High Unawareness of Chronic Kidney Disease in Germany
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Variable Definition
2.3. Missing Values
2.4. Statistical Methods
3. Results
3.1. Characteristics of Patients
3.2. Prevalence of CKD Unawareness
3.3. Prevalence of CKD Unawareness in Regard to CKD Stages
3.4. Association between CKD Unawareness and Comorbidities and Markers of Renal Dysfunction
4. Discussion
4.1. Unawareness in Patients, Physicians and Public
4.2. CKD Unawareness and Additional CKD Related Risk Factors
4.3. Unawareness and High Risk of Renal Failure
4.4. Gender Gap in CKD Awareness
4.5. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Not Aware of CKD (N = 2267) | Aware of CKD (N = 1038) | Total (N = 3305) | |
---|---|---|---|
Sex (Female) | 883 (39.0) | 354 (34.1) | 1237 (37.4) |
Age (Mean (SD)) | 73.0 (10.6) | 74.5 (9.9) | 73.5 (10.4) |
<50 years | 65 (2.9) | 18 (1.7) | 83 (2.5) |
50–59 years | 179 (7.9) | 59 (5.7) | 238 (7.2) |
60–69 years | 472 (20.8) | 176 (17.0) | 648 (19.6) |
70–79 years | 931 (41.1) | 469 (45.2) | 1400 (42.4) |
80+ years | 620 (27.3) | 316 (30.4) | 936 (28.3) |
eGFR (mL/min/1.73 m2) (median (IQR)) | 58.4 (49.1–80.8) | 48.4 (36.9–57.8) | 55.3 (45.3–74.3) |
CKD1 | 312 (13.8) | 50 (4.8) | 362 (11.0) |
CKD2 | 691 (30.5) | 166 (16.0) | 857 (25.9) |
CKD3a | 906 (40.0) | 378 (36.4) | 1284 (38.9) |
CKD3b | 301 (13.3) | 310 (29.9) | 611 (18.5) |
CKD4 | 57 (2.5) | 134 (12.9) | 191 (5.8) |
ACR (mg/g, median (IQR)) (N = 3253) | 40.7 (13.3–95.5) | 37.5 (12.4–112.2) | 40.0 (13.0–99.8) |
ACR < 30 (=no proteinuria) | 798 (35.9) | 435 (43.3) | 1233 (38.2) |
30–299 | 1233 (53.4) | 446 (44.4) | 1679 (52.0) |
≥300 | 195 (8.8) | 124 (12.3) | 319 (9.9) |
BMI (kg/m2, Mean (SD)) | 29.7 (5.4) | 30.0 (5.5) | 29.1 (5.5) |
BMI < 25 | 432 (19.1) | 177 (17.1) | 609 (18.5) |
25–30 | 883 (39.0) | 399 (38.5) | 1282 (38.9) |
≥30 | 946 (41.8) | 460 (44.4) | 1406 (42.6) |
Current smoker | 258 (11.4) | 77 (7.4) | 335 (10.1) |
Antihypertensive medication | 1979 (87.3) | 961 (92.8) | 2940 (89.0) |
BP <140/90 mmHg | 1167 (51.5) | 546 (52.8) | 1713 (51.9) |
140/90–160/95 mmHg | 593 (26.2) | 271 (26.2) | 864 (26.2) |
≥160/95 mmHg | 506 (22.3) | 218 (21.1) | 724 (21.9) |
Antidiabetic medication | 1029 (45.4) | 466 (44.9) | 1495 (45.2) |
Comorbidities | |||
Anemia a (N = 3184) | 433 (20.0) | 326 (32.8) | 759 (24.1) |
Stroke, heart failure or IHD | 706 (31.1) | 398 (38.3) | 1104 (33.4) |
Sum CKD risk factors b (4+) | 248 (10.9) | 175 (16.9) | 423 (12.8) |
Risk for ESRD (KFRE) (N = 3253)) | |||
<2% | 1990 (89.4) | 673 (67.0) | 2663 (82.4) |
2–5% | 146 (6.6) | 139 (13.8) | 285 (8.8) |
5–15% | 60 (2.7) | 104 (10.4) | 164 (5.1) |
≥15% | 30 (1.4) | 89 (8.9) | 119 (3.7) |
N | Prevalence of CKD Unawareness | Crude PR (95%-CI) | PR (95%-CI) Adj. for Age and Sex | |
---|---|---|---|---|
Female | 1237 | 71.4 (68.8; 73.9) | 1.07 (1.02; 1.12) | 1.07 (1.03; 1.13) |
Male | 2068 | 66.9 (64.9; 69.0) | Ref. | Ref. |
Age | ||||
<50 years | 83 | 78.3 (67.9; 86.6) | Ref. | Ref. |
50–59 years | 238 | 75.2 (69.2; 80.6) | 0.96 (0.84; 1.10) | 0.96 (0.84; 1.09) |
60–69 years | 648 | 72.8 (69.2; 76.2) | 0.93 (0.82; 1.05) | 0.95 (0.84; 1.07) |
70–79 years | 1400 | 66.5 (64.0; 69.0) | 0.85 (0.75, 0.96) | 0.85 (0.76; 0.96) |
80+ years | 936 | 66.2 (63.1; 69.3) | 0.85 (0.75; 0.96) | 0.84 (0.75; 0.95) |
CKD stages | ||||
CKD 1 | 362 | 86.2 (82.2; 89.6) | Ref. | Ref. |
CKD 2 | 857 | 80.6 (77.8; 83.2) | 0.94 (0.89; 0.99) | 0.93 (0.88; 0.98) |
CKD 3a | 1284 | 70.6 (68.0; 73.0) | 0.82 (0.78; 0.86) | 0.81 (0.76; 0.86) |
CKD 3b | 611 | 49.3 (45.2; 53.5) | 0.57 (0.52; 0.63) | 0.57 (0.52; 0.62) |
CKD 4 | 191 | 29.8 (23.5; 36.3) | 0.35 (0.28; 0.43) | 0.34 (0.28; 0.43) |
Proteinuria (ACR, mg/g, N = 3253) | ||||
ACR < 30 | 1233 | 64.7 (62.0; 67.4) | Ref. | Ref. |
30–299 | 1679 | 73.4 (71.3; 75.5) | 1.13 (1.08; 1.19) | 1.13 (1.07; 1.19) |
≥300 | 319 | 61.1 (55.5; 66.5) | 0.94 (0.86; 1.04) | 0.94 (0.86; 1.04) |
Body Weight (BMI, kg/m2) | ||||
BMI < 25 | 609 | 70.9 (67.2; 74.5) | Ref. | Ref. |
25–30 | 1282 | 68.9 (66.3; 71.4) | 0.97 (0.91; 1.03) | 0.96 (0.90; 1.03) |
≥30 | 1406 | 67.3 (64.8; 69.7) | 0.95 (0.89; 1.01) | 0.91 (0.86; 0.97) |
Current smoking | ||||
No/Ex-smoker | 2968 | 67.7 (66.0; 69.4) | Ref. | Ref. |
Current smoker | 335 | 77.0 (72.1; 81.4) | 1.14 (1.70; 1.21) | 1.10 (1.03; 1.18) |
Hypertension/Blood pressure (mmHg) | ||||
No antihypertensive medication | 363 | 79.3 (74.8; 83.4) | Ref. | Ref. |
Antihypertensive medication | 2940 | 67.3 (65.6; 69.1) | 0.85 (0.80; 0.90) | 0.88 (0.83; 0.93) |
BP < 140/90 mmHg | 1713 | 68.1 (65.9; 70.3) | Ref. | Ref. |
140/90–160/95 mmHg | 864 | 68.6 (65.4; 71.7) | 1.01 (0.95; 1.07) | 1.01 (0.96; 1.07) |
≥160/95 mmHg | 724 | 69.9 (66.4; 73.2) | 1.03 (0.97; 1.09) | 1.03 (0.97; 1.09) |
Diabetes | ||||
No antidiabetic medication | 1810 | 68.4 (66.2; 70.5) | Ref. | Ref. |
Antidiabetic medication | 1495 | 68.8 (66.4; 71.2) | 1.01 (0.96; 1.05) | 0.98 (0.93; 1.03) |
Comorbidities | ||||
Anemia a (N = 3184) | 759 | 57.1 (53.4; 60.6) | 0.79 (0.74; 0.85) * | 0.80 (0.75; 0.86) |
IHD or Heart Failure or Stroke | 1104 | 64.0 (61.0; 66.8) | 0.90 (0.86; 0.95) * | 0.91 (0.87; 0.96) |
4+ CKD risk factors b | 486 | 59.5 (55.0; 63.9) | 0.83 (0.76; 0.91) * | 0.84 (0.78; 0.92) |
Risk for ESRD (KFRE) (N = 3253)) | ||||
<2% | 2663 | 74.7 (73.0; 76.4) | Ref. | Ref. |
2–5% | 285 | 51.2 (45.3; 57.2) | 0.69 (0.61; 0.77) | 0.69 (0.62; 0.78) |
5–15% | 164 | 36.6 (29.2; 44.5) | 0.49 (0.40; 0.60) | 0.50 (0.41; 0.61) |
≥15% | 119 | 25.2 (17.7; 34.0) | 0.34 (0.25; 0.46) | 0.34 (0.25; 0.46) |
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Stolpe, S.; Kowall, B.; Scholz, C.; Stang, A.; Blume, C. High Unawareness of Chronic Kidney Disease in Germany. Int. J. Environ. Res. Public Health 2021, 18, 11752. https://doi.org/10.3390/ijerph182211752
Stolpe S, Kowall B, Scholz C, Stang A, Blume C. High Unawareness of Chronic Kidney Disease in Germany. International Journal of Environmental Research and Public Health. 2021; 18(22):11752. https://doi.org/10.3390/ijerph182211752
Chicago/Turabian StyleStolpe, Susanne, Bernd Kowall, Christian Scholz, Andreas Stang, and Cornelia Blume. 2021. "High Unawareness of Chronic Kidney Disease in Germany" International Journal of Environmental Research and Public Health 18, no. 22: 11752. https://doi.org/10.3390/ijerph182211752