[Show abstract][Hide abstract] ABSTRACT: Metabolic syndrome (MS) is prevalent, with an increasing contribution to the incidence of chronic kidney disease (CKD). The study of the relationship between them is important. The CKD survey, a national cross-sectional study, provided a large database to accomplish this study. The study population were 41 131 adults from this survey between 2008 and 2009. CKD was defined as estimate glomerular filtration rate (eGFR) less than 60 mL/min per 1.73 m2 or the presence of albuminuria. MS was diagnosed by National Cholesterol Education Program-Adult Treatment Panel III (ATPIII), ATPIII-modified or International Diabetes Federation (IDF) criteria. Logistic regression model was applied to study the impact of MS or its components on CKD or its components. The age and sex standardized prevalence of MS by ATPIII, ATPIII-modified and IDF criteria was 11.77% (11.13%-12.40%), 21.51% (20.69%-22.34%) and 16.67% (15.92-17.42)% respectively. Multivariate logistic regression models showed that MS and its components were associated with higher CKD prevalence. The risk for CKD and its components increased with the number of MS components. After adjusting for hypertension and diabetes, the odds ratios of MS for CKD decreased, but remained significantly more than 1 between 1.16(95%CI 1.07-1.26) and 1.37 (95% CI 1.25-1.50) across the different models. Similar results were found with albuminuria, while for decreased eGFR, after adjusting for hypertension and diabetes, the odds ratios of MS and MS components (except elevated TG) became insignificant. In conclusion, MS is prevalent and associated with a higher prevalence of CKD. Different MS components are associated with different risks for CKD, even after adjusting for hypertension and diabetes, which may mainly be contributed more by the increased risk for albuminuria than that for decreased eGFR. More attention must be paid to the population with MS, including those with elevated blood pressure and serum glucose.
PLoS ONE 07/2015; 10(7):e0132220. DOI:10.1371/journal.pone.0132220 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To study the effect of blood pressure (BP) control on the progression of renal function in elderly patients with chronic kidney disease (CKD) stages 3 and 4.
Patients aged 65 years or older in our CKD clinic with baseline CKD stages 3 and 4 and with more than one-year followup until February 2014 were included in this study. Those who had an annual loss of epidermal growth factor receptor (eGFR) for more than 5 ml·min(-1) · 1.73 m(-2), or reached CKD stage 5, and/or initiated renal replacement therapy were regarded as progression of CKD. Cox regression was used to analyze the effect of BP control on the progression of CKD.
A total of 118 patients [57 men, mean age (73.8±5.1) years] were enrolled in the final analysis with median baseline eGFR of 37.9 (29.3, 46.7) ml·min(-1)·1.73 m(-2). The baseline BP was (137.0±18.0)/(72.5±10.3)mmHg (1 mmHg=0.133 kPa). During the median 26 months (12-94 m) follow-up period, the average treated BP was (136.2±12.1)/(70.5±6.9)mmHg. Among all the subjects, 64.4% of them reached the BP target (<140/90 mmHg) and 23.7% had progression of CKD. Treated systolic BP (HR = 1.504, 95% CI 1.023-2.212) and baseline eGFR (HR = 0.923, 95% CI 0.872-0.977) were independent risk factors for renal function progression in multivariate Cox analysis. Patients with treated systolic BP over 140 mmHg had higher risk to develop progression of CKD compared with those with systolic BP ≤140 mmHg (HR = 2.505, 95% CI 1.090-5.756).
Tight blood pressure control is important in the routine care of elderly patients with CKD stage 3 and stage 4.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 03/2015; 54(3):181-187.
