RESUMO
AIM: Assessment of chronic renal disease (CRD) prevalence and morbidity rate and approaches to early CRD in one of the regions of the RF (Tyva Republic). MATERIAL AND METHODS: A population study in the Tyva Republic performed from 01.07.2003 to 30.06.2004 included patients with glomerular filtration rate (GFR) < 30 ml/min, nephrosclerosis signs at autopsy, terminal GFR < 30 ml/min, on replacement renal therapy (RRT). CRD prevalence and morbidity were estimated (stage IV-V). Examination of 374 Tyva citizens was made for estimation of early CRD and risk factors of developing CRD (the sectional study). The participants of the sectional study were examined clinically and biochemically with measurement of albuminuria, calculation of urine albumin/creatinine (ACR) and study of some molecular-genetic characteristics. RESULTS: Prevalence of CRD stage IV-V in Tyva population was 493 cases per million, prevalence of RRT--126 cases per million. Elevated ACR was found in 4.7% of healthy subjects and 15.9% of hypertensive subjects. Initial lowering of GFR occurred in some healthy subjects and in 1 of 12 hypertensive patients. Significant predictors of albuminuria were serum albumin concentration (p < 0.00001), GFR (p < 0.0002), a male sex (p < 0.004), diabetes mellitus (DM) (p = 0.0057) and left ventricular myocardial mass index (p = 0.0253). GFR depended significantly on age (p < 0.000001), male sex (p < 0.000001), uric acid concentration in the serum (p < 0.000001), presence of DM (p = 0.000019), ACR (p = 0.0059), diastolic pressure (p = 0.0347), triglyceridemia (p = 0.0369). Citizens of Tyva had more frequently than citizens of other regions of Russia IlI-genotype of angiotensin 1-converting enzyme (ACE) (p < 0.0001), T-allele of methylentetrahydrofolatereductase (p < 0.0001), E3-allele of gene of apoprotein E (p < 0.0001). Prevalence of aa, ab, bb genotypes of eNO-synthetase was 82.3%, 15% and 2.7% in the group of Tyva examinees vs 62, 31 and 7% in European Russians (p < 0.01). CONCLUSION: Prevalence of both early and advanced stages of CRD among population of Tyva Republic is rather high. CRD morbidity may depend, besides conventional risk factors, some genetic specific features. Screening studies require continuation for early detection of CRD and timely planning of therapeutic and preventive measures.
Assuntos
Falência Renal Crônica/epidemiologia , Feminino , Humanos , Incidência , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/genética , Masculino , Prevalência , Fatores de Risco , Sibéria/epidemiologiaRESUMO
AIM: To study epoidemiology of chronic renal disease (CRD) in the North-West region of the Russian Federation. MATERIAL AND METHODS: A population retrospective trial was performed from 01.07.98 to 30.06.99 in the Vologda region, towns Veliky Novgorod and Syktyvkar (total population 1840000). 490 cases of chronic renal failure (CRF) with creatinin levels > 300 mcmol/l corresponding to CRD stage IV and V by glomerular filtration rate were detected. CRD stage IV-V prevalence, morbidity including sex- and age-specific parameters, cumulative survival in different etiology of CRD regarding replacement therapy (RT) and nephrologist supervision were estimated. RESULTS: Mean prevalence and morbidity were 266 and 108 cases per million. Number of affected males and females was the same. CRD was provoked by chronic glomerulonephritis (CGN)--41%, chronic interstitional nephritis--16%, diabetes mellitus--14%, renal polycystic disease--8%, amyloidosis--6%, hypertension nephrosclerosis--2%, other causes--3%, cases of unclear etiology--10%. Among patients with primary renal pathology on RT, number of CGN patients was higher--61% while diabetic and amyloidosis shares were much lower 1.6 and 0.8%. 31.1% patients given no RT had Cr > 500 mcmol/l and glomerular filtration rate < 10 ml/min. Incidence of CRD stage IV-V in RT patients was 80 per million, 8 patients per million for 1 year started RT for the first time. CRF mortality was 85 patients per million a year. 88.4% of deaths in patients given no RT was due to uremia. Cumulative survival for RT patients and RT untreated was 90 and 50% a year, respectively. Survival of the RT untreated observed by the nephrologist was significantly higher (p = 0.003). CONCLUSION: New cases of CRD stage IV-V were comparable in number to European incidence rate while prevalence was much less because of lower number of old patients and RT treated. The problem of CRD treatment is urgent for RF and requires updating nephrological service and development of RT programs.
