Prevalence of Albuminuria in the U.S. Adult Population Over the age of 40: Results from the National Health and Nutrition Examination Survey (1999-2008)

摘要

Introduction. Albuminuria, defined as either microalbuminuria with an Albumin to Creatinine Ratio (ACR) ratio of 30 – 300 or macroalbuminuria with an ACR ratio > 300, is accepted as a risk factor for the progression of chronic kidney disease and for cardiovascular disease. The purpose of this study was to examine the prevalence of albuminuria in the United States general population in total and by ethnicity over the age of 40 using the 1999-2008 National Health and Nutrition Examination Surveys. The relationship of hypertension, diabetes and metabolic syndrome to albuminuria with age will be reviewed. The effect of age on prevalence of albuminuria will also be demonstrated.Results: Overall the prevalence of microalbuminuria in U.S. adults 40 years of age and older was 9.8% and the prevalence of macroalbuminuria was 1.7%. The prevalence of albuminuria is highest in patients with diabetes, a history of cardiovascular disease, obesity, and metabolic syndrome. While the prevalence of albuminuria does not differ by males or females in total, there is a difference with females > males in the fourth decade, males > females in the fifth and sixth decades, and then becoming equal with age > 70 years old. Albuminuria is higher in non Hispanic (NH) Black than either Hispanic or NH White.Conclusion: The NHANES surveys provide a national estimate of the prevalence of albuminuria of nearly 7% in 40-49 year old US adults to 24% in 70+ year old US adults. As the US population ages, the implications of increased prevalence of obesity combined with increased proteinuria has profound implications for the healthcare system in the US - patients, providers, insurance companies, and policy makers. With greater implications is the increased risk of albuminuria across all age groups in the NH Black population. This seems to correlate with the increased cardiovascular risk in this population. The presence of metabolic syndrome seems to have a synergistic effect on increasing the prevalence of albuminuria. This data supports the need to promote increased utilization of albuminuria screening in these high risk populations. Introduction Chronic kidney disease (CKD) is rapidly evolving into a public health problem in the United States. The ever-increasing prevalence of obesity, hypertension and type 2 diabetes mellitus is influencing the rise of chronic kidney disease (CKD) in the United States. Markers of kidney damage typically used to evaluate CKD are a urine albumin-creatinine ratio or a decreased estimated Glomerular filtration rate (eGFR) and the assessment of albuminuria or proteinuria, a creatinine-normalized urinary ratio for albumin or total protein. Both albuminuria and decreased eGFR are linked to an increased risk of kidney failure and risk of fatal and nonfatal cardiovascular disease (1-7).The goal of the present study was to examine the prevalence of proteinuria in the adult U.S. population over the age of 40 by gender, race/ethnicity, obesity, diabetes, hypertension, history of cardiovascular disease and the metabolic syndrome. Methods and Materials The National Health and Nutrition Examination Survey (NHANES) is a nationally representative survey of the U.S. civilian non-institutionalized population conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. Since 1999, NHANES has conducted continuous interviews and physical examinations. This study is based on ten years (1999-2008) of the continuous NHANES data.NHANES participants are interviewed in their homes to obtain information on health history, health behaviors, and risk factors. Those participants then undergo a detailed physical examination, laboratory studies and additional interviews were performed at a mobile examination center (MEC). The procedures followed to select the representative sample and conduct the interview and examinations are carefully outlined in the National Center for Health Statistics Analytic Guidelines and infor