The Global prevalence of Chronic Kidney Disease
Chronic kidney disease (CKD) is a global health burden with a high economic cost to health systems and is an independent risk factor for cardiovascular disease (CVD). All stages of CKD are associated with increased risks of cardiovascular morbidity, premature mortality, and/or decreased quality of life. CKD is usually asymptomatic until later stages and accurate prevalence data are lacking. Thus we sought to determine the prevalence of CKD globally, by stage, geographical location, gender and age.
Data Sources: Medline/PubMed, Embase, CINAHL, the Cochrane Register for Controlled Trials (CENTRAL), LILACS, SciELO, clinicaltrials.gov, WHO ICTRP search portal. Databases were searched from inception to 1st September 2014.
Study Selection: Observational studies, population >500 people, year 2000 onwards, used Modification of Diet in Renal Disease or Chronic Kidney Disease Epidemiology Collaboration equation, reported CKD prevalence, and conducted in general population. Translations sought for non-English articles.
Data Extraction: Two independent reviewers extracted the data. An adjudicator resolved disagreement. Data included CKD prevalence, equation to calculate eGFR, study setting: year, country, gender split, age and quality assessment.
Global mean(95%CI) CKD prevalence of 5 stages 13·4%(11·7-15·1%), and stages 3–5 was 10·6%(9·2-12·2%).
Of 5,842 potential articles, 100 studies of diverse quality were included, comprising 6,908,440 patients. Weighting by study quality did not affect prevalence estimates. CKD prevalence by stage was Stage-1 (eGFR>90+ACR>30): 3·5% (2·8-4·2%); Stage-2 (eGFR 60-89+ACR>30): 3·9% (2·7-5·3%); Stage-3 (eGFR 30-59): 7·6% (6·4-8·9%); Stage-4=(eGFR 29-15): 0·4% (0·3-0·5%); and Stage-5 (eGFR<15): 0·1% (0·1-0·1%).
CKD has a high global prevalence with a consistent estimated global CKD prevalence of between 11 to 13% with the majority stage 3. Future research should evaluate intervention strategies deliverable at scale to delay the progression of CKD and improve CVD outcomes.