In a recent study posted to Preprints with the Lancet*, researchers investigate gender-, socioeconomic status-, and age-based disparities in chronic kidney disease (CKD) and update global CKD estimates.
Study: Global Health Inequalities of Chronic Kidney Disease: A Systematic Review and Meta-Analysis Examining Prevalence and Disparities in Age, Sex and Socio-Economic Status. Image Credit: Marko Aliaksandr / Shutterstock.com
*Important notice: Preprints with The Lancet publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
What is CKD?
CKD, a non-communicable illness, is a significant global burden that is influenced by age, socioeconomic status, and gender. Understanding the burden of CKD in older populations is crucial for effective screening and management.
Lower socioeconomic regions have a higher burden of CKD, with gender effects on CKD prevalence remaining unclear. A comprehensive understanding of these factors can guide healthcare professionals, policymakers, and the public to identify priority areas for intervention and research, ultimately reducing the overall burden and improving patient quality of life.
About the study
The Cochrane Library Embase, PubMed/MEDLINE, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched on September 28, 2022, for relevant records published in English or French between 2014 and 2022. Gray literature and references to the included records were also searched.
Epidemiological, case-control, cross-sectional, and cohort studies were included if they were conducted on the general public aged 18 years or above. Studies conducted in specialist populations, including individuals 18 years or younger, studies that did not report CKD prevalence, and records such as case reports, case series, opinion pieces, and papers, were not included in the analysis.
Random-effects modeling was performed to determine the global overall CKD prevalence and that of CKD stages three to five among men and women. Subgroup analyses were performed to evaluate the impact of gender, socioeconomic status, and gender on CKD estimates, whereas meta-regression analyses and bias risk evaluations were performed to assess heterogeneity.
Data were screened independently by three researchers, with any disagreements resolved by a fourth researcher. CKD was described as proteinuria/albuminuria and/or an estimated glomerular filtration rate (eGFR) below 60 ml/minute/1.7 m2. Maintenance dialysis recipients and those with a history of kidney transplantation were also considered as CKD patients.
Study findings
Initially, 14,871 records were identified, of which 119 records, including 29,159,948 individuals, were analyzed. Among the included studies, 8%, 44%, and 48% had low, moderate, and high bias risks, respectively. The pooled global CKD prevalence estimate was 13%, whereas a 6.6% prevalence for CKD stages three to five was observed.
Similar results were obtained by eliminating high-bias risk records for CKD stages one to five and for stages three to five. The prevalence estimates were higher among 13 records, which included older individuals. Furthermore, meta-regression analysis identified independent associations between body mass index (BMI), age, hypertension, and diabetes and the prevalence of CKD stages three to five.
CKD prevalence estimates for stages one to five were similar among men and women at 13% each, whereas those for stages three to five was higher among women at 7.5% than men at 6.4%. For stages one to five, CKD prevalence rates were 11%, 15%, and 11% for high-, middle-and low-income nations, respectively. For CKD stages three to five, the corresponding prevalence rates were 6.8%, 6.7%, and 4.0%, respectively.
Stage-wise CKD prevalence estimates were 3%, 2.9%, 4.1%, 1.3%, 0.4%, and 0.1% for stages one, two, three, four, and five, respectively. The highest prevalence of CKD stages one through five was in Asia at 16%, whereas the highest prevalence of CKD stages three to five was in Oceania and Australia at 8.1%.
CKD stages one through five were least prevalent in Europe at 10%, whereas Africa had the lowest prevalence of CKD stages three to five at 5.7%. High-income nations had the lowest prevalence of CKD stages one to five at 11%, whereas low-income nations had the lowest prevalence of CKD stages three to five at 4%.
Conclusions
The current study highlights global CKD prevalence and disparities in prevalence estimates by age, socioeconomic status, and gender. Future studies must emphasize CKD screening and targeted interventions to improve healthcare accessibility, especially for middle ultimately- and low-income nations.
Age-specific interventions and understanding the reasons responsible for these disparities will help reduce the overall burden of CKD. Understanding factors like age, socioeconomic status, and gender, as well as outcomes like quality of life and mortality, can facilitate positive changes in global health.
*Important notice: Preprints with The Lancet publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
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