Correspondence
n engl j med 375;9 nejm September 1, 2016
905
Trends in Chronic Kidney Dia in China
To the Editor: Diabetes is the leading cau of end-stage kidney dia worldwide, though glomerulonephritis has been the more predomi-nant cau in developing countries.1 We hypothe-sized that the surging prevalence of diabetes in developing countries may have a substantial ef-fect on the obrved spectrum of chronic kidney dia.
To evaluate trends in chronic kidney dia related to diabetes or to glomerulonephritis, we ud two resources — one that tracks hospital-ized persons and another that tracks the general population in China. To track hospitalized per-
sons, we ud the Hospital Quality Monitoring System, a mandatory patient-level national data-
ba for hospital accreditation, under the author-ity of the National Health and Family Planning Commission of the People’s Republic of China. We analyzed a data t of 35.3 million patients hospitalized in class 3 hospitals (which are simi-lar to tertiary hospitals but also provide primary of Dias and Related Health Problems, 10th Revision,were ud to extract cas of chronic kidney dis-ea related to diabetes and to glomerulonephri-to glomerulonephritis according to the patients’ medical history and laboratory test results.
In 2010, among hospitalized patients, the per-centage with chronic kidney dia related to diabetes was lower than the percentage with chronic kidney dia related to glomerulone-phritis (0.82% vs. 1.01%). Starting from 2011, the percentage with chronic kidney dia re-lated to diabetes exceeded the percentage with chronic kidney dia related to glomerulone-phritis, and the gap between them incread progressively (Fig. 1). In 2015, the percentage of the hospitalized population with chronic kidney dia related to diabetes and to glomerulone-phritis was 1.10% and 0.75%, respectively. In both 2010 and 2015, the percentage of hospital-Figure 1. Trends in Chronic Kidney Dia Related to Diabetes and to Glomerulonephritis among Hospitalized
P atients in China.The percentages shown were calculated among overall hospitalized patients in each year. The overall numbers of hospitalized patients for each year (numbers at risk) were obtained from the Hospital Quality Monitoring System, which is a mandatory patient-level national databa for hospital accreditation, under the authority of National Health and Family Planning Commission of the People’s Republic of China.
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0.66
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0.75
H o s p i t a l i z e d P a t i e n t s w i t h D i a b e t e s M e l l i t u s a n d C h r o n i c K i d n e y D i s e a s e (%)
H o s p i t a l i z e d P a t i e n t s w i t h C h r o n i c K i d n e y D i s e a s e R e l a t e d t o D i a b e t e s M e l l i t u s a n d t o G l o m e r u l o n e p h r i t i s (%)
12
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2011
2012
2013
2014
2015
Chronic kidney dia related to diabetes mellitus Chronic kidney dia related
to glomerulonephritis
Diabetes mellitus
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Chronic kidney dia
No. at Risk
596,857
165,771
252,240
8,948,853
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11,175,678
The New England Journal of Medicine
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Correspondence
n engl j med 375;9 nejm September 1, 2016
906
ized urban patients with chronic kidney dia related to diabetes was higher than that of hos-pitalized urban patients with chronic kidney dia related to glomerulonephritis, and the gap had incread by 2015 (1.02% vs. 0.84% in 2010 and 1.55% vs. 0.72% in 2015). However, among hospitalized rural patients during that same time frame, glomerulonephritis-related chronic kidney dia predominated, and the percent-age with chronic kidney dia related to diabe-tes was lower than the percentage with chronic kidney dia related to glomerulonephritis, though the gap had narrowed by 2015 (0.68% vs. 1.51% in 2010, and 0.76% vs. 0.95% in 2015).In the general population, the percentage with chronic kidney dia related to diabetes also exceeded the percentage with chronic kidney dia related to glomerulonephritis (1.23% vs. 0.91%). When stratified according to the area of residence, the percentage with chronic kidney dia related to diabetes surpasd the per-centage with chronic kidney dia related to glomerulonephritis among both urban and rural residents, though the gap was narrower among rural residents — 1.76% (95% confidence inter-val [CI], 1.61 to 1.93) vs. 0.84% (95% CI, 0.73 to 0.96) among urban residents, and 1.32% (95% CI, 1.17 to 1.47) vs. 0.89 (95% CI, 0.77 to 1.02%) among rural residents. Approximately 21.3% of the participants with diabetes were classified as having chronic kidney dia
in our study. Hence, on the basis of a study in 2013 that showed there were 113.9 million persons with diabetes in China,2 the estimated number of pa-tients with chronic kidney dia related to dia-betes in China was 24.3 million, of whom 60.5% have prerved kidney function with slightly in-cread albuminuria.
Our study indicates that chronic kidney dis-ea related to diabetes has become more com-mon than chronic kidney dia related to glomerulonephritis in both the general popula-tion and a hospitalized urban population in China, a finding that is preceded by decades of increasing prevalence of diabetes mellitus.3,4Luxia Zhang, M.D., M.P.H.
奥巴马视频Peking University First Hospital Beijing, China
Jianyan Long, M.Sc. Wenshi Jiang, M.Sc. Ying Shi, B.M.S.actualize
Xiangxiang He, M.Sc. Zhiye Zhou, M.S. Yanwei Li, B.Sc.
China Standard Medical Information Rearch Center Shenzhen, China
Roanne O. Yeung, M.D., M.P.H.
Chine University of Hong Kong Hong Kong, China
Jinwei Wang, Ph.D.
Peking University First Hospital Beijing, China
Kunihiro Matsushita, M.D., Ph.D. Jof Coresh, M.D., Ph.D.
Johns Hopkins Bloomberg School of Public Health Baltimore, MD
Ming-Hui Zhao, M.D.
Peking University First Hospital Beijing, China
Haibo Wang, M.B., B.S., M.P.H.
First Affiliated Hospital of Sun Yat-Sen University Guangzhou, China
haibo@mail.harvard.edu
Drs. Zhang and H. Wang contributed equally to this letter.Supported by the World Health Organization (WHO Refer-ence 2014/435380-0 and 2015/533939-0 for the China–World Health Organization Biennial Collaborative Projects 2014–2015), the Ministry of Science and Technology of
the People’s Repub-lic of China (the National Key Technology R&D Program, 2011BAI10B01), the Beijing Science and Technology Committee (Establishment of Early Diagnosis Pathway and Model for Evaluat-ing Progression of Chronic Kidney Dia, D131100004713007), and the National Health and Family Planning Commission of the People’s Republic of China.
Disclosure forms provided by the authors are available with the full text of this letter at NEJM.
1. B arsoum RS. Chronic kidney dia in the developing world. N Engl J Med 2006; 354: 997-9.
2. Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chine adults. JAMA 2013; 310: 948-59.
3. Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China. N Engl J Med 2010; 362: 1090-101.
4. Pan XR, Yang WY, Li GW, Liu J. Prevalence of diabetes and its risk factors in China, 1994. Diabetes Care 1997; 20: 1664-9.
DOI: 10.1056/NEJMc1602469
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