Prevalence of CKD in Northeastern Italy: Results of the INCIPE Study and Comparison with NHANES

[摘要] Background and objectives: Sufficiently powered studies to investigate the CKD prevalence are few and do not cover southern Europe.Design, setting, participants, & measurements: For the INCIPE study, 6200 Caucasian patients ≥40 years old were randomly selected in northeastern Italy in 2006. Laboratory determinations were centralized. The albumin to creatinine ratio in urine and estimated GFR from calibrated creatinine (SCr) were determined. A comparison with 2001 through 2006 NHANES surveys was performed.Results: Prevalence of CKD was 13.2% in northeastern (NE) Italy (age and gender standardized to the U.S. 2007 Caucasian population). Prevalence of CKD in U.S. Caucasians is higher (20.3%), the major difference being in CKD 3. Risk factors for CKD are more prevalent in the United States than in Italy. With use of CKD 3a and 3b stages, CKD prevalence decreased in NE Italy (8.5%) and in the United States (12.8%).Conclusions: The prevalence of CKD is high in NE Italy, but lower than that in the United States. A large part of the difference in CKD prevalence in NE Italy versus that in the United States is due to the different prevalence of CKD 3. The higher prevalence of a number of renal risk factors in persons from the United States explains in part the different dimensions of the CKD problem in the two populations.According to a number of reports from different parts of the world, the burden of chronic kidney disease (CKD) is dramatically increasing (1). However, many of such studies are not comparable because of different criteria for defining CKD. In fact, screening has often been limited to measuring only estimated GFR (eGFR), not including the determination of albuminuria, which would offer identification of CKD stages 1 and 2. Furthermore, the issue of the serum creatinine assay and calibration has not been adequately addressed by some, thus biasing comparison between different populations. Consequently, there are a few large, sufficiently powered epidemiologic studies using similar methodologies and these do not cover significant geographical areas. The NHANES surveys (2) have constituted the template for CKD prevalence studies. Thus, all of the most significant CKD epidemiology surveys compare with them. In northern Europe, the Prevend (3) and the HUNT II study (4) investigated CKD prevalence. No other sufficiently powered study has been performed in Europe and in particular in the southern Mediterranean area which is known to differ consistently from northern Europe regarding nutritional habits and prevalence of pathologic conditions that increase the risk of developing CKD.Because of the perception of a large and increasing burden of CKD in different parts of the world, the term “CKD epidemics” has been coined. However, much of the contribution to such a burden is due to CKD stage 3. The definition of CKD 3 is based only on an eGFR <60 ml/min per 1.73 m2, which has been questioned as being a reliable marker of renal dysfunction, particularly in persons over 65 years and women (5). Different CKD 3 definitions have thus been proposed to better estimate the epidemiologic relevance of the CKD (5).To assess the prevalence of CKD in Italy, in 2006, in NE Italy, we launched the “INCIPE” study (Initiative on Nephropathy, of relevance to public health, which is Chronic, possibly in its Initial stages, and carries a Potential risk of major clinical End-points).

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome