| Background:Chronic kidney disease (CKD) has been a common chronic disease,seriously affected public health problem.CKD is well known for its high prevalence,high morbility, high medical expensives and low awareness rate.That reform and opening enterprise is steadily on going,the speed of old age is aggrevated and lifestyle is changing making for great social-ecnomic burdern.Currently,the epidemiology study of CKD both at home and abroad is numerous,but there is little epidemiology figure of CKD in urban and rural areas in uniform area.It has been globly proved that old age is an independent risk factor for C-KD. Evendently,the prevalence of CKD and cardiovascular event occurrence and morbidity is high in the elders than that of the ordinary population. As a specific group, its physiological feasures, such as old age, more commorbities and so on may result for its difference in etiology,manifestation and prevalence from the ordinary people.Based on the statement above,screening CKD among old residents both from urban and rural areas has a significant clinical value for understanding the occurrence,development,sequelae and outcomes of CKD.Objective:To get the prevalence and its risk factors of CKD primarily by means of analyzing the social-ecnomic data and clinical materials. Then comparing the prevalence of CKD in rural and urban areas, finding out their difference in the-ir risk factors of CKD, so as to supply some feasible information for the ter-tiary prevention for CKD, slowing the progression of disease and improving the quality of life.Methods:Based on the more-than-60-year old people health examination program, to select the old resident population from urban (Jiangchuan Street) and rural (Pujiang Town)as research objects. The epidemiology study was implemented from May,2010to Sep,2010. The diagnosis of chronic disease based on the International or national diagnostic standards. The basic personal information, re-lated disease history and living and behaviral styles and so on of all subjects were evaluated by questionnaire.The height, weight, waistline,hip measurement, blood pressure value were obtained by physical examination. All subjects under-went blood serum creatinine,fasting blood glucose,total cholesterol,triglyceride, urinary albumin/creatinine ratio, hematuria (microscopic examination of centrifug-ed urine sediment) and kidney B tomode ultrasound examinations. Glomerular filtration rate(eGFR) was calculated by the simplified MDRD formula corrected with Chinese people.6151reserch objectives with complete data were analyzed into two groups(rural N=4345AND urban N=1806) according to its geographic difference to analyze the difference of clinical-epidemiological data, blood bio-chemical index and urinary testing items between the two groups above. Based on whether it was CKD or not,to analyze the demographic, epidemiologic, sesurm biochemical aspects as well as urinary testing items in order to explore possible factors affecting CKD; to do preliminarily comparative research of pot-ential risk factors of CKD patients both in urban and rural areasThe objects were divided into two groups(urban and rural) according to its place of birth to compare the difference of prevalence of hemauria, proteinuria, eGFR decrease and CKD by using χ2testing.On this base, compare the difference of demographic, epidemilogic, sesurm biochemical aspects as well as urinary testing items between CKD and non-CKD population both from rural and urba-n areas respectively. Logistic regression model was used to analyse the risk fact-ors for CKD in urban and rural areas.In the Logictic regression model analysi-s, stepward method was executed. If p value<0.05, regression coefficient>0, OR>1, the factor was considered as risk factor; while p value<0.05, regression coefficient<0, OR<1, the factor was considered as protective factors.Results:Among the reseach objects analysed,2536(41.3%)were male,3615(58.7%) were female. The ratio of male to female was1:1.43; the average age was69.57±7.04years;4345were urban residents.1806were rural residents.The age-sex distribution of the study population is comparable to the statistic data of MinHang District.The chronic diseases’condition of the research objects:the prevalence of hypertention, diabetes, dyslipidemia, hperuicacidemia were61.7%,22.7%,67.3%, and7.7%respectively; the awareness were98.2%,96.5%,78.2%and43.8% respectivelyThe prevalence of CKD, hemauria, albuminruria and eGFR in the total population were21.8%.4.8%,15.8%and4.93%.The awareness rate was36.4%. The prevalence of CKD in female was higher than that of male (25%a nd17.2%P<0.01). Aside from hemauria,the prevalence of CKD. albuminuria, eGFR decrease were evendently increased with the age increase.The prevalence of CKD and albuminuria in the different age groups (60to69years,70to79years, more than80-year old) were16.5%,25.6%,36.6%and12.3%,18.5%,25.6%respectively.There were statistical significance in the prevalence of differ-ent groups(P<0.01).The prevalence of CKD1to5were8.5%,8.4%,4.6%,0.2%and0.1%. The CKD patients were concentrated in Stage1to stage2, the overwhelming majority(79.6%) of CKD population lied in the early stage of CKD.There were significant differences in the mean age, serum creatinine, fasti-ng blood glucose, triglyceride, waistline, hip measurement, waist hip ratio,body mass index, systolic blood pressure, diastolic blood pressure, pulse pressure, mean arterial pressure and eGFR between the CKD and non-CKD population (P<0.01).Bianary logistic regression model analysis:female, old age, smoking hypertention, diabetes, hyperuricidemia.interventional therapy were independently associated with CKD, while secondary and high education and drinking were the protective factors(P<0.05).The mean age of the old population from urban and rural areas were69.31±6.82years and70.21±7.5years. The ratio of male to female were1:1.26and1:1.96respectively.The mean age and female ratio in rural residents were high than that of urban population; the ratio of secondary and high education coverage rate of medical insurance, employment rate,smoking rate, drinking rate, the prevanence of hypertention,diabetes,hypercholesterolemia,hypertriglyceridemia, hperuicacidemia and cardiocerebrovascular disease is distinctly higher than that of rural residents, the differences were statistically significant.The prevalence of CKD and hemauria among rural residents were higher than that of urban residents (24.6%,20.6%and10.4%,2.5%, P<0.01); The prevalence of eGFR decrease in ruban residents was slightly higher than the ru-ral (5.4%and4.93%, P<0.05).The prevalence of albuminuria were similar both in urban and rural population(P>0.05).Forms of expression of CKD:The top three in urban CKD patients were simple albuminuria(62.9%), simple eGFR decrease (17.1%) and albuminuria combined with eGFR decrease(8.4%);The top three in rural CKD patients were simple albuminuria (45%), simple hemauria (28%) and hemauria combined with albuminuria(11%).The leading manifestation of total CKD patients was the occ-urrence of albuminuria, while hemauria was secondary form of CKD in rural areas and albuminuria in urban areas.CKD Stage:The prevalence of CKD1to CKD5were7.18%,8.03%5.13%,0.18%,0.02%and11.5%.9.36%,3.5%、0.22%、0.05%,respectively. CKD stage were concentrated in CKD1-3both in urban and rural patients.Most CKD patients were early-to-moderate-stage persons.There were significant differences in the mean age,serum creatinine,fasting blood glucose, postprandial blood glucose,triglyceride, cholesterol,waistline, hip measurement, waist/hip ratio, body mass index,systolic blood pressure,diastolic blood pressure, pulse pressure, mean anterial pressure and eGFR between the C-KD and non-CKD population in urban areas (P<0.01). There were significant differences in the mean age, serum creatinine, fasting blood glucose, choleste-rol, waist hip ratio, body mass index, systolic blood pressure, diastolic blood pressure, pulse pressure, mean anterial pressure and eGFR beteen the CKD and non-CKD population in urban areas (P<0.01).The single-factor logistic regression analysis for urban CKD patients showed that female, past history of kidney disease, hypertention, hypercholesterolemia, hypertriglyceridemia, obesity, hyperuricidemia,interventional therapy and stroke were associated with CKD. Secondary and higher education and drinking were the protective factors. After multiple logistic regression analysis, older age, hy-pertention, hypertriglyceridemia, hyperuricacidemia, past history of kidney disea-se, interventional therapy were the risk factors of CKD among urban elders Secondary and higher education, drinker were negatively associated with urban CKD population by adjusting confounding factors.The single-factor logistic regression analysis for rural CKD patients showed that female, old age, hypertention, diabetes and hypercholesterolemia were as-sociated with CKD.Secondary and higher education, non-farmer, smoking, dri-nking were the protective factors. After multiple logistic regression analysis, f emale, older age,hypertention, diabetes were the risk factors of CKD among rural elders by adjusting confounding factors.Conclusions:Female accounts for the main part in the old population in Minhang Dist rict of ShangHai. The prevalence of chronic diseases were high.The top three chronic diseases are dyslipidemia, hypertention, and diabetes. The prevalence of CKD among the elders in Minhang District is21.8%second to diabetes. CKD has been a common chronic progressive disease of old people in Minhang District,but its awareness is relatively lower.Sex, age,smoking,hypertention,diabetes,hyperuricidemia,interventional therapy were independently associated with CKD in Minhang District, education and drinking were the protective factors.The prevalence of CKD is high in urban areas than that in rural.Age and hypertention are the common risk factors for both CKD. Hypertriglyceridemia, hyperuricacidemia, past history of kidney disease are the independent risk facto-rs of urban CKD patients.Sex and diabetes are the risk factors for rural CKD population. Education and drinking are protective factors for urban CKD... |
PDF Full Text Request