NDT Advance Access originally published online on January 3, 2006
Nephrology Dialysis Transplantation 2006 21(4):935-944; doi:10.1093/ndt/gfk021
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Clinical Nephrology
Prevalence of renal impairment and its association with cardiovascular risk factors in a general population: results of the Swiss SAPALDIA study
1 Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK, 2 Institute of Social and Preventive Medicine, University of Basel, 3 Institute of Clinical Chemistry, University Hospital Zurich, 4 Division of General Internal Medicine and Cardiology Division, University Hospitals, Geneva, 5 Service of Pulmonology, University Hospital of Lausanne, CHUV, 6 Centre Valaisan de Pneumonology, Montana, 7 Zuercher Hoehenklinik, Wald, 8 Hirslanden Hospital, Aarau, 9 Pulmonology Service, University Hospitals, Geneva and 10 Molecular Epidemiology/Cancer Registry, Institute of Social and Preventive Medicine/Department of Pathology, University of Zurich, Switzerland
Correspondence and offprint requests to: Dorothea Nitsch, Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Email: Dorothea.Nitsch{at}lshtm.ac.uk
Background. Impaired renal function is evolving as an independent marker of the risk of cardiovascular morbidity and mortality. Little is known about the prevalence of impaired renal function and its relationship to cardiovascular risk factors in the Swiss general population.
Methods. SAPALDIA comprises a random sample of the Swiss population established in 1991, originally to investigate the health effects of long-term exposure to air pollution. Participants were reassessed in 2002/3 and blood measurements were obtained (n = 6317). Renal function was estimated using the Cockcroft–Gault equation and the modified MDRD (four-component) equation incorporating age, race, gender and serum creatinine level.
Results. The estimated prevalence of impaired renal function [estimated glomerular filtration rate <60 ml/min/1.73 m2] differed substantially between men and women, particularly at higher ages, and amounted to 13% [95% confidence interval (CI) 10–16%] and 36% (95% CI 32–40%) in men and women, respectively, of 65 years or older. Smoking, obesity, blood lipid levels, high systolic blood pressure and hyperuricaemia were all more common in men when compared with women. These cardiovascular risk factors were also associated independently with creatinine in both women and men. Women were less likely to receive cardiovascular drugs, in particular angiotensin-converting enzyme inhibitors and ß-blockers, when compared with men of the same age.
Conclusion. Moderate renal impairment seems to be prevalent in the general population, with an apparent excess in females which is not explained by conventional cardiovascular risk factors. The unexpected finding questions the validity of the prediction equations, in particular in females.
Keywords: cardiovascular risk; cross-sectional survey; diabetes; general population; prevalence; renal impairment
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