[Show abstract][Hide abstract] ABSTRACT: AimNonsteroidal anti-inflammatory drugs (NSAIDs) have been reported to be associated with adverse effects including kidney injury, while relevant studies from developing countries are limited. We aimed to explore the status of NSAIDs use in China, as well as cross-sectional association between NSAIDs intake and presence of chronic kidney disease (CKD).MethodsA national representative sample of 47,204 adults in China were used. Prevalence of regular NSAIDs use was reported. Age- and sex- matched controls of NSAIDs user were then selected. And the association between NSAIDs use and kidney injury were analyzed using logistic regression.ResultsAltogether 1,129 participants reported regular use of NSAIDs, with the adjusted prevalence of 3.6% (95% CI, 3.2%-3.9%). And 76.9% of them (n=868) had taken phenacetin-containing analgesics, with an adjusted prevalence of 3.2% (95% CI, 2.9%-3.5%). After adjusting for potential confounders, long-term NSAIDs intake (≥48 months) was associated with eGFR< 60 mL/min/1.73m2, with an OR of 2.36 (95% CI, 1.28-4.37).Conclusion
Regular use of NSAIDs, especially phenacetin-containing drugs, is prevalent in China. And long-term NSAIDs intake (≥48 months) was independently associated with reduced renal function.
[Show abstract][Hide abstract] ABSTRACT: Chronic kidney disease (CKD) is a common disorder associated with multiple adverse clinical consequences, especially cardiovascular risk and end-stage renal disease. A recent national survey demonstrated that CKD has become a leading health problem in China. There is an urgent need to implement an in-depth investigation of the CKD burden and also to explore underlying mechanisms of CKD progression and it association with adverse consequences.
[Show abstract][Hide abstract] ABSTRACT: Hypertension is one of the major risk factor for cardiovascular disease worldwide. The objective of this study was to investigate the prevalence, awareness, treatment, and control of hypertension in China.
A multistage, stratified sampling method was used to obtain a representative sample of persons aged 18 years or older in the general population of China. Blood pressure (BP) was measured by sphygmomanometer 3 times at 5-minute intervals. Hypertension was defined as a systolic BP ≥ 140mm Hg, or diastolic BP ≥ 90mm Hg, or self-reported use of antihypertensive medications in the last 2 weeks irrespective of the BP.
Altogether 50,171 subjects finished the survey across the entire country. The adjusted prevalence of hypertension was 29.6% (95% confidence interval (CI) = 28.9%-30.4%) and was higher among men than among women (31.2%, 95% CI = 30.1%-32.4%; vs. 28.0%, 95% CI = 27.0%-29.0%). The awareness, treatment among all hypertensive participants, control among all hypertensive participants, and control among treated hypertensive participants were 42.6%, 34.1%, 9.3%, and 27.4%, respectively. Multiple lifestyle factors were independently associated with presence of hypertension, including physical inactivity, habitual drinking, chronic use of nonsteroidal anti-inflammatory drugs, high body mass index, and central obesity.
Hypertension is an important public health burden in China, and control of hypertension is still suboptimal. Several modifiable lifestyle activities were associated with hypertension and thus should be considered potential targets for intervention, with special attention to socioeconomically disadvantaged subpopulations in China.
American Journal of Hypertension 04/2014; 27(11). DOI:10.1093/ajh/hpu053 · 3.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Previous studies indicated that lifestyle-related cardiovascular risk factors tend to be clustered in certain individuals. However, population-based studies, especially from developing countries with substantial economic heterogeneity, are extremely limited. Our study provides updated data on the clustering of cardiovascular risk factors, as well as the impact of lifestyle on those factors in China.
A representative sample of adult population in China was obtained using a multistage, stratified sampling method. We investigated the clustering of four cardiovascular disease (CVD) risk factors (defined as two or more of the following: hypertension, diabetes, dyslipidemia and overweight) and their association with unhealthy lifestyles (habitual drinking, physical inactivity, chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) and a low modified Dietary Approaches to Stop Hypertension (DASH) score).
Among the 46,683 participants enrolled in this study, only 31.1% were free of any pre-defined CVD risk factor. A total of 20,292 subjects had clustering of CVD risk factors, and 83.5% of them were younger than 65 years old. The adjusted prevalence of CVD risk factor clustering was 36.2%, and the prevalence was higher among males than among females (37.9% vs. 34.5%). Habitual drinking, physical inactivity, and chronic use of NSAIDs were positively associated with the clustering of CVD risk factors, with ORs of 1.60 (95% confidence interval [CI] 1.40 to1.85), 1.20 (95%CI 1.11 to 1.30) and 2.17 (95%CI 1.84 to 2.55), respectively. The modified DASH score was inversely associated with the clustering of CVD risk factors, with an OR of 0.73 (95%CI 0.67 to 0.78) for those with modified DASH scores in the top tertile. The lifestyle risk factors were more prominent among participants with low socioeconomic status.
