All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan.
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.


RESULTS
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.


CONCLUSIONS
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.
Wen
Chi Pang
CP
Center for Health Policy Research and Development, National Health Research Institutes, Zhunan, Taiwan. cwengood@nhri.org.tw
Cheng
Ting Yuan David
TY
Tsai
Min Kuang
MK
Chang
Yen Chen
YC
Chan
Hui Ting
HT
Tsai
Shan Pou
SP
Chiang
Po Huang
PH
Hsu
Chih Cheng
CC
Sung
Pei Kun
PK
Hsu
Yi Hua
YH
Wen
Sung Feng
SF
D000328:Adult; D017677:Age Distribution; D001364:Awareness; D002908:Chronic Disease; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003644:Death Certificates; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000145:classification / Q000453:epidemiology* / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008403:Mass Screening / Q000379:methods*; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D015995:Prevalence; D012720:Severity of Illness Index; D012923:Social Class; D040443:Students, Public Health; D013624:Taiwan / Q000453:epidemiology
D003404:Creatinine