Analysis Of The Prevalence And Influencing Factors Of Chronic Kidney Disease In Shanghai

ObjectiveChronic kidney disease(CKD)is a chronic disease which seriously endangers human life and health.It is a common public health problem in the world.It has the characteristics of high prevalence,low awareness and high medical costs,which bring a huge burden to individuals,families and society.In many countries,the incidence of chronic kidney disease is as high as 200 cases per million persons/year.According to the 2016 annual data report of the American kidney disease data system(USRDS),the prevalence rate of CKD in adults is 14.8%.In China,the prevalence of CKD in different regions is about 9%-13%,and is still on the rise.By the end of 2015,the total number of adult chronic diseases was up to 130 million,but the awareness rate was only 12.5%.Early detection and early prevention can effectively delay the progression of disease and prevent the occurrence of end-stage renal disease.Therefore,it is urgent to screen and understand the prevalence and risk factors of different age,sex and regional population in Shanghai as soon as possible,and become the urgent need to formulate reasonable public health policies and effective interventions.This study closely combines the national health development strategy and the three level diagnosis and treatment system.In the case of fully analyzing the three elements of population,economy and health resources,this study selects the permanent residence population in Jingan District and Minhang District by CKD screening,and explores the prevalence of chronic kidney disease in Shanghai,which is different from the same age,sex and region.And the influencing factors provide a reliable basis for the prevention and control strategy of chronic kidney disease in Shanghai,and give full play to the demonstration role to provide ideas and reference for the investigation of chronic kidney disease in other provinces and cities of the country.Data and MethodsA cluster random sampling method was used to intercept the permanent resident population of 27 community health service centers in Jingan District and Minhang District from January 1,2015 to January 2017 in Shanghai,which was more than 18 years old and volunteered for CKD screening.The screening included data from questionnaires,physicalexaminations and laboratory tests.The questionnaire involves basic demographic characteristics,disease history,family history;physical examination involves height,weight,and blood pressure;laboratory tests include urine routine and blood creatinine tests.The diagnostic criteria used the K/DOQI guidelines established by the American nephrology foundation,which was diagnosed as chronic kidney disease when renal damage was more than 3 months,or with a decrease of glomerular filtration rate(GFR <60ml/min/1.73m2)> 3 months.The main diagnostic parameters were urine protein,urine red blood cells,urine ACR and eGFR.The age group standard is: 18-39 years old for youth group;40-64 years old for middle-aged group;65 years old and above for elderly group.SPSS 21.0 software was used to analyze the basic situation,medical history,laboratory examination and morbidity of the subjects.Descriptive analysis,chi square test,Mann-Whitney U test and Kruskal.Waillis H test were used to analyze the subjects of different ages,sexes and regions.In the study of the relationship between the factors and the relationship with chronic kidney disease,the single factor analysis and Logistic stepwise regression analysis were used.P<0.05 believes that it is statistically significant.Results1.Among the subjects,21343 cases were male,accounting for 40.51%,the average age(70.37 + 8.98)years,and 31342 women,accounting for 59.49% of the subjects,and the average age(69.78 + 9.16)years.From the perspective of regional distribution,18554 cases in Jingan District accounted for 35.22% of the research object,and 34131 cases in Minhang District accounted for 64.78%.From the age distribution,77% of the respondents concentrated in 60-80 years old,with a large age span,a minimum age of 18 years,and a maximum age of 102.According to the standard of youth(18-34 years old),middle age(35-64 years old)and old age(65 years old and above),the youth group was 513,accounting for 0.97%,13867 in the middle group,26.32%,and 38305 in the elderly group,accounting for 72.71%.2.History of diseaseAmong the 52685 subjects,there were 29912 cases of hypertension(56.78%),19078 cases of diabetes(36.21%),1284 hyperuricemia(2.44%),65 hereditary renal history(0.12%),97 chronic nephritis family history(0.18%),950 cases of renal tubular disease(1.80%),and renal ultrasound abnormalities.The history of renal biopsy was 23 cases(0.04%),and renal transplant history was 12 cases(0.02%).3.CKD prevalenceThe detection rate of CKD was 13569,and the prevalence rate was 25.75%.The detection rate of women was 27.29%,the rate of male detection was 23.50%,there was no significant difference between men and women(P=0.569).The detection rate in the elderly group was higher than that in the middle age group.The detection rate in the middle-aged group was higher than that in the young group.The detection rate of 65 years old and above was 77.31%,and the difference between the young group and the young group was statistically significant(P=0.037),and the difference between the middle-aged group and the middle age group.There was no statistical significance(P=0.411).The detection rate of Jingan District was 35.32%,which was higher than that of Minhang District(18.32%),and the difference between two regions was statistically significant(P=0.006),which may be closely related to the developed regional economy in Jingan District and the large population size.4.Stage of CKD and risk stratificationStage of CKD: 3252 were in CKD1(23.97%),5667 in CKD2(41.76%),6826 in CKD3(50.31%),756 in CKD4(5.57%),and 484 in CKD5(3.57%).Risk stratification: 4830 cases of low risk patients(35.60%),6089 cases(44.87%),1670 cases(12.31%)of high-risk patients and 980 cases of extremely high risk patients(7.22%).5.Influence factors of CKDThe influencing factors of chronic renal disease include 7 major factors(P < 0.05),such as region,age,BMI,hypertension,diabetes,high uric acid history and hereditary renal disease(P < 0.05).The regression equation is Y=-1.257 + 0.377X1-0.77X2-0.177X3+ 0.135X4 + 0.108X5 + 0.208X6-0.729X7.The inclusion criteria were alpha =0.05,and the correct prediction rate of the model was 66.1%.Conclusion and recommendationsWe should respond actively to early prevention and control in order to delay the CKD process and reduce the economic,psychological and disease burden of family and society.For the patients at the early stage of CKD,health publicity and education should be strengthened to remind them to periodically review the process of further development;for the medium-term patients,they are gradually entering the final stage.The group should follow up regularly and strictly follow the three stage referral system;for end-stagepatients,only through the blood through the blood.Analysis,peritoneal dialysis and renal transplantation maintain life.On the whole,it should be adapted to local conditions,strengthen the management of age stratification,strengthen the management of CKD patients in middle and old age,reduce the prevalence of hypertension and diabetes,and prevent some hypertension and diabetic patients from the source to chronic kidney disease.Secondly,regular screening of middle and low risk patients and regular follow-up work of patients in middle and late stage are widely carried out.Screening work is widely used in areas without CKD screening,and regular follow-up is advocated in areas where CKD screening has been carried out in order to achieve the purpose of early detection and early treatment.Thirdly,we should pay attention to the epidemiological investigation and study of CKD in thought,grasp the situation,distribution characteristics and influencing factors of CKD in time,make the foundation for the formulation and decision of health policy,pay attention to the epidemiological investigation of CKD in different regions,and control the key risk factors.Finally,the government should actively carry out health education activities to improve the residents' CKD cognition level,so that patients can visit in time when CKD symptoms are mild.