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Trends in Albuminuria and GFR Among Adolescents in the United States, 1988-2014.
Am J Kidney Dis. 2018 11; 72(5):644-652.AJ

Abstract

RATIONALE & OBJECTIVE

Albuminuria and low estimated glomerular filtration rate (eGFR) define chronic kidney disease in adults and youth. Different from adults, the burden of abnormal kidney markers among youth in the general United States population is largely unknown.

STUDY DESIGN

Serial cross-sectional national surveys.

SETTING & PARTICIPANTS

Adolescents aged 12 to 18 years participating in the National Health and Nutrition Examination Surveys 1988 to 2014. Surveys were grouped into three 6-year periods.

PREDICTORS

Demographic and clinical determinants of kidney markers.

OUTCOME

Prevalence and trends in persistent albuminuria, low (< 60mL/min/1.73m2) and reduced (< 90mL/min/1.73m2) eGFRs.

ANALYTICAL APPROACH

Outcomes defined as persistent albumin-creatinine ratio ≥ 30mg/g (persistent albuminuria), eGFR < 90mL/min/1.73m2 (reduced kidney function), and eGFR < 60mL/min/1.73m2 (low kidney function). Multiple imputation analysis was used to estimate missing follow-up values of albuminuria.

RESULTS

Prevalences of persistent albuminuria were 3.64% (95% CI, 1.82%-5.46%) in 1988-1994 and 3.29% (95% CI, 1.94%-4.63%) in 2009-2014 (adjusted prevalence ratio, 0.93; 95% CI, 0.53-1.62; P=0.8 for trend). Prevalences of reduced eGFR were 31.46% (95% CI, 28.42%-34.67%) and 34.58% (95% CI, 32.07%-37.18%), respectively (adjusted prevalence ratio, 1.21; 95% CI, 1.00-1.46; P < 0.001 for trend). Prevalences of low eGFR were 0.32% (95% CI, 0.12%-0.84%) in 1988-1994 and 0.91% (95% CI, 0.58%-1.42%) in 2009-2014 (adjusted prevalence ratio, 3.10; 95% CI, 1.10-9.01; P = 0.09 for trend). Prevalences of albuminuria and/or low eGFR remained at 4.0% in 1988-1994 and 2009-2014 (adjusted prevalence ratio, 1.06; 95% CI, 0.64-1.77; P = 0.8 for trend).

LIMITATIONS

Persistent albuminuria data were based on imputed values (for second assessment of albuminuria) in 91% of participants; lack of second eGFR assessment to confirm sustained reduction in kidney function.

CONCLUSIONS

Albuminuria prevalence has not changed significantly in the US adolescent population between 1988 and 2014. Prevalences of both reduced and low eGFRs were higher in the most recent study period; however, < 1% of adolescents had low eGFRs.

Authors+Show Affiliations

Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA. Electronic address: mpavkov@cdc.gov.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30017204

Citation

Saydah, Sharon H., et al. "Trends in Albuminuria and GFR Among Adolescents in the United States, 1988-2014." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 72, no. 5, 2018, pp. 644-652.
Saydah SH, Xie H, Imperatore G, et al. Trends in Albuminuria and GFR Among Adolescents in the United States, 1988-2014. Am J Kidney Dis. 2018;72(5):644-652.
Saydah, S. H., Xie, H., Imperatore, G., Burrows, N. R., & Pavkov, M. E. (2018). Trends in Albuminuria and GFR Among Adolescents in the United States, 1988-2014. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 72(5), 644-652. https://doi.org/10.1053/j.ajkd.2018.04.021
Saydah SH, et al. Trends in Albuminuria and GFR Among Adolescents in the United States, 1988-2014. Am J Kidney Dis. 2018;72(5):644-652. PubMed PMID: 30017204.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in Albuminuria and GFR Among Adolescents in the United States, 1988-2014. AU - Saydah,Sharon H, AU - Xie,Hui, AU - Imperatore,Giuseppina, AU - Burrows,Nilka Ríos, AU - Pavkov,Meda E, Y1 - 2018/07/14/ PY - 2017/12/20/received PY - 2018/04/19/accepted PY - 2018/7/19/pubmed PY - 2019/9/5/medline PY - 2018/7/19/entrez KW - Adolescent KW - National Health and Nutrition Examination Surveys (NHANES) KW - United States KW - albumin-creatinine ratio (ACR) KW - albuminuria KW - albuminuria persistence KW - chronic kidney disease (CKD) KW - estimated glomerular filtration rate (eGFR) KW - kidney function KW - kidney markers KW - nationally representative population KW - population-based study KW - prevalence estimate KW - teenaged KW - youth SP - 644 EP - 652 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 72 IS - 5 N2 - RATIONALE & OBJECTIVE: Albuminuria and low estimated glomerular filtration rate (eGFR) define chronic kidney disease in adults and youth. Different from adults, the burden of abnormal kidney markers among youth in the general United States population is largely unknown. STUDY DESIGN: Serial cross-sectional national surveys. SETTING & PARTICIPANTS: Adolescents aged 12 to 18 years participating in the National Health and Nutrition Examination Surveys 1988 to 2014. Surveys were grouped into three 6-year periods. PREDICTORS: Demographic and clinical determinants of kidney markers. OUTCOME: Prevalence and trends in persistent albuminuria, low (< 60mL/min/1.73m2) and reduced (< 90mL/min/1.73m2) eGFRs. ANALYTICAL APPROACH: Outcomes defined as persistent albumin-creatinine ratio ≥ 30mg/g (persistent albuminuria), eGFR < 90mL/min/1.73m2 (reduced kidney function), and eGFR < 60mL/min/1.73m2 (low kidney function). Multiple imputation analysis was used to estimate missing follow-up values of albuminuria. RESULTS: Prevalences of persistent albuminuria were 3.64% (95% CI, 1.82%-5.46%) in 1988-1994 and 3.29% (95% CI, 1.94%-4.63%) in 2009-2014 (adjusted prevalence ratio, 0.93; 95% CI, 0.53-1.62; P=0.8 for trend). Prevalences of reduced eGFR were 31.46% (95% CI, 28.42%-34.67%) and 34.58% (95% CI, 32.07%-37.18%), respectively (adjusted prevalence ratio, 1.21; 95% CI, 1.00-1.46; P < 0.001 for trend). Prevalences of low eGFR were 0.32% (95% CI, 0.12%-0.84%) in 1988-1994 and 0.91% (95% CI, 0.58%-1.42%) in 2009-2014 (adjusted prevalence ratio, 3.10; 95% CI, 1.10-9.01; P = 0.09 for trend). Prevalences of albuminuria and/or low eGFR remained at 4.0% in 1988-1994 and 2009-2014 (adjusted prevalence ratio, 1.06; 95% CI, 0.64-1.77; P = 0.8 for trend). LIMITATIONS: Persistent albuminuria data were based on imputed values (for second assessment of albuminuria) in 91% of participants; lack of second eGFR assessment to confirm sustained reduction in kidney function. CONCLUSIONS: Albuminuria prevalence has not changed significantly in the US adolescent population between 1988 and 2014. Prevalences of both reduced and low eGFRs were higher in the most recent study period; however, < 1% of adolescents had low eGFRs. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/30017204/Trends_in_Albuminuria_and_GFR_Among_Adolescents_in_the_United_States_1988_2014_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(18)30707-8 DB - PRIME DP - Unbound Medicine ER -