1. Chronic kidney disease, hypertension, diabetes, and obesity in the adult population of Morocco: how to avoid "over"- and "under"-diagnosis of CKD.
- Author
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Benghanem Gharbi M, Elseviers M, Zamd M, Belghiti Alaoui A, Benahadi N, Trabelssi el H, Bayahia R, Ramdani B, and De Broe ME
- Subjects
- Adult, Age Factors, Aged, Arabs, Blood Glucose analysis, Creatinine blood, Cross-Sectional Studies, Diabetes Mellitus blood, Diabetes Mellitus urine, Female, Hematuria diagnosis, Hematuria epidemiology, Humans, Hypertension blood, Hypertension urine, Male, Middle Aged, Morocco epidemiology, Obesity blood, Obesity urine, Prevalence, Proteinuria diagnosis, Proteinuria epidemiology, Random Allocation, Renal Insufficiency, Chronic blood, Renal Insufficiency, Chronic urine, Risk Factors, Sex Factors, Diabetes Mellitus epidemiology, Glomerular Filtration Rate, Hypertension epidemiology, Obesity epidemiology, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic epidemiology
- Abstract
The prevalence of hypertension, diabetes, obesity, and chronic kidney disease (CKD) in an adult Arabic-Berber population was investigated according to 2012 KDIGO guidelines. A stratified, randomized, representative sample of 10,524 participants was obtained. Weight, height, blood pressure, proteinuria (dipstick), plasma creatinine, estimated glomerular filtration rate, and fasting glycemia were measured. Abnormal results were controlled within 2 weeks; eGFR was retested at 3, 6, and 12 months. The population adjusted prevalences were 16.7% hypertension, 23.2% obesity, 13.8% glycemia, 1.6% for eGFR under 60 ml/min/1.73 m(2) and confirmed proteinuria 1.9% and hematuria 3.4%. Adjusted prevalence of CKD was 5.1%; distribution over KDIGO stages: CKD1: 17.8%; CKD2: 17.2%; CKD3: 52.5% (3A: 40.2%; 3B: 12.3%); CKD4: 4.4%; CKD5: 7.2%. An eGFR distribution within the sex and age categories was constructed using the third percentile as threshold for decreased eGFR. A single threshold (under 60 ml/min/1.73 m(2)) eGFR classifying CKD3-5 leads to "overdiagnosis" of CKD3A in the elderly, overt "underdiagnosis" in younger individuals with eGFR over 60 ml/min/1.73 m(2), below the third percentile, and no proteinuria. By using the KDIGO guidelines in a correct way, "kidney damage" (confirmed proteinuria, hematuria) and the demonstration of chronicity of decreased eGFR <60 ml/min/1.73 m(2), combined with the third percentile as a cutoff for the normality of eGFR for age and sex, overcome false positives and negatives, substantially decrease CKD3A prevalence, and greatly increase the accuracy of identifying CKD., (Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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