Clustering of CVD risk factors was common in China. Lifestyle modification might be an effective strategy to control CVD risk factors.
PLoS ONE 06/2013; 8(6):e66780. DOI:10.1371/journal.pone.0066780 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND/PURPOSE: There is relatively little literature on prevalence of chronic kidney disease (CKD) prior to surgery in patients with upper urinary tract urothelial carcinoma (UTUC). We evaluated the prevalence and clinical associated factors of baseline CKD in patients with UTUC. MATERIALS AND METHODS: There were 785 patients with a pathologic diagnosis of UTUC from January 2002 to December 2011 who were analyzed in this study. Estimated glomerular filtration rate (eGFR) was calculated by re-expressed Modification of Diet in Renal Disease (MDRD) formulas for the Chinese population. A multivariate logistic regression was performed to evaluate the odds ratios (ORs) for CKD stage 3 or higher in UTUCs after data differences were tested. RESULTS: The prevalence of CKD in UTUCs presenting at our hospital was 58.6% and 70.8% in the group age 70 years and older. Older age [per year increased; OR = 1.050; 95% confidence interval (CI): 1.034-1.067], lower tumor stage (T stage; per stage increased; OR = 0.666; 95% CI: 0.544-0.816), higher tumor grade (per grade increased; OR = 1.392; 95% CI: 1.004-1.930) and the main tumor locating in the pelvis (ureter as reference; OR = 0.648; 95% CI: 0.475-0.885) were independently associated with decreased kidney function in the multivariate logistic regression. The use of serum creatinine (Scr) only to evaluate the renal function would ignore a large proportion of patients suffering from CKD stage 3 in UTUCs, especially in those older than 70 years (39.3% vs. 54.1%, p = 0.022). CONCLUSION: We demonstrated a high prevalence (58.6%) of CKD in patients with UTUC, particularly in the group older than 70 years (70.8%). Older age, lower T stage, higher tumor grade, and the main tumor locating in pelvis (ureter as reference) were independently associated with CKD in UTUCs.
Journal of the Formosan Medical Association 05/2013; 113(8). DOI:10.1016/j.jfma.2013.04.001 · 1.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Long-term intake of herbs containing aristolochic acid (AA) has been reported to be associated with increased risk of chronic kidney disease (CKD), whereas population-based studies are limited. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: A national representative sample of 47,204 adults in China. PREDICTOR: Self-reported long-term use of medications containing AA. OUTCOMES & MEASUREMENTS: CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and/or the presence of albuminuria, defined as albumin-creatinine ratio >30 mg/g. RESULTS: 467 participants reported long-term AA intake, with a prevalence adjusting for a synthesized weight of 1.5% (95% CI, 1.2%-1.7%). After adjusting for age, sex, and other potential confounders, long-term AA intake was associated with eGFR <60 mL/min/1.73 m2 and albuminuria, with ORs of 1.83 (95% CI, 1.22-2.74) and 1.39 (95% CI, 1.03-1.87), respectively. Further adjustment for intake of nonsteroidal anti-inflammatory drugs did not change ORs substantially. A positive association between accumulated time of AA intake and kidney disease also was observed, with fully adjusted ORs of 1.07 (95% CI, 1.03-1.12) per 6-month longer intake for eGFR <60 mL/min/1.73 m2 and 1.04 (95% CI, 1.01-1.08) per 6-month longer intake for albuminuria. LIMITATIONS: Self-reported intake of herbs containing AA; the AA content of the preparations by weight was unknown; single measurement of indicators of kidney damage. CONCLUSIONS: Long-term intake of medications containing AA is prevalent in China and is associated with the presence of CKD.
