在CKD高危人群中开展CKD的筛检计划,提高知晓率,并加强病人的管理,改善病人的治疗和控制现状。
Backgroud and objectives
Chronic kidney disease(CKD) is a common disease that threatening life and health of human being with its high prevalence, low awareness, difficult treatment and high medical expense. It has became a worldwide public health problem. Many countries have reported the high prevalence rate, while a complete national epidemiology of CKD is absent in China. There were several reports about CKD epidimology in other regions of China except the southwest region. The prevalence of CKD in different area, different gender and different age groups in Sichuan is still unknown. Therefore, screening for CKD in Sichuan Province will allow us to acquire the epidemiology of CKD in this area, and to establish an effective, applicable strategy for CKD prevention and manangement. The incidence of metabolic syndrome(MS) is increasing, and researches have revealed its intimated relationship with CKD. But the influence of CKD by different components of MS is still unclear, so it is important to uncover this relation for establishing effective policy for CKD prevention and management.
In this research, people from Sichuan province were enrolled for CKD screening, the prevalence and risk factors were analysed, and the relation between CKD and metabolic syndrome was studied at the same time.
Study design and methods
This research was based on the situation of Sichuan province,3024 people older than 18 years were enrolled by cluster random sampling. Acording to the design,3300 people should be enrolled, the actual investigated people were 3024 with a responsed rate of 91.6%. This rearch included a questionnaire (demographic characteristics, history of chronic disease, past history, family history, behavior and diet status, etc.), physical exminations (body height, weight, waist circumference, hip circumference and blood pressure) and laboratory examinations (urine routine and sediment, urine albumin and urine creatinine). CKD was diagnosed by decreased eGFR(<60ml/min/1.73m2) or presentation of microalbuminuria, macroalbuminuria, proteinuria or hematuria. MS was diagnosed according to International Diabetes Federation guidelines. A cross-secitonal study was adopted to investigate the Sichuan adults about the prevalence, awareness rate, and current status of treatment of CKD, metabolic syndrome. Multivariate analysis were applied to study the risk factors of CKD,. The relationship between CKD and metabolic syndrome was also studied.
Results
1. Prevalence of CKD in Sichuan province:The overall prevalence and age-and-sex-standardized prevalence of CKD in Sichuan was 19.1% and 16.48% respectively. The prevalence of hematuria, albuminuria, proteinuria and decreased eGFR was 7.2%,11.4%,1.4% and 2.9%; and the standardized prevalence was 6.74%, 9.49%,1.11% and 2.34%, respectively. Prevalence of CKD, hematuria, microalbuminuria and macroalbuminuria was 15.1%,11.2%,12.4% and 1.1% in female, and it was lower in male population with the corresponding prevalence of 6.2%,3.3%,8.4% and 1.0%(p<0.001). There was no difference in prevalence of proteinuria or decreased eGFR between male and female population. Prevalence of CKD in Chengdu was lower than in Guanghan(10.4% vs 19.1%, p<0.001). And prevalence of hematuria, proteinuria, albuminuria and decreased eGFR was also lower in Chengdu than in Guanghan(p<0.001). Prevalence of CKD and microalbuminuria increased with age. In different age groups(18～39,40～49,50～59, 60～69,70～95), the prevalence of CKD was 11.6%,16.8%,19.9%,27.4%和41.3%; and the prevalence of microalbuminuria was 5.6%、7.3%、11.5%、17.8% and 24.3% respectively. There was no difference of prevalence of hematuria in different age groups. The awareness rate of CKD was 7.9%.
2. Prevalence of other chronic diseases in Sichuan province:The prevalence and age-and-sex-standardized prevalence of hypertension was 16.5% and 11.9% respectively with a higher prevalence in Guanghan than in Chengdu(22.0% vs 11.0%, p<0.001). There was no difference in the prevalence between male and female(17.2% vs 15.9%, p>0.05). The prevalence and age-and-sex-standardized prevalence of diabetes was 6.6% and 5.1% respectively with a higher prevalence in Guanghan than in Chengdu(9.2% vs 4.0%, p<0.001), there was no difference in the prevalence between male and female(6.9% vs 6.4%, p>0.05). The prevalence and age-and-sex-standardized prevalence of hyperlipidemia was 53.4% and 50.76% respectively with a higher prevalence in Guanghan than in Chengdu(57.5% vs 49.3%, p<0.05), it was higher in male than in female(56.2% vs 50.6%%, p<0.05). The prevalence and age-and-sex-standardized prevalence of obesity was 60.0% and 65.30% respectively with a higher prevalence in Chengdu than in Guanghan (65.8% vs 54.1%, p<0.001), it was higher in male than in female(65.4% vs54.4%, p<0.001). The prevalence and age-and-sex-standardized prevalence of hyperuricemia was 14.4% and 15.13% respectively with a higher prevalence in Chengdu than in Guanghan (18.3 vs 10.4%, p<0.001), it was higher in male than in female(19.8% vs 8.8%, p<0.001).
3. Prevalence of metabolic syndrome and its components in Sichuan province:The prevalence and age-and-sex-standardized prevalence of metabolic syndrome was 10.0% and 8.57% respectively without difference in Chengdu and Guanghan (9.9% vs 10.0%, p>0.05), it was higher in female than in male(13.8% vs 6.1%, p<0.001). Different group of MS:prevalence of group A, B, C, D, E and J was 3.9%,2.3%, 1.7%,0.8%,0.9% and 0.3%. And the corresponding age-and-sex-standardized prevalence was 4.13%,1.57%,1.31%,0.53%,0.75% and 0.22%。
4. Relationship between MS and CKD:In the diagnosed MS patients, the prevalence of CKD was higher than non-MS people (26.2% vs 18.4, p<0.001). Group C (OR=1.955,95.0%CI=1.075-3.557) and D (OR=2.432,95.0%CI=1.068-5.540) was associated with increased prevalence of CKD。
5. Risk factors of CKD:The logistic regression analysis showed that hypertension(OR =1.933,95.0%CI:1.506-2.482), diabetes(OR=4.528,95.0%CI:3.239-6.329), hyperuricemia(OR=1.644,95.0%CI:1.233-2.192) and past history of reral disease (OR=1.682,95.0%CI:1.137-2.487) was risk factors of CKD. And male(OR=0.496, 95.0%CI:0.379-0.648), high degree of education(OR=0.839,95.0%CI:0.738-0.955), and high income(OR=0.804,95.0%CI:0.727-0.889) was negative associated with CKD.
Conclusions
1. The prevalence of CKD in Sichuan province is relatively high in China with a higher prevalence in rural population than in urban population.
2. The prevalence of metabolic syndrome and its components is high in Sichuan Province. There is no difference in MS prevalence between rural and urban populations. Prevalence of centric obesity is higher in urban population while prevalence of other components are higher in rural population.
3. Prevalence and stages of CKD are higher in MS patients than in general population in Sichuan,
4. Centric obesity accompanied with hypertriglyceridemia and glycometabolism disorders, obesity accompanied with decreased HDL-C and hypertension may be more at high risk of developing CKD.
5. Female gender, hypertension, hyperuricemia, diabetes, past history of renal disease, low degree of education and low income are risk factors of CKD.
6. Screening plan for CKD in populations with high risk is urgent to increase the awareness, to enhance patients' management, and to improve the current status of treatment and control of CKD.
引文
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