WASHINGTON, DC – The prevalence of chronic kidney disease (CKD) is higher in the United States than in Europe, partly because the incidence of risk factors like diabetes and obesity is higher in America than in most European countries, according to a Kidney Week 2019 presentation.

In contrast, blood pressure levels are lower in the U.S. than in Europe, said Kitty J. Jager MD, PhD, a professor of medical informatics and kidney epidemiology at Amsterdam University Medical Center in The Netherlands, during a talk on “CKD in the United States and Europe: Juxtaposing the Epidemiology and Evolution.”

The prevalence of CKD is determined by factors such as age, diabetes and hypertension, Jager said. In Western Europe, more than 20% of the population is over age 65, while in both the U.S. and Eastern Europe more than 60% of the population is over 65. Looking at presence of diabetes, North America and the Caribbean have a 50% higher diabetes prevalence than in Europe, according to the 2017 IDF Diabetes Atlas. Diabetes cases increased from 10-12% in the U.S. from 1999-2012¹, with the increase seen mainly in obese people. Comparing the U.S. and Europe, she said, diabetes is most prevalent in the U.S., Portugal and Turkey². Cases are rising to a lesser extent in countries like the United Kingdom, France and Romania, and diabetes is stable in Sweden, Norway and Germany. In all countries, diabetes is more common among males.

Regarding raised blood pressure, another risk factor for CKD, the situation is reversed, Jager said. Raised blood pressure is lower in the Americas than in Europe, according to World Health Organization data. European rates are variable, with countries in Eastern Europe having a higher prevalence. Average systolic blood pressure among Europeans is about 7 mmHg higher than in the U.S.³, and European physicians are more likely to prescribe renin-angiotensin-aldosterone system (RAAS) inhibitors, while American physicians are more likely to prescribe a range of antihypertensive medications including beta blockers.

Latitude could partly explain the geographical variation in blood pressure control, Jager noted. One study⁴ found that for each 10-degree increase in latitude, there was a 5 mmHg increase in systolic blood pressure. The center of Europe, near Strasbourg, is at 49 degrees latitude while the center of the U.S., around Kansas City, is at 39 degrees latitude, Jager said.

The Global Burden of Disease study⁵ found that from 1990-2016, crude CKD prevalence was lower in Western and Central Europe than in the United States, and highest in Eastern Europe. The drivers of change during that period include aging and population growth. Total CKD prevalence in the U.S. is 14.8%, and stages 3 to 5 make up 6.9% of that⁶, Jager said. Among diabetic patients, there appears to be a decrease of CKD in patients with albumin-creatinine ratios over 30, she said, whereas in hypertensive patients the adjusted CKD prevalence is stable. Europe has less systematic measurement of CKD prevalence, she noted, which happens occasionally and only in some countries. On a global level, the most important driver of CKD is diabetes, followed by hypertension, with a substantial contribution from glomerular nephritis, she said.

Finland, the United Kingdom and Iceland have performed the best in managing their burden of CKD, while the United States, Montenegro and Turkey have “the largest unrealized opportunity for improvement of CKD DALYs (disability-adjusted life years) that would be possible based on their place in the sociodemographic index,” Jager said. There is some variation across the states, she added. Rates of renal replacement therapy also are higher in the U.S. than in Europe.

Resources

1. Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. JAMA. 2015 Sep 8;314(10):1021-9. doi: 10.1001/jama.2015.10029.
2. WHO diabetes country profiles, 2016.
3. Alencar de Pinho N, Levin A, Fukagawa M, et al. Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease. Kidney Int. 2019 Oct;96(4):983-994. doi: 10.1016/j.kint.2019.04.032. Epub 2019 Jul 26.
4. Duranton F, Kramer A, Szwarc I, et al. Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease. Kidney Int. 2019 Oct;96(4):983-994. doi: 10.1016/j.kint.2019.04.032. Epub 2019 Jul 26.
5. Xie Y, Bowe B, Mokdad AH, et al. Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int. 2018 Sep;94(3):567-581. doi: 10.1016/j.kint.2018.04.011. Epub 2018 Aug 3.
6