American Journal of Kidney Diseases 03/2013; 61(6). DOI:10.1053/j.ajkd.2012.12.027 · 5.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Uromodulin (UMOD) genetic variants cause familial juvenile hyperuricemic nephropathy, characterized by hyperuricemia with decreased renal excretion of UMOD and uric acid, suggesting a role for UMOD in the regulation of plasma uric acid. To determine this, we screened common variants across the UMOD locus in one community-based Chinese population of 1000 individuals and the other population from 642 American twins and siblings of European and Hispanic ancestry. Transcriptional activity of promoter variants was estimated in luciferase reporter plasmids transfected into HEK-293 cells and mIMCD3 cells. In the primary Chinese population, we found that carriers of the GCC haplotype had higher plasma uric acid, and three promoter variants were associated with plasma uric acid. UMOD promoter variants displayed reciprocal effects on urine uric acid excretion and plasma uric acid concentration, suggesting a primary effect on renal tubular handling of urate. These UMOD genetic marker-on-trait associations for uric acid were replicated in the independent American cohort. Site-directed mutagenesis at trait-associated UMOD promoter variants altered promoter activity in transfected luciferase reporter plasmids. Thus, UMOD promoter variants seem to initiate a cascade of transcriptional and biochemical changes influencing UMOD secretion, leading to altered plasma uric acid levels.Kidney International advance online publication, 23 January 2013; doi:10.1038/ki.2012.449.
Kidney International 01/2013; 83(4). DOI:10.1038/ki.2012.449 · 8.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Family members of patients with end stage renal disease were reported to have an increased prevalence of chronic kidney disease (CKD). However, studies differentiated genetic and non-genetic family members are limited. We sought to investigate the prevalence of CKD among fist-degree relatives and spouses of dialysis patients in China.
Seventeen dialysis facilities from 4 cities of China including 1062 first-degree relatives and 450 spouses of dialysis patients were enrolled. Sex- and age- matched controls were randomly selected from a representative sample of general population in Beijing. CKD was defined as decreased estimated glomerular (eGFR < 60 mL/min/1.73 m2) or albuminuria.
The prevalence of eGFR less than 60 mL/min/1.73 m2, albuminuria and the overall prevalence of CKD in dialysis spouses were compared with their counterpart controls, which was 3.8% vs. 7.8% (P < 0.01), 16.8% vs. 14.6% (P = 0.29) and 18.4% vs. 19.8% (P = 0.61), respectively. The prevalence of eGFR less than 60 mL/min/1.73 m2, albuminuria and the overall prevalence of CKD in dialysis relatives were also compared with their counterpart controls, which was 1.5% vs. 2.4% (P = 0.12), 14.4% vs. 8.4% (P < 0.01) and 14.6% vs. 10.5% (P < 0.01), respectively. Multivariable Logistic regression analysis indicated that being spouses of dialysis patients is negatively associated with presence of low eGFR, and being relatives of dialysis patients is positively associated with presence of albuminuria.
The association between being family members of dialysis patients and presence of CKD is different between first-degree relatives and spouses. The underlying mechanisms deserve further investigation.
[Show abstract][Hide abstract] ABSTRACT: Background
Previous studies have indicated that the performance of glomerular filtration rate (GFR) estimation equations vary according to the races of the target population. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation has not been validated in the Chinese population including patients with chronic kidney disease (CKD) and healthy controls.MethodsA total of 977 adult persons (682 patients with CKD and 295 healthy volunteers) from nine renal institutes of university hospitals located in nine geographic regions of China were enrolled in the study. A diagnostic test study comparing the CKD-EPI two-level and four-level race equation, the Modification of Diet in Renal Disease (MDRD) Study equation and the modified MDRD equation for Chinese (the Chinese equation). The (99m)Tc- diethylenetriamine pentaacetic acid dual plasma clearance was used as a reference method for measuring GFR.ResultsThe mean age of participants was 48.3 ± 16.0 years and 479 (49.0%) were male. The CKD-EPI two-level race equation and the Chinese equation performed better than the MDRD Study equation and CKD-EPI four-level race equation, with less bias (median difference between estimated GFR and reference GFR, 0.2 and 0.3 versus -2.4 and 3.0 mL/min/1.73 m(2)), improved precision (interquartile range of the difference, 20.5 and 20.8 versus 23.4 and 20.5 mL/min/1.73 m(2)) and greater accuracy (percentage of estimated GFR within 30% of reference GFR, 73.4 and 73.0% versus 69.8 and 70.1%).Conclusions
The CKD-EPI two-level race equation and the Chinese equation performed similarly in the Chinese population, and both performed better than the MDRD Study equation and the CKD-EPI four-level race equation.
[Show abstract][Hide abstract] ABSTRACT: Aims: To investigate the prospective association between changes in the urinary albumin-creatinine ratio (ACR) and abnormal ankle-brachial index (ABI) in a community-based Chinese population.Methods: This prospective cohort study included 799 residents aged 58.3±9.2 years and without a history of cardiovascular disease from an urban district of Beijing, China. Urinary ACR was measured at baseline, and at 4 and 6 years of follow-up. The 75th percentile of the baseline urinary ACR (5.82 mg/g) was used to define "high" ACR. The changes in urinary ACR were categorized as consistently low urinary ACR, intermittent high urinary ACR, and consistently high urinary ACR. ABI was measured at 6 years of follow-up. Multinomial logistic regression was used to evaluate the associations of changes in urinary ACR categories with the ABI categories.Results: During 6 years of follow-up, 16.1% of participants (n= 128) had low ABI and 13.9% of participants (n= 111) had high ABI. After adjusting for potential confounders including baseline albuminuria, individuals who had consistently high urinary ACR or intermittent high urinary ACR had a significantly higher risk for low ABI than individuals who had consistently low urinary ACR, with odds ratios (OR) of 2.75 (95%CI, 1.37-5.52) and 2.06 (95%CI, 1.18-3.57), respectively. No independent association was observed between changes in urinary ACR and high ABI among participants.Conclusion: Changes in urinary ACR below the definition for albuminuria predict low ABI among this community-based population without a history of cardiovascular disease.
Journal of atherosclerosis and thrombosis 06/2012; DOI:10.5551/jat.13185 · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hypertension is an important risk factor for chronic kidney disease. The kidney, in turn, has an important role in the regulation of blood pressure (BP). On the basis of a genome-wide association study, single-nucleotide polymorphisms in the uromodulin (UMOD) promoter region had been considered to influence both renal sodium reabsorption and BP. In this study, we asked whether common variants across the UMOD gene influence BP in a community-based Chinese cohort. We screened seven common variants across the UMOD locus in a community-based population from Beijing, including 1000 individuals with 48% males and an average age of 63.7±9.0 years. The urinary UMOD concentration was measured by enzyme-linked immunosorbent assay. We then analyzed the association of common variants of UMOD with BP. The UMOD promoter common variant rs13333226 G/A is associated with diastolic BP (DBP), and G allele carriers have higher DBP compared with A/A homozygotes (P=0.035). The variant rs6497476 C/T predicted the DBP level, with C homozygotes having a higher DBP compared with CT heterozygotes and T homozygotes (P=0.025). Urinary UMOD excretion was correlated with urinary sodium excretion (R=0.239, P=0.656*10(-13)). We determined that common variants of UMOD are associated with DBP level in a community-based Chinese cohort.
Hypertension Research 05/2012; 35(7):769-74. DOI:10.1038/hr.2012.51 · 2.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The prevalence of chronic kidney disease is high in developing countries. However, no national survey of chronic kidney disease has been done incorporating both estimated glomerular filtration rate (eGFR) and albuminuria in a developing country with the economic diversity of China. We aimed to measure the prevalence of chronic kidney disease in China with such a survey.
We did a cross-sectional survey of a nationally representative sample of Chinese adults. Chronic kidney disease was defined as eGFR less than 60 mL/min per 1·73 m(2) or the presence of albuminuria. Participants completed a lifestyle and medical history questionnaire and had their blood pressure measured, and blood and urine samples taken. Serum creatinine was measured and used to estimate glomerular filtration rate. Urinary albumin and creatinine were tested to assess albuminuria. The crude and adjusted prevalence of indicators of kidney damage were calculated and factors associated with the presence of chronic kidney disease analysed by logistic regression.
50,550 people were invited to participate, of whom 47,204 agreed. The adjusted prevalence of eGFR less than 60 mL/min per 1·73 m(2) was 1·7% (95% CI 1·5-1·9) and of albuminuria was 9·4% (8·9-10·0). The overall prevalence of chronic kidney disease was 10·8% (10·2-11·3); therefore the number of patients with chronic kidney disease in China is estimated to be about 119·5 million (112·9-125·0 million). In rural areas, economic development was independently associated with the presence of albuminuria. The prevalence of chronic kidney disease was high in north (16·9% [15·1-18·7]) and southwest (18·3% [16·4-20·4]) regions compared with other regions. Other factors independently associated with kidney damage were age, sex, hypertension, diabetes, history of cardiovascular disease, hyperuricaemia, area of residence, and economic status.
Chronic kidney disease has become an important public health problem in China. Special attention should be paid to residents in economically improving rural areas and specific geographical regions in China.
The Ministry of Science and Technology (China); the Science and Technology Commission of Shanghai; the National Natural Science Foundation of China; the Department of Health, Jiangsu Province; the Sichuan Science and Technology Department; the Ministry of Education (China); the International Society of Nephrology Research Committee; and the China Health and Medical Development Foundation.
The Lancet 03/2012; 379(9818):815-22. DOI:10.1016/S0140-6736(12)60033-6 · 45.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Previous study indicated a high prevalence of ocular fundus pathology among patients with chronic kidney disease (CKD), while the relationship between them has never been explored in a Chinese Population.
This cross-sectional study included 9 670 participants enrolled in a medical screening program. Ocular fundus examination was performed by ophthalmologists using ophthalmoscopes. The presence of eGFR less than 60 mL/min/1.73 m(2) and/or proteinuria was defined as CKD.
Compared to participants without CKD, participants with CKD had higher prevalence of retinopathy (28.5% vs. 16.3%, P < 0.001), glaucoma suspect (3.1% vs. 1.8%, P = 0.004), age-related macular degeneration (1.7% vs. 0.9%, P = 0.01) and overall eye pathology (32.0% vs. 19.4%, P < 0.001). After adjusting for potential confounders, the odds ratio of proteinuria for overall eye pathology and retinopathy was 1.29 (95% confidence interval [CI] 1.07-1.55) and 1.37 (95% CI 1.12-1.67), respectively. The results were robust after excluding participants with hypertension or with diabetes.
Ocular fundus pathology is common among Chinese patients with CKD. Regular eye exam among persons with proteinuria is warranted.
[Show abstract][Hide abstract] ABSTRACT: Uric acid may be associated with kidney damage through multiple pathways. Previous cohort studies revealed inconsistent results, and research among the non-hypertensive and non-diabetic population are extremely limited.
This prospective cohort study included 1410 residents aged 59.1 ± 9.4 years from an urban district of Beijing, China. All participants had an estimated glomerular filtration rate >60 mL/min/1.73m(2). Plasma uric acid was assessed at baseline; and its relation with renal function decline after 4 years' follow-up was analyzed.
During 4 years (5630 person-years) of follow-up, 168 patients (11.9%) developed renal function decline. After adjusting for potential confounders including baseline renal function, plasma uric acid levels were independently associated with an increased risk of renal function decline, with a fully adjusted odds ratio (OR) of 1.19 [per 1 mg/dL increase; 95% confidence interval (CI) 1.04-1.38]. Analysis among 615 hypertension-free and diabetes-free participants yielded similar results, with an adjusted OR of 1.50 (per 1 mg/dL increase; 95% CI 1.13-1.98).
Our prospective cohort study revealed that plasma uric acid level is independently associated with an increasing likelihood of renal function decline.