Journal
AMERICAN JOURNAL OF KIDNEY DISEASES
Volume 62, Issue 2, Pages 253-260Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.ajkd.2013.03.013
Keywords
Cystatin C; chronic kidney disease; estimating equations; prevalence
Categories
Funding
- National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [K08DK092287]
- NIH/NIDDK [K23DK081017-05, U01 DK067651]
- NIH/National Heart, Lung and Blood Institute [T32 HL007024]
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Background: The US prevalence of reduced estimated glomerular filtration rate (eGFR) based on serum creatinine level increased during the decade ending in 2002. National Health and Nutrition Examination Survey (NHANES) cystatin C measurements recently were calibrated to the international standard, allowing for an independent test of the trend in prevalence of reduced eGFR using cystatin C level. Study Design: Cross-sectional surveys performed during 2 periods. Setting & Participants: Nationally representative subsamples of adult participants from NHANES III (1988-1994) and the NHANES 1999-2002 surveys. Predictor: Survey period. Outcomes: Prevalence of reduced GFR, defined as eGFR <60 mL/min/1.73 m(2) based on levels of serum creatinine, cystatin C, or both (eGFR(cr), eGFR(cys), and eGFR(cr-cys)), using estimating equations developed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Measurements: Serum cystatin C level, measured from stored samples in 2006, calibrated to the international standard in 2012. Results: Between 1988-1994 and 1999-2002, the prevalence of reduced eGFR(cr), eGFR(cys), and eGFR(cr-cys) increased from 4.7% (95% CI, 4.1%-5.3%) to 6.5% (95% CI, 5.9%-7.1%) (P < 0.001), from 5.5% (95% CI, 4.6%-6.5%) to 8.7% (95% CI, 7.5%-10.0%) (P < 0.001), and from 4.4% (95% CI, 3.7%-5.2%) to 7.1% (95% CI, 6.2%-8.0%) (P < 0.001), respectively. The higher prevalence of reduced GFR in the later period was observed in all subgroups of age, race, sex, and GFR categories. After adjusting for changes in the US population by age, sex, race, diabetes, hypertension, and body mass index, prevalence ratios of reduced GFR in the later versus earlier survey were 1.24 (95% CI, 1.09-1.45), 1.34 (95% CI, 1.15-1.67), and 1.33 (95% CI, 1.17-1.65) using eGFR(cr), eGFR(cys), and eGFR(cr-cys), respectively. Limitations: Likely underascertainment of persons with GFR <15 mL/min/1.73 m(2); GFR was estimated and not measured; comparability of laboratory assays based on a calibration subsample. Conclusions: The prevalence of reduced eGFR(cys) in the US civilian noninstitutionalized population increased between 1988-1994 and 1999-2002, confirming the increase observed in the prevalence of reduced eGFR(cr). (c) 2013 by the National Kidney Foundation, Inc.
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