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Change in prevalence of chronic kidney disease in England over time: comparison of nationally representative cross-sectional surveys from 2003 to 2010

Change in prevalence of chronic kidney disease in England over time: comparison of nationally representative cross-sectional surveys from 2003 to 2010
Change in prevalence of chronic kidney disease in England over time: comparison of nationally representative cross-sectional surveys from 2003 to 2010
Design: Cross-sectional analysis of nationally representative Health Survey for England (HSE) random samples.

Setting: England 2003 and 2009/2010.

Survey participants: 13?896 adults aged 16+ participating in HSE, adjusted for sampling and non-response, 2009/2010 surveys combined.

Main outcome measure: Change in prevalence of estimated glomerular filtration rate (eGFR) <60?mL/min/1.73?m2 (as proxy for stage 3–5 CKD), from 2003 to 2009/2010 based on a single serum creatinine measure using an isotope dilution mass spectrometry traceable enzymatic assay in a single laboratory; eGFR derived using Modified Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) eGFR formulae.

Analysis: Multivariate logistic regression modelling to adjust time changes for sociodemographic and clinical factors (body mass index, hypertension, diabetes, lipids). A correction factor was applied to the 2003 HSE serum creatinine to account for a storage effect.

Results: National prevalence of low eGFR (<60) decreased within each age and gender group for both formulae except in men aged 65–74. Prevalence of obesity and diabetes increased in this period, while there was a decrease in hypertension. Adjustment for demographic and clinical factors led to a significant decrease in CKD between the surveyed periods. The fully adjusted OR for eGFR <60?mL/min/1.73?m2 was 0.75 (0.61 to 0.92) comparing 2009/2010 with 2003 using the MDRD equation, and was similar using the CKDEPI equation 0.73 (0.57 to 0.93).

Conclusions: The prevalence of a low eGFR indicative of CKD in England appeared to decrease over this 7-year period, despite the rising prevalence of obesity and diabetes, two key causes of CKD. Hypertension prevalence declined and blood pressure control improved but this did not appear to explain the fall. Periodic assessment of eGFR and albuminuria in future HSEs is needed to evaluate trends in CKD.
epidemiology, public health
1-13
Aitken, G.R.
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Roderick, P.J.
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Fraser, Simon D.S.
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Mindell, J.S.
cf8f741c-bf13-46fa-8959-4a31807103ac
O'Donoghue, D.
d188e25a-314f-41b0-9243-c51e6345a4d9
Day, J.
4fc7e066-aed2-444e-905c-ba309b3bc347
Moon, G.
68cffc4d-72c1-41e9-b1fa-1570c5f3a0b4
Aitken, G.R.
975c863b-70cb-4524-898f-a414e19a3cea
Roderick, P.J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Fraser, Simon D.S.
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Mindell, J.S.
cf8f741c-bf13-46fa-8959-4a31807103ac
O'Donoghue, D.
d188e25a-314f-41b0-9243-c51e6345a4d9
Day, J.
4fc7e066-aed2-444e-905c-ba309b3bc347
Moon, G.
68cffc4d-72c1-41e9-b1fa-1570c5f3a0b4

Aitken, G.R., Roderick, P.J., Fraser, Simon D.S., Mindell, J.S., O'Donoghue, D., Day, J. and Moon, G. (2014) Change in prevalence of chronic kidney disease in England over time: comparison of nationally representative cross-sectional surveys from 2003 to 2010. BMJ Open, 4 (9), 1-13. (doi:10.1136/bmjopen-2014-005480). (PMID:25270853)

Record type: Article

Abstract

Design: Cross-sectional analysis of nationally representative Health Survey for England (HSE) random samples.

Setting: England 2003 and 2009/2010.

Survey participants: 13?896 adults aged 16+ participating in HSE, adjusted for sampling and non-response, 2009/2010 surveys combined.

Main outcome measure: Change in prevalence of estimated glomerular filtration rate (eGFR) <60?mL/min/1.73?m2 (as proxy for stage 3–5 CKD), from 2003 to 2009/2010 based on a single serum creatinine measure using an isotope dilution mass spectrometry traceable enzymatic assay in a single laboratory; eGFR derived using Modified Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) eGFR formulae.

Analysis: Multivariate logistic regression modelling to adjust time changes for sociodemographic and clinical factors (body mass index, hypertension, diabetes, lipids). A correction factor was applied to the 2003 HSE serum creatinine to account for a storage effect.

Results: National prevalence of low eGFR (<60) decreased within each age and gender group for both formulae except in men aged 65–74. Prevalence of obesity and diabetes increased in this period, while there was a decrease in hypertension. Adjustment for demographic and clinical factors led to a significant decrease in CKD between the surveyed periods. The fully adjusted OR for eGFR <60?mL/min/1.73?m2 was 0.75 (0.61 to 0.92) comparing 2009/2010 with 2003 using the MDRD equation, and was similar using the CKDEPI equation 0.73 (0.57 to 0.93).

Conclusions: The prevalence of a low eGFR indicative of CKD in England appeared to decrease over this 7-year period, despite the rising prevalence of obesity and diabetes, two key causes of CKD. Hypertension prevalence declined and blood pressure control improved but this did not appear to explain the fall. Periodic assessment of eGFR and albuminuria in future HSEs is needed to evaluate trends in CKD.

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Accepted/In Press date: 5 September 2014
Published date: 29 September 2014
Keywords: epidemiology, public health
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 370051
URI: https://eprints.soton.ac.uk/id/eprint/370051
PURE UUID: 2a34e9b9-2424-49a8-935f-be3c36a37387
ORCID for P.J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850
ORCID for Simon D.S. Fraser: ORCID iD orcid.org/0000-0002-4172-4406
ORCID for G. Moon: ORCID iD orcid.org/0000-0002-7256-8397

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Date deposited: 17 Oct 2014 16:18
Last modified: 01 Oct 2019 01:00

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Contributors

Author: G.R. Aitken
Author: P.J. Roderick ORCID iD
Author: J.S. Mindell
Author: D. O'Donoghue
Author: J. Day
Author: G. Moon ORCID iD

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