All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan

Chi Pang Wen, Ting Yuan David Cheng, Min Kuang Tsai, Yen Chen Chang, Hui Ting Chan, Shan Pou Tsai, Po Huang Chiang, Chih Cheng Hsu, Pei Kun Sung, Yi Hua Hsu, Sung Feng Wen

Research output: Contribution to journalArticle

Abstract

Background: Both end-stage renal disease and chronic kidney disease are increasing worldwide; however, the full effect of chronic kidney disease is unknown because mortality risks for all five stages are unavailable. We assessed prevalence and mortality risks for all stages of chronic kidney disease and quantified its attributable mortality in Taiwan. Methods: The cohort consisted of 462 293 individuals aged older than 20 years who participated in a standard medical screening programme since 1994. As of Dec 31, 2006, we identified 14 436 deaths. Chronic kidney disease was determined by glomerular filtration rate and urinary protein. We estimated national prevalence in Taiwan from the cohort by adjusting age and educational levels. Hazard ratios (HRs) were calculated with Cox proportionate hazards model. We calculated mortality attributable to chronic kidney disease for national population and for low socioeconomic status. Findings: The national prevalence of chronic kidney disease was 11·93% (95% CI 11·66-12·28), but only 3·54% (3·37-3·68) of participants in the cohort were aware of their disorder. Prevalence was substantially higher in the group with low socioeconomic status than in the high status group (19·87% [19·84-19·91] vs 7·33% [7·31-7·35]). 56 977 (12%) of cohort participants had chronic kidney disease; those with disease had 83% higher mortality for all cause (HR 1·83 [1·73-1·93]) and 100% higher for cardiovascular diseases (2·00 [1·78-2·25]), in a cohort that was observed for 13 years with median follow-up of 7·5 years (IQR 4·0-10·1). 10·3% (95% CI 9·57-11·03) of deaths in the entire population were attributable to chronic kidney disease, but 17·5% (16·27-18·67) of deaths in the low socioeconomic status population. 2350 (39%) deaths occurred before 65 years of age in those with chronic kidney disease. Regular users of Chinese herbal medicines had a 20% (odds ratio 1·20 [1·16-1·24]) increased risk of developing chronic kidney disease. Interpretation: The high prevalence of chronic kidney disease and its associated all-cause mortality, especially in people with low socioeconomic status, make reduction of this disorder a public-health priority. Promotion of its recognition through the general public knowing their glomerular filtration rate and testing their urine is crucial to reduce premature deaths from all causes and to attenuate this global epidemic. Funding: None.

Original languageEnglish (US)
Pages (from-to)2173-2182
Number of pages10
JournalThe Lancet
Volume371
Issue number9631
DOIs
StatePublished - 2008
Externally publishedYes

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Taiwan
Chronic Renal Insufficiency
Cohort Studies
Prospective Studies
Mortality
Social Class
Glomerular Filtration Rate
Population
Health Priorities
Premature Mortality
Herbal Medicine
Proportional Hazards Models
Chronic Kidney Failure
Cardiovascular Diseases
Public Health
Odds Ratio
Urine

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wen, C. P., Cheng, T. Y. D., Tsai, M. K., Chang, Y. C., Chan, H. T., Tsai, S. P., ... Wen, S. F. (2008). All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan. The Lancet, 371(9631), 2173-2182. https://doi.org/10.1016/S0140-6736(08)60952-6

All-cause mortality attributable to chronic kidney disease : a prospective cohort study based on 462 293 adults in Taiwan. / Wen, Chi Pang; Cheng, Ting Yuan David; Tsai, Min Kuang; Chang, Yen Chen; Chan, Hui Ting; Tsai, Shan Pou; Chiang, Po Huang; Hsu, Chih Cheng; Sung, Pei Kun; Hsu, Yi Hua; Wen, Sung Feng.

In: The Lancet, Vol. 371, No. 9631, 2008, p. 2173-2182.

Research output: Contribution to journalArticle

Wen, CP, Cheng, TYD, Tsai, MK, Chang, YC, Chan, HT, Tsai, SP, Chiang, PH, Hsu, CC, Sung, PK, Hsu, YH & Wen, SF 2008, 'All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan', The Lancet, vol. 371, no. 9631, pp. 2173-2182. https://doi.org/10.1016/S0140-6736(08)60952-6
Wen, Chi Pang ; Cheng, Ting Yuan David ; Tsai, Min Kuang ; Chang, Yen Chen ; Chan, Hui Ting ; Tsai, Shan Pou ; Chiang, Po Huang ; Hsu, Chih Cheng ; Sung, Pei Kun ; Hsu, Yi Hua ; Wen, Sung Feng. / All-cause mortality attributable to chronic kidney disease : a prospective cohort study based on 462 293 adults in Taiwan. In: The Lancet. 2008 ; Vol. 371, No. 9631. pp. 2173-2182.
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AU - Wen, Chi Pang

AU - Cheng, Ting Yuan David

AU - Tsai, Min Kuang

AU - Chang, Yen Chen

AU - Chan, Hui Ting

AU - Tsai, Shan Pou

AU - Chiang, Po Huang

AU - Hsu, Chih Cheng

AU - Sung, Pei Kun

AU - Hsu, Yi Hua

AU - Wen, Sung Feng

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N2 - Background: Both end-stage renal disease and chronic kidney disease are increasing worldwide; however, the full effect of chronic kidney disease is unknown because mortality risks for all five stages are unavailable. We assessed prevalence and mortality risks for all stages of chronic kidney disease and quantified its attributable mortality in Taiwan. Methods: The cohort consisted of 462 293 individuals aged older than 20 years who participated in a standard medical screening programme since 1994. As of Dec 31, 2006, we identified 14 436 deaths. Chronic kidney disease was determined by glomerular filtration rate and urinary protein. We estimated national prevalence in Taiwan from the cohort by adjusting age and educational levels. Hazard ratios (HRs) were calculated with Cox proportionate hazards model. We calculated mortality attributable to chronic kidney disease for national population and for low socioeconomic status. Findings: The national prevalence of chronic kidney disease was 11·93% (95% CI 11·66-12·28), but only 3·54% (3·37-3·68) of participants in the cohort were aware of their disorder. Prevalence was substantially higher in the group with low socioeconomic status than in the high status group (19·87% [19·84-19·91] vs 7·33% [7·31-7·35]). 56 977 (12%) of cohort participants had chronic kidney disease; those with disease had 83% higher mortality for all cause (HR 1·83 [1·73-1·93]) and 100% higher for cardiovascular diseases (2·00 [1·78-2·25]), in a cohort that was observed for 13 years with median follow-up of 7·5 years (IQR 4·0-10·1). 10·3% (95% CI 9·57-11·03) of deaths in the entire population were attributable to chronic kidney disease, but 17·5% (16·27-18·67) of deaths in the low socioeconomic status population. 2350 (39%) deaths occurred before 65 years of age in those with chronic kidney disease. Regular users of Chinese herbal medicines had a 20% (odds ratio 1·20 [1·16-1·24]) increased risk of developing chronic kidney disease. Interpretation: The high prevalence of chronic kidney disease and its associated all-cause mortality, especially in people with low socioeconomic status, make reduction of this disorder a public-health priority. Promotion of its recognition through the general public knowing their glomerular filtration rate and testing their urine is crucial to reduce premature deaths from all causes and to attenuate this global epidemic. Funding: None.

AB - Background: Both end-stage renal disease and chronic kidney disease are increasing worldwide; however, the full effect of chronic kidney disease is unknown because mortality risks for all five stages are unavailable. We assessed prevalence and mortality risks for all stages of chronic kidney disease and quantified its attributable mortality in Taiwan. Methods: The cohort consisted of 462 293 individuals aged older than 20 years who participated in a standard medical screening programme since 1994. As of Dec 31, 2006, we identified 14 436 deaths. Chronic kidney disease was determined by glomerular filtration rate and urinary protein. We estimated national prevalence in Taiwan from the cohort by adjusting age and educational levels. Hazard ratios (HRs) were calculated with Cox proportionate hazards model. We calculated mortality attributable to chronic kidney disease for national population and for low socioeconomic status. Findings: The national prevalence of chronic kidney disease was 11·93% (95% CI 11·66-12·28), but only 3·54% (3·37-3·68) of participants in the cohort were aware of their disorder. Prevalence was substantially higher in the group with low socioeconomic status than in the high status group (19·87% [19·84-19·91] vs 7·33% [7·31-7·35]). 56 977 (12%) of cohort participants had chronic kidney disease; those with disease had 83% higher mortality for all cause (HR 1·83 [1·73-1·93]) and 100% higher for cardiovascular diseases (2·00 [1·78-2·25]), in a cohort that was observed for 13 years with median follow-up of 7·5 years (IQR 4·0-10·1). 10·3% (95% CI 9·57-11·03) of deaths in the entire population were attributable to chronic kidney disease, but 17·5% (16·27-18·67) of deaths in the low socioeconomic status population. 2350 (39%) deaths occurred before 65 years of age in those with chronic kidney disease. Regular users of Chinese herbal medicines had a 20% (odds ratio 1·20 [1·16-1·24]) increased risk of developing chronic kidney disease. Interpretation: The high prevalence of chronic kidney disease and its associated all-cause mortality, especially in people with low socioeconomic status, make reduction of this disorder a public-health priority. Promotion of its recognition through the general public knowing their glomerular filtration rate and testing their urine is crucial to reduce premature deaths from all causes and to attenuate this global epidemic. Funding: None.

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