CKD Prevalence Varies across the European General Population

Abstract

CKD prevalence estimation is central to CKD management and prevention planning at the population level. This study estimated CKD prevalence in the European adult general population and investigated international variation in CKD prevalence by age, sex, and presence of diabetes, hypertension, and obesity. We collected data from 19 general-population studies from 13 European countries. CKD stages 1-5 was defined as eGFR<60 ml/min per 1.73 m(2), as calculated by the CKD-Epidemiology Collaboration equation, or albuminuria >30 mg/g, and CKD stages 3-5 was defined as eGFR<60 ml/min per 1.73 m(2) CKD prevalence was age- and sex-standardized to the population of the 27 Member States of the European Union (EU27). We found considerable differences in both CKD stages 1-5 and CKD stages 3-5 prevalence across European study populations. The adjusted CKD stages 1-5 prevalence varied between 3.31% (95% confidence interval [95% CI], 3.30% to 3.33%) in Norway and 17.3% (95% CI, 16.5% to 18.1%) in northeast Germany. The adjusted CKD stages 3-5 prevalence varied between 1.0% (95% CI, 0.7% to 1.3%) in central Italy and 5.9% (95% CI, 5.2% to 6.6%) in northeast Germany. The variation in CKD prevalence stratified by diabetes, hypertension, and obesity status followed the same pattern as the overall prevalence. In conclusion, this large-scale attempt to carefully characterize CKD prevalence in Europe identified substantial variation in CKD prevalence that appears to be due to factors other than the prevalence of diabetes, hypertension, and obesity.

Keywords: chronic kidney disease; clinical epidemiology; creatinine.

Figure 1.

Adjusted CKD stages 1–5 prevalence in the population aged 45–74 years, in IDMS studies. Prevalence was age- and sex-adjusted to the EU27 population of 2005. The study names in uncolored regions are studies which used non–IDMS-standardized creatinine or studies which recruited subjects aged ≥50 years: the CKD prevalence results of these studies are shown in Supplemental Appendix 1. 3C, Three City Study; ActiFE, Activity and Function in the Elderly in Ulm study; EPIRCE, Estudio Epidemiológico de la Insuficiencia Renal en España; HUNT, Nord-Trøndelag Health Study; INCIPE, Initiative on Nephropathy, of relevance to public health, which is Chronic, possibly in its Initial stages, and carries a Potential risk of major clinical Endpoints; LifeLines, LifeLines Cohort and Study Biobank; MRC, Medical Research Council trial of assessment and management of older people in the community; PolSenior, Medical, psychological, sociological and economical aspects of aging of people in Poland; PREVEND, Prevention of Renal and Vascular End-stage Disease; SLAN, Survey of Lifestyle and Attitudes & Nutrition in Ireland.

Figure 2.

(A) Adjusted CKD prevalence stages 1–5 (95% CI) in the population aged 45–74 years, in IDMS studies. (B) CKD prevalence stages 1–5 (95% CI) in the population aged 45–74 years, in IDMS studies, by diabetic status. (C) CKD prevalence stages 1–5 (95% CI) in the population aged 45–74 years, in IDMS studies, by hypertensive status. (D) CKD prevalence stages 1–5 (95% CI) in the population aged 45–74 years, in IDMS studies, by obesity status. Prevalence was age- and sex-adjusted to the EU27 population of 2005. N, the number of study subjects aged 45–74 years with creatinine and albuminuria measurement. Studies not covering the entire age range are not included in this figure. DM, diabetes mellitus; EPIRCE, Estudio Epidemiológico de la Insuficiencia Renal en España; HUNT, Nord-Trøndelag Health Study; HT, hypertension; INCIPE, Initiative on Nephropathy, of relevance to public health, which is Chronic, possibly in its Initial stages, and carries a Potential risk of major clinical Endpoints; LifeLines, LifeLines Cohort and Study Biobank; SLAN, Survey of Lifestyle and Attitudes & Nutrition in Ireland; Ɵ, studies using enzymatic method; | studies using Jaffe method.

Figure 3.

Adjusted CKD stages 3–5 prevalence in the population aged 45–74 years, in IDMS studies. Prevalence was age- and sex-adjusted to the EU27 population of 2005. The study names in uncolored regions are studies which used non–IDMS-standardized creatinine or studies which recruited subjects aged ≥50 years; the CKD prevalence results of these studies are shown in Supplemental Appendix 1. 3C, Three City Study; ActiFE, Activity and Function in the Elderly in Ulm study; EPIRCE, Estudio Epidemiológico de la Insuficiencia Renal en España; ESTHER, Epidemiologische Studie zu Chancen der Verhütung, Früherkennung und optimierten THerapie chronische ERkrankungen in der älteren Bevolkerung; FINRISK, Finland Cardiovascular Risk Study; HUNT, Nord-Trøndelag Health Study; INCIPE, Initiative on Nephropathy, of relevance to public health, which is Chronic, possibly in its Initial stages, and carries a Potential risk of major clinical Endpoints; LifeLines, LifeLines Cohort and Study Biobank; MATISS, Malattie cardiovascolari ATerosclerotiche Istituto Superiore di Sanita; MONA LISA, MOnitoring NAtionaL du rISque Arterie; MRC, Medical Research Council trial of assessment and management of older people in the community; PIVUS, Prospective Investigation of the Vasculature in Uppsala Seniors Study; PolSenior, Medical, psychological, sociological and economical aspects of aging of people in Poland; PREVADIAB, Prevalence of Diabetes and Risk Factors in Portugal; PREVEND, Prevention of Renal and Vascular End-stage Disease; SLAN, Survey of Lifestyle and Attitudes & Nutrition in Ireland; VIP, Valle dell'Irno Prevenzione

Figure 4.

(A) Adjusted CKD prevalence stages 3–5 (95% CI) in the population aged 45–74 years, in IDMS studies. (B) CKD prevalence stages 3–5 (95% CI) in the population aged 45–74 years, in IDMS studies, by diabetic status. (C) CKD prevalence stages 3–5 (95% CI) in the population aged 45–74 years, in IDMS studies, by hypertensive status. (D) CKD prevalence stages 3–5 (95% CI) in the population aged 45–74 years, in IDMS studies, by obesity status. Prevalence was age- and sex-adjusted to the EU27 population of 2005. N, the number of study subjects aged 45–74 years with creatinine measurement. Studies not covering the entire age range are not included in this figure. DM, diabetes mellitus; EPIRCE, Estudio Epidemiológico de la Insuficiencia Renal en España; FINRISK, Finland Cardiovascular Risk Study; HUNT, Nord-Trøndelag Health Study; INCIPE, Initiative on Nephropathy, of relevance to public health, which is Chronic, possibly in its Initial stages, and carries a Potential risk of major clinical Endpoints; LifeLines, LifeLines Cohort and Study Biobank; MATISS, Malattie cardiovascolari ATerosclerotiche Istituto Superiore di Sanita. Ɵ studies using enzymatic method; | studies using Jaffe method.