title: All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan.
abstract: 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.
authors.affiliation: Center for Health Policy Research and Development, National Health Research Institutes, Zhunan, Taiwan. cwengood@nhri.org.tw
authors.forename: Chi Pang
authors.initials: CP
authors.lastname: Wen
authors.forename: Ting Yuan David
authors.initials: TY
authors.lastname: Cheng
authors.forename: Min Kuang
authors.initials: MK
authors.lastname: Tsai
authors.forename: Yen Chen
authors.initials: YC
authors.lastname: Chang
authors.forename: Hui Ting
authors.initials: HT
authors.lastname: Chan
authors.forename: Shan Pou
authors.initials: SP
authors.lastname: Tsai
authors.forename: Po Huang
authors.initials: PH
authors.lastname: Chiang
authors.forename: Chih Cheng
authors.initials: CC
authors.lastname: Hsu
authors.forename: Pei Kun
authors.initials: PK
authors.lastname: Sung
authors.forename: Yi Hua
authors.initials: YH
authors.lastname: Hsu
authors.forename: Sung Feng
authors.initials: SF
authors.lastname: Wen
mesh_terms: 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
chemical_list: D003404:Creatinine