Prevalence and Risk Factors for CKD: A Comparison Between the Adult Populations in China and the United States

Introduction: Chronic kidney disease (CKD) is an important noncommunicable disease globally. Overall prevalence of CKD and distribution of its stages differ between countries. We postulate that these differences may not only be due to variation in prevalence of risk factors but also their differential impact in different populations or settings. Methods: We used nationally representative data on the adult populations from both the United States (US; National Health and Nutrition Examination Survey [NHANES], 2009 to 2010, N = 5557) and China (China National Survey of CKD, 2009 to 2010, N = 46,949). Age, sex, central obesity, cardiovascular disease, diabetes, hypertension, and hyperuricemia were explored as candidate risk factors for CKD. The prevalence of CKD was calculated using survey weights. Results: The prevalence of decreased estimated glomerular filtration rate (eGFR), defined as eGFR < 60 ml/min per 1.73 m(2), was 6.5% in the US versus 2.7% in China, whereas the prevalence of albuminuria (defined as urine albumin to creatinine ratio of >= 30 mg/g) was 8.1% in the US versus 9.5% in China. The distribution of eGFR categories differed between the countries (P < 0.001). Stronger associations of diabetes with both indicators were seen in the US participants, whereas stronger associations of male sex with both indicators and of hypertension with albuminuria were observed in the Chinese participants (P< 0.05). After multivariable adjustment, a 65% change in prevalence difference for decreased eGFR was seen between China and the US. Conclusion: People in China and the US share many common risk factors for CKD, but differences in prevalence and the potential impact of these risk factors for CKD were observed.