Prevalence of chronic renal disease among Brazilian adults: a systematic review

Abstract Introduction Chronic kidney disease is a global public health issue but its prevalence in Brazil remains uncertain. Objective To estimate the prevalence of chronic kidney disease among Brazilian adults. Methods A systematic review through an electronic literature searches on MEDLINE, Embase, other databases plus microdata from national surveys. Two researchers selected, extracted data, and assessed the quality. Results We included 16 studies: national population-based using self-reported criteria found 4.57% (1998) to 1.43% (2013) prevalence; in those employing hypercreatininemia showed rate of 3.46% in Bambuí (1997) and 3.13% in Salvador (2000). Studies with non-representative samples employed clinical and laboratory criteria and showed higher prevalences: 6.26% in campaigns (2010), 8.94% in public employees (2010), 9.62% in private laboratory’s patients (2003), 27.20% in hospital (2013), and 1.35-10.64% in primary care (2011). Patients on dialysis represent 0.05% of the Brazilian population. Discussion Representative studies did not adequately assess the disease and investigations with better diagnostic criteria had convenience sampling. Heterogeneity across studies hampered the calculation of meta-analysis. Conclusion It was not possible to estimate the prevalence of chronic kidney disease patients in Brazil due to the heterogeneity of studies included in this review. The prevalence varied according to the diagnostic criteria employed among studies. Considering population criteria, 3-6 million people would have the disease. Roughly 100.000 receive dialysis in Brazil.

摘要：慢性肾脏病（Chronic Kidney Disease）是全球性公共卫生问题，但巴西的慢性肾脏病患病率仍不明确。
研究目的：估算巴西成人慢性肾脏病的患病率。
研究方法：本研究为系统综述，通过MEDLINE、Embase及其他数据库开展电子文献检索，并结合全国调查的微观数据。由两名研究人员独立完成文献筛选、数据提取及质量评价。
研究结果：共纳入16项研究。采用自我报告诊断标准的全国人群队列研究显示，患病率为1.43%（2013年）至4.57%（1998年）；采用高肌酐血症作为诊断标准的研究中，巴西Bambuí市（1997年）与Salvador市（2000年）的患病率分别为3.46%和3.13%。采用非代表性样本的研究采用临床与实验室诊断标准，患病率更高：2010年健康筛查活动中为6.26%，2010年公职人员队列中为8.94%，2003年私立实验室就诊患者中为9.62%，2013年住院患者中为27.20%，2011年基层医疗人群中为1.35%~10.64%。透析患者占巴西总人口的0.05%。
讨论：采用代表性抽样的研究未能对该病进行充分评估，而采用更优诊断标准的研究则采用了方便抽样法。研究间的异质性阻碍了Meta分析的开展。
结论：由于本综述纳入的研究存在异质性，无法准确估算巴西慢性肾脏病患者的总体患病率。不同研究中的患病率因所采用的诊断标准不同而存在差异。若以人群代表性研究的诊断标准估算，巴西约有300万至600万慢性肾脏病患者。巴西目前约有10万名透析患者。