Increased albuminuria is highly prevalent in the general population: prevalence of CKD in the Gutenberg Health Study

TL;DR

This study shows that many people in the general population have early signs of kidney disease, even without common risk factors.

Contribution

The first longitudinal study to report CKD prevalence in the general population using chronic increased albuminuria as a marker.

Findings

10.4% of individuals had increased albuminuria at baseline.

6.8% of all subjects had chronic increased albuminuria over 5 years.

3.2% of individuals without hypertension, diabetes, or known kidney disease had chronic increased albuminuria.

Abstract

Early diagnosis of chronic kidney disease (CKD) is essential to slow progression and delay or prevent dialysis. However, in the absence of specific symptoms, patients and physicians may remain unaware of the disease for a long period. Here we present an analysis from the Gutenberg Health Study, a prospective longitudinal cohort study, to estimate the prevalence of CKD indicators in the population.

A representative sample of 10 125 individuals underwent extensive medical testing at baseline; 9331 were tested again after 5 years. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula with serum creatinine. Urinary albumin:creatinine ratios (UACRs) were determined from spot urine samples.

At baseline, 2.5% of subjects had decreased eGFR (<60 ml/min/1.73 m2), 10.4% had increased albuminuria (UACR >30 mg/g) and 1.0% had both. Within 5 years, the incidence of new-onset decreased eGFR was 3.4%, the incidence of new-onset increased albuminuria was 6.9% and 1.4% had both new-onset decreased eGFR and increased albuminuria. Most importantly, 6.8% of all subjects and 3.2% of subjects without hypertension, diabetes or known kidney disease had chronic increased albuminuria, consistent with the presence of CKD.

This is the first study to report the longitudinal prevalence of CKD in the population. Chronic increased albuminuria, a sensitive marker of CKD, is highly prevalent in the German population even in the absence of risk factors for kidney disease.

GRAPHICAL ABSTRACT

Figures