Chronic kidney disease: Asia’s ‘silent epidemic’

Medical Tribune August 2008 P14
David Brill


Reducing chronic kidney disease (CKD) should become a public-health priority, according to the authors of a large prospective study which found the national prevalence of the condition in Taiwan to be 11.9 percent.

This figure puts the condition on a par with smoking and obesity as a leading cause of death, the researchers wrote in The Lancet.

Awareness among the study population was low – just 3.5 percent of people knew that they had CKD.

The study, which followed 462,293 people over 13 years, also found that CKD is much more prevalent among lower socioeconomic groups, and that the regular use of Chinese herbal medicines carries a 20% increased risk for developing the condition.

“I think this is a silent epidemic,” said the study’s lead author Dr. Chi Pang Wen, from the National Health Research Institutes in Taiwan.

“It’s growing globally, and particularly Asians need to be even more concerned because of our fondness of taking medicine, including Chinese herbal medicine. The seriousness of this has not been well appreciated because people are only looking at the tip of the iceberg, which is the people on dialysis,” he said.

People with CKD were twice as likely to die from cardiovascular causes and 1.83 times as likely to die from any cause, the study found. Almost 40 percent of those who died were aged less than 65. [Lancet 2008 Jun 28;371(9631):2173-82]

The study highlights the importance of modifying risk factors such as hypertension, diabetes and smoking said Wen, who noted that the kidneys seem to be the earliest warning signal for vascular problems that may lead to cardiovascular death.

He called on the whole medical establishment to get involved with tackling the burden of CKD, beginning with the laboratories.

“When they report creatinine they need to have a formula to convert it into glomerular filtration rate (GFR). Without that conversion most Asian doctors are looking at creatinine which does not have as a high a level of sensitivity as GFR and cannot classify people into the 5 stages of CKD,” he said.

Wen added that the public should be encouraged to ask their doctor about their GFR value and whether or not they have proteinuria, which is an important warning sign for CKD.

Dr. Chan Choong Meng, Head and Senior Consultant in the Department of Renal Medicine at Singapore General Hospital, said: “This study shows that patients of a lower socioeconomic status are more susceptible to developing CKD. Unfortunately, they are likely to be unaware of the disease until a later stage.

“Early detection by screening and treatment for diabetes and hypertension will help reduce the burden of CKD, and early treatment will help in preventing and retarding the progression of the disease,” he said.

Chan added that the rates of CKD observed in the study are comparable to those previously documented for the US and Norway.