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Vol. 30. Núm. 1.Enero 2010
También incluye anexos, los Resúmenes de la XLIII y de la XLIV Reunión Científica de la Sociedad Castellano Astur-Leonesa de Nefrología, celebradas en Cervera de Pisuerga, Palencia, 2006, y en Ponferrada, 2007, respectivamente.
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Vol. 30. Núm. 1.Enero 2010
También incluye anexos, los Resúmenes de la XLIII y de la XLIV Reunión Científica de la Sociedad Castellano Astur-Leonesa de Nefrología, celebradas en Cervera de Pisuerga, Palencia, 2006, y en Ponferrada, 2007, respectivamente.
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Prevalencia de la insuficiencia renal crónica en España: Resultados del estudio EPIRCE
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on behalf of the EPIRCE Study Group, Alfonso Otero Gonzálezb, A.. de Franciscoc, P.. Gayosob, F.. Garcíad
b Nephrology Department and Research Unit, Ourense Hospital Complex, Orense, Spain,
c Nephrology Department, Hospital Marqués de Valdecilla, Santander, Spain,
d Clinical Epidemiology Unit, University Hospital Puerta de Hierro, Majadahonda, Madrid, Spain,
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Introducción: La insuficiencia renal crónica (IRC) constituye un factor de riesgo cardiovascular independiente. El conocimiento de su prevalencia en la población general puede contribuir a la detección precoz de esta enfermedad y de prevenir o retrasar su evolución. Métodos: Se seleccionó una muestra aleatoria de población general española, con edad igual o superior a 20 años, distribuida por todo el territorio nacional y estratificada por hábitat, edad y sexo conforme al censo de 2001 (n = 2.746). Se recopilaron datos sociodemográficos y clínicos, y se evaluó la prevalencia de IRC mediante determinación centralizada de creatinina sérica y aplicación de la ecuación MDRD. Se llevaron a cabo análisis univariantes y multivariantes para evaluar la asociación entre la IRC y diversos factores de riesgo. Resultados: La edad media fue de 49,5 años. La prevalencia global de IRC en estadios 3-5, según la Kidney Disease Outcomes Quality Initiative, fue del 6,8%, con un intervalo de confianza del 95% (IC) de 5,4 a 8,2 (3,3% para edades 40-64 años y 21,4% para edades >64 años). Las prevalencias estimadas para cada uno de los estadios de IRC fueron: 0,99% para estadio 1 (tasa de filtrado glomerular [TFG] >_90 ml/min por 1,73 m2 con proteinuria); 1,3% para estadio 2 (TFG 60-89); 5,4% para estadio 3a (TFG 45-59); 1,1% para estadio 3b (TFG 30-44); 0,27% para estadio 4 (TFG 15-29), y 0,03% para estadio 5 (TFG <15). Se apreció una prevalencia considerable de factores de riesgo cardiovascular clásicos: dislipemia (29,3%), obesidad (26,1%), hipertensión (24,1%), diabetes (9,2%) y tabaquismo activo (25,5%). Los factores predictores independientes de IRC fueron la edad, la obesidad y la hipertensión previamente diagnosticada. Conclusiones: La prevalencia de IRC (en cualquier estadio) en la población general española es relativamente elevada, en especial en los individuos de edad avanzada, y similar a la de otros países del mismo entorno geográfico. Además de la edad, dos factores de riesgo modificables, la hipertensión y la obesidad, se asociaron con una mayor prevalencia de IRC.

Palabras clave:
Epidemiología
Palabras clave:
Insuficiencia renal crónica
Palabras clave:
Factores de riesgo cardiovascular

Introduction: Chronic kidney disease (CKD) is an independent cardiovascular risk factor. The knowledge of prevalence in general population may help to early detection of CKD and prevent or delay its progression. Methods: Sociodemographic, baseline characteristics, and CKD prevalence (measured by centralized serum creatinine and MDRD equation) were evaluated in a randomly selected sample of general population aged 20 years or older, collected in all Spanish regions and stratified by habitat, age and sex according to 2001 census (n = 2,746). Univariate and multivariate logistic regression analyses were used to evaluate associations with CKD risk factors. Results: Mean age was 49.5 years. The overall prevalence of Kidney Disease Outcomes Quality Initiative grades 3-5 CKD was 6.8%, with a 95% confidence interval (CI) of 5.4 to 8.2 (3.3% for age 40-64 years and 21.4% for age >64 years). The prevalence estimates of CKD stages were: 0.99% for stage 1 (glomerular filtration rate [GFR] >_90 ml/min per 1.73 m2 with proteinuria); 1.3% for stage 2 (GFR 60-89); 5.4% for stage 3a (GFR 45-59); 1.1% for stage 3b (GFR 30-44); 0.27% for stage 4 (GFR 15-29); and 0.03% for stage 5 (GFR <15). An important prevalence of classical cardiovascular risk factors was observed: dyslipemia (29.3%), obesity (26.1%), hypertension (24.1%), diabetes (9.2%) and current smoking (25.5%). The independent predictor factors for CKD were age, obesity and previously diagnosed hypertension. Conclusions: The prevalence of CKD at any stage in general population from Spain is relatively high, especially in the elderly, and similar to countries of the same geographical area. Independently of age, two modifiable risks factors, hypertension and obesity, are associated with an increased prevalence of CKD.

Keywords:
Epidemiology
Keywords:
Chronic kidney disease
Keywords:
Cardiovascular risk factors
Texto completo

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Tabla 1. Demographic and clinical characteristics of Spanish population aged 20 years or older based on the cohort collected in the EPIRCE study (n = 2,746).

Tabla 2. Prevalence of chronic kidney disease in the Spanish population aged 20 years or older based on thee cohort collected in the EPIRCE study (n = 2,746).

Tabla 3. Unadjusted associations between demographic or clinical characteristics and the presence of chronic kidney disease (eGFR <60 ml min per 1 73 m2

Tabla 4. Independent predictors of chronic kidney disease (eGFR <60 ml min per 1 73 m2 in the multivariate logistic regression model

Bibliography
[1]
Stenvinkel P, Barany P, Heimburger O, Pecoits-Filho R, Lindholm B. Mortality, malnutrition, and atherosclerosis in ESRD: what is the role of interleukin-6? Kidney Int Suppl. 2002;80:103-8.
[2]
Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 2003;108:2154-69.
[3]
Ruggenenti P, Schieppati A, Remuzzi G. Progression, remission, regression of chronic renal diseases. Lancet 2001;357:1601-8.
[4]
Mann JF, Gerstein HC, Pogue J, Bosch J, Yusuf S. Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med 2001;134:629-36. [Pubmed]
[5]
Muntner P, He J, Hamm L, Loria C, Whelton PK. Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States. J Am Soc Nephrol 2002;13:745-53. [Pubmed]
[6]
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr., et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289:2560-72.
[7]
Perneger TV, Brancati FL, Whelton PK, Klag MJ. End-stage renal disease attributable to diabetes mellitus. Ann Intern Med 1994;121:912-8. [Pubmed]
[8]
Haroun MK, Jaar BG, Hoffman SC, Comstock GW, Klag MJ, Coresh J. Risk factors for chronic kidney disease: a prospective study of 23,534 men and women in Washington County, Maryland. J Am Soc Nephrol 2003;14:2934-41. [Pubmed]
[9]
Locatelli F, Vecchio LD, Pozzoni P. The importance of early detection of chronic kidney disease. Nephrol Dial Transplant 2002;17(Suppl 11):2-7. [Pubmed]
[10]
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2 Suppl 1):S1-266. [Pubmed]
[11]
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31-41. [Pubmed]
[12]
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461-70.
[13]
Verhave JC, Balje-Volkers CP, Hillege HL, De Zeeuw D, De Jong PE. The reliability of different formulae to predict creatinine clearance. J Intern Med 2003;253:563-73. [Pubmed]
[14]
Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health 2008;8:117. [Pubmed]
[15]
Rule AD, Larson TS, Bergstralh EJ, Slezak JM, Jacobsen SJ, Cosio FG. Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med 2004;141:929-37. [Pubmed]
[16]
Lamb EJ, Tomson CR, Roderick PJ. Estimating kidney function in adults using formulae. Ann Clin Biochem 2005;42:321-45. [Pubmed]
[17]
Stevens LA, Coresh J, Feldman HI, Greene T, Lash JP, Nelson RG, et al. Evaluation of the modification of diet in renal disease study equation in a large diverse population. J Am Soc Nephrol 2007;18:2749-57. [Pubmed]
[18]
Martín de Francisco AL, Aguilera L, Fuster V. Cardiovascular, renal and other chronic diseases. Early intervention is necessary in chronic kidney disease. Nefrología 2009;29:6-9. [Pubmed]
[19]
De Francisco AL, De la Cruz JJ, Cases A, De la Figuera M, Egocheaga MI, Gorriz JI, et al. Prevalence of kidney insufficiency in primary care population in Spain: EROCAP study. Nefrología 2007;27:300-12. [Pubmed]
[20]
Levey AGT, Kuseek, JW, the MDRD Study Group. A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol 2000;11:155A.
[21]
Cirillo M, Laurenzi M, Mancini M, Zanchetti A, Lombardi C, De Santo NG. Low glomerular filtration in the population: prevalence, associated disorders, and awareness. Kidney Int 2006;70:800-6. [Pubmed]
[22]
Nitsch D, Felber D, Von Eckardstein A, Gaspoz JM, Downs SH, Leuenberger P, et al. Prevalence of renal impairment and its association with cardiovascular risk factors in a general population: results of the Swiss SAPALDIA study. Nephrol Dial Transplant 2006;21:935-44. [Pubmed]
[23]
Hallan SI, Coresh J, Astor BC, Asberg A, Powe NR, Romundstad S, et al. International comparison of the relationship of chronic kidney disease prevalence and ESRD risk. J Am Soc Nephrol 2006;17:2275-84. [Pubmed]
[24]
Viktorsdottir O, Palsson R, Andresdottir MB, Aspelund T, Gudnason V, Indridason OS. Prevalence of chronic kidney disease based on estimated glomerular filtration rate and proteinuria in Icelandic adults. Nephrol Dial Transplant 2005;20:1799-807. [Pubmed]
[25]
Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. JAMA 2007;298:2038-47. [Pubmed]
[26]
López Revuelta K, Saracho R, García López F, Gentil MA, Castro P, Castilla J, et al. Dialysis and Transplant Registry of the Spanish Society of Nephrology and regional registries. Rapport 2001. Nefrología 2004;24:21-6,8-33.
[27]
Hallan SI, Ritz E, Lydersen S, Romundstad S, Kvenild K, Orth SR. Combining GFR and Albuminuria to Classify CKD Improves Prediction of ESRD. J Am Soc Nephrol 2009;28.
[28]
Kronborg J, Solbu M, Njolstad I, Toft I, Eriksen BO, Jenssen T. Predictors of change in estimated GFR: a population-based 7-year follow-up from the Tromso study. Nephrol Dial Transplant 2008;23:2818-26. [Pubmed]
[29]
Foley RN, Wang C, Collins AJ. Cardiovascular risk factor profiles and kidney function stage in the US general population: the NHANES III study. Mayo Clin Proc 2005;80:1270-7. [Pubmed]
[30]
Bohm M, Rosenkranz S, Laufs U. Alcohol and red wine: impact on cardiovascular risk. Nephrol Dial Transplant 2004;19:11-6. [Pubmed]
[31]
Douville P, Martel AR, Talbot J, Desmeules S, Langlois S, Agharazii M. Impact of age on glomerular filtration estimates. Nephrol Dial Transplant 2009;24:97-103. [Pubmed]
[32]
Lamb EJ, O¿Riordan SE, Delaney MP. Kidney function in older people: pathology, assessment and management. Clin Chim Acta 2003;334:25-40. [Pubmed]
[33]
Lindeman R. Overview: renal physiology and pathophysiology of aging. Am J Kidney Dis 1990;16:275-82. [Pubmed]
[34]
Pisoni R, Remuzzi G. How much must blood pressure be reduced in order to obtain the remission of chronic renal disease? J Nephrol 2000;13:228-31. [Pubmed]
[35]
Ljungman S. The kidney as a target of hypertension. Curr Hypertens Rep 1999;1:164-9. [Pubmed]
[36]
Gelber RP, Kurth T, Kausz AT, Manson JE, Buring JE, Levey AS, et al. Association between body mass index and CKD in apparently healthy men. Am J Kidney Dis 2005;46:871-80. [Pubmed]
[37]
Ryu S, Chang Y, Woo HY, Kim SG, Kim DI, Kim WS, et al. Changes in body weight predict CKD in healthy men. J Am Soc Nephrol 2008;19:1798-805. [Pubmed]
[38]
Bavbek N, Isik B, Kargili A, Uz E, Uz B, Kanbay M, et al. Association of obesity with inflammation in occult chronic kidney disease. J Nephrol 2008;21:761-7. [Pubmed]
[39]
Palomar R, Fernández-Fresnedo G, Domínguez-Díez A, López-Deogracias M, Olmedo F, Martín de Francisco AL, et al. Effects of weight loss after biliopancreatic diversion on metabolism and cardiovascular profile. Obes Surg 2005;15:794-8. [Pubmed]
[40]
Pérez-García R, Martín-Malo A, Fort J, Cuevas X, Lladós F, Lozano J, et al. Baseline characteristics of an incident haemodialysis population in Spain: results from ANSWER-a multicentre, prospective, observational cohort study. Nephrol Dial Transplant 2009;24:578-88. [Pubmed]
[41]
Verhave JC, Gansevoort RT, Hillege HL, De Zeeuw D, Curhan GC, De Jong PE. Drawbacks of the use of indirect estimates of renal function to evaluate the effect of risk factors on renal function. J Am Soc Nephrol 2004;15:1316-22. [Pubmed]
[42]
Glassock RJ, Winearls C. Screening for CKD with eGFR: doubts and dangers. Clin J Am Soc Nephrol 2008;3:1563-8. [Pubmed]
[43]
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604-12. [Pubmed]
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