上海城市社区成年人群慢性肾脏病流行病学研究

Community-based study on adult chronic kidney diseases and its associated risk factors in Shanghai

目的获取上海城市社区成年人群慢性肾脏病流行病学及其高危人群数据，有助于慢性肾脏病的早期发现、早期诊断、早期治疗及有助于国家卫生政策的制定。方法采用多阶段整群随机抽样法对上海市长宁区江苏街道中2596名18岁以上常住居民进行问卷调查并检测肾脏损伤指标及相关危险因素，包括体格检查、尿常规＋沉渣镜检、尿白蛋白／肌酐比值（ACR）、Scr、BUN、血尿酸、血糖、血胆固醇（Cho）、血三酰甘油（TG）、血红蛋白（Hb）及肾脏B超等。调查员均经过培训及接受技术指导，同时培训社区居委会有关人员，以便与居民的沟通与联络。3个月后对ACR试纸半定量检查阳性者进行复查。结果在2554例资料完整的居民中，白蛋白尿患病率为6．3％；肾功能下降为5．8％；镜下血尿为1．2％。该人群中CKD患病率11．8％，知晓率8．2％。多因素Logistic回归提示，CKD的最强烈危险因素为高尿酸血症，其余依次为肾结石、贫血、糖尿病、腹型肥胖、高血压、年龄。结论在上海城市社区人群中，CKD患病率为11.8％，知晓率仅为8．2％。CKD的危险因素为高尿酸血症、肾结石、贫血、糖尿病、腹型肥胖、高血压、年龄。

Objective To investigate the prevalence, awareness and risk factors of chronic kidney disease （CKD） among community adult population in Shanghai, China, in order to provide early diagnosis and treatment of CKD, and informations for national health policy makers. Methods Two thousand five hundred and ninety six residents （〉/18 years old） were randomly selected from community population in Changning district of Shanghai, China. They were interviewed and tested for albuminuria -morning spot urine albumin to creatinine ratio [ACR, abnormah ≥ 17 mg/g （male）, 1〉25 mg/g （female）], reduced renal function-estimated GFR by abbreviated MDRD equation [abnormah 〈60 ml min-1·（1.73 m2）-1] and hemataria-morning spot urine dipstick confirmed by urine microscopy. The associations among demographic characteristics, healthy characteristics （e.g. diabetes and hypertension） and indicators of kidney damage were examined. The investigators and neighborhood committee were well trained. Those who had semi- quantitative positive were detected again by albuminuria-moming spot urine albumin to creatinine ratio after three months. Results Two thousand five hundred and fifty four residents with complete data were enrolled in the study. Albuminuria was detected in 6.3% of subjects, reduced renal function in 5.8%, hematuria in 1.2%. Approximately 11.8% of these subjects had at least one indicator of kidney damage. The awareness rate of CKD was 8.2%. The Logistic regression model showed that hyperuricemia, nephrolithiasis, anemia, diabetes, central obesity, hypertension and age contributed to the development of CKD. Conclusions The prevalence of CKD in community adult population in Shanghai is 11.8%, And the awareness rate of CKD is 8.2%. Hyperuricemia, nephrolithiasis, anemia, diabetes, central obesity, hypertension and age are risk factors of CKD.