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American Journal of Kidney Diseases

Trends in Albuminuria and GFR Among Adolescents in the United States, 1988-2014

      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 (< 60 mL/min/1.73 m2) and reduced (< 90 mL/min/1.73 m2) eGFRs.

      Analytical Approach

      Outcomes defined as persistent albumin-creatinine ratio ≥ 30 mg/g (persistent albuminuria), eGFR < 90 mL/min/1.73 m2 (reduced kidney function), and eGFR < 60 mL/min/1.73 m2 (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.

      Index Words

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      Linked Article

      • CKD in Children: The Importance of a National Epidemiologic Study
        American Journal of Kidney DiseasesVol. 72Issue 5
        • Preview
          Chronic kidney disease (CKD) is a global health issue of epidemic proportions and the adverse effects on quality of life, cardiovascular health, and increased mortality in particular create a substantial burden on health care systems.1 In contrast to the adult population, very little is known about the epidemiology of CKD in children, especially in the United States. Although the US Renal Data System (USRDS) tracks end-stage renal disease (ESRD) data in children and adolescents, there is no obligatory national registry for CKD in the pediatric population.
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