Original Investigation
Pathogenesis and Treatment of Kidney Disease
Epidemiological Features of CKD in Taiwan

https://doi.org/10.1053/j.ajkd.2006.10.007Get rights and content

Background

The incidence of end-stage renal disease (ESRD) in Taiwan is the highest in the world. However, epidemiological features of earlier chronic kidney disease (CKD) have not been investigated.

Methods

Since implementation of the National Health Insurance Program in 1995, more than 96% of the population in Taiwan has been enrolled. A nationally representative cohort of 200,000 individuals randomly sampled from the National Health Insurance enrollees was followed up from 1996 to 2003. Clinical conditions were defined by using diagnostic codes. The prevalence and incidence of clinically recognized CKD were assessed. We also identified risk factors associated with the development of CKD.

Results

The prevalence of clinically recognized CKD increased from 1.99% in 1996 to 9.83% in 2003. The overall incidence rate during 1997 to 2003 was 1.35/100 person-years. The multivariate model indicates that age is a key predictor of CKD, with an odds ratio of 13.95 for the group aged 75-plus years compared with the group younger than 20 years. Other factors associated with increased risk for the development of CKD include diabetes, hypertension, hyperlipidemia, and female sex.

Conclusion

The prevalence and incidence of CKD in Taiwan are relatively high compared with other countries. Our finding provides a reasonable explanation for the subsequent epidemic of ESRD in Taiwan. Further study is needed to identify the entire burden of CKD and the effectiveness of risk-factor modification.

Section snippets

Study Population

All contracted medical institutions must submit standard claim documents for medical expenses on a computerized form that includes dates of visit and discharge, identification number, sex, birthday, diagnostic code, prescription drugs dispensed, and so on.

In cooperation with the Bureau of NHI, the National Health Research Institute randomly sampled a representative database from the entire database by means of a systematic sampling method for use in health insurance–related studies. The size of

Results

Table 1 lists demographic characteristics of the 176,365 enrolled study group participants and the nationwide population in 1996. There are no differences in demographic characteristics between these 2 groups. Outcomes of the study population are shown in Fig 1. There were 18,779 and 599 individuals identified as CKD and ESRD cases during the 8-year study period, respectively. Of 171,769 individuals initially not diagnosed as CKD/ESRD cases in 1996, a total of 15,271 (8.89%) and 294 (0.17%)

Discussion

Most epidemiological studies of renal disease focused on ESRD, rather than the early stage of CKD. Because of the increasing burden on health care resources of ESRD and the preventable nature of CKD, it is imperative to shift the emphasis of the approach to renal disease from treatment of ESRD to early detection and prevention of CKD.

CKD prevalence has been estimated in other countries,4, 9, 10, 11, 12, 13, 14 all of which were surveys of only adults. Prospective studies focusing on the

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    Originally published online as doi:10.1053/j.ajkd.2006.10.007 on November 28, 2006.

    This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health, and managed by National Health Research Institute. The interpretation and conclusions contained herein do not represent those of Bureau of National Health Insurance, Department of Health, or National Health Research Institute.

    Support: None. Potential conflicts of interest: None.

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