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. 2023 Apr 1;183(4):298-310.
doi: 10.1001/jamainternmed.2022.6817.

Prevalence of Chronic Kidney Disease in China: Results From the Sixth China Chronic Disease and Risk Factor Surveillance

Limin Wang  1 , Xin Xu  2 , Mei Zhang  1 , Caihong Hu  1   3 , Xiao Zhang  1 , Chun Li  1 , Sheng Nie  2 , Zhengjing Huang  1 , Zhenping Zhao  1 , Fan Fan Hou  2 , Maigeng Zhou  1
Affiliations

Prevalence of Chronic Kidney Disease in China: Results From the Sixth China Chronic Disease and Risk Factor Surveillance

Limin Wang et al. JAMA Intern Med. .

Abstract

Importance: To our knowledge, there has been no update on the prevalence of chronic kidney disease (CKD) in China since 2012.

Objective: To provide periodic nationwide data on the prevalence of CKD and the associated behavioral and metabolic risk factors in China.

Design, setting, and participants: This nationally representative cross-sectional study included data from 176 874 adults from all 31 provincial-level administrative divisions in mainland China, as reported in the sixth China Chronic Disease and Risk Factor Surveillance conducted from August 2018 to June 2019. Data analysis was performed in 2021 to 2022.

Exposures: Serum creatinine, urinal creatinine, and urine albumin were measured for all participants. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine using the CKD-EPI equation.

Main outcomes and measures: The primary outcome was weighted prevalence of CKD in the overall population and different strata, defined as presence of impaired kidney function (eGFR of <60 mL/min/1.73m2) or albuminuria (urine albumin-to-creatinine ratio of ≥30 mg/g). Secondary outcomes were awareness of CKD and control of comorbidities. Logistic regression was used to examine the association of sociodemographic characteristics, behavioral and dietary habits, physical activity, and comorbidities with CKD.

Results: A total of 184 876 participants contributed data to this study, and of the 176 874 adults 18 years and older with measurements of eGFR and urine albumin-to-creatinine ratio in 2018 to 2019, the mean age was 43.8 years and the weighted proportion of women was 44.6%. The estimated prevalence of CKD, impaired kidney function, and albuminuria were 8.2%, 2.2%, and 6.7%, respectively. A higher prevalence of CKD was observed in the subgroups characterized by older age, female gender, non-Han ethnicity, residency of rural or north and central parts of China, receiving less education or lower income, former smoking, no alcohol drinking, lacking physical activity, and presence of risk factors such as obesity, hypertension, diabetes, dyslipidemia, and self-reported cardiovascular disease. Among the adults with CKD, 73.3%, 25.0%, and 1.8% were at stage 1 to 2, 3, and 4 to 5, respectively, and the awareness of CKD was 10.0%.

Conclusions and relevance: This cross-sectional study found a weighted estimated of 82 million adults with CKD in China in 2018 to 2019. The prevalence appears to have decreased by 30% in the past decade. Better environmental protection, integration of CKD into the national public health surveillance program, and control of common CKD comorbidities appear to be associated with reducing the disease burden of CKD.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Xu reported grants from the Ministry of Science and Technology of China during the conduct of the study. Dr Hou reported grants from the National Natural Science Foundation of China and the Department of Science and Technology of Guangdong Province, as well as personal fees from AstraZeneca for serving as an executive committee member and national leading investigator in the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease study outside the submitted work. No other disclosures were reported.

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