Prevalence of chronic kidney disease in the community using data from OxRen: a UK population-based cohort study

Abstract

Background: Chronic kidney disease (CKD) is a largely asymptomatic condition of diminished renal function, which may not be detected until advanced stages without screening.

Aim: To establish undiagnosed and overall CKD prevalence using a cross-sectional analysis.

Design and setting: Longitudinal cohort study in UK primary care.

Method: Participants aged ≥60 years were invited to attend CKD screening visits to determine whether they had reduced renal function (estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m² or albumin:creatinine ratio ≥3 mg/mmol). Those with existing CKD, low eGFR, evidence of albuminuria, or two positive screening tests attended a baseline assessment (CKD cohort).

Results: A total of 3207 participants were recruited and 861 attended the baseline assessment. The CKD cohort consisted of 327 people with existing CKD, 257 people with CKD diagnosed through screening (CKD prevalence of 18.2%, 95% confidence interval [CI] = 16.9 to 19.6), and 277 with borderline/transient decreased renal function. In the CKD cohort, 54.4% were female, mean standard deviation (SD) age was 74.0 (SD 6.9) years, and mean eGFR was 58.0 (SD 18.4) ml/min/1.73 m². Of the 584 with confirmed CKD, 44.0% were diagnosed through screening. Over half of the CKD cohort (51.9%, 447/861) fell into CKD stages 3-5 at their baseline assessment, giving an overall prevalence of CKD stages 3-5 of 13.9% (95% CI = 12.8 to 15.1). More people had reduced eGFR using the Modification of Diet in Renal Disease (MDRD) equation than with CKD Epidemiology Collaboration (CKD-EPI) equation in the 60-75-year age group and more had reduced eGFR using CKD-EPI in the ≥80-year age group.

Conclusion: This study found that around 44.0% of people living with CKD are undiagnosed without screening, and prevalence of CKD stages 1-5 was 18.2% in participants aged >60 years. Follow-up will provide data on annual incidence, rate of CKD progression, determinants of rapid progression, and predictors of cardiovascular events.

Keywords: OxRen; chronic kidney diseases; glomerular filtration rate; kidney failure; prevalence; primary health care.

Figure 1.

Classification of chronic kidney disease (CKD) using glomerular filtration rate (GFR) and albumin:creatinine ratio (ACR). Adapted from KDIGO guidelines with permission from Elsevier. A1 = normal albuminuria. A2 = micro-albuminuria. A3 = macro-albuminuria. G = stage of CKD (1–5) by GFR category.

Figure 2.

Participant flow chart. ^aNational Institute for Health and Care Excellence criteria for diagnosis of chronic kidney disease (CKD): ≥2 results at least 3 months apart. ^bEstimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m², or eGFR >60 ml/min/1.73 m², and albumin:creatinine ratio (ACR) >3 mg/mmol; at least one result must be from Screening A or Screening B.

Figure 3.

Chronic kidney disease (CKD) stage of participants stratified by entry to the cohort calculated using the Modification of Diet in Renal Disease (MDRD) equation.

Figure 4.

Participant eGFR using the Modification of Diet in Renal Disease (MDRD) equation and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation stratified by age. CKD = chronic kidney disease. eGFR = estimated glomerular filtration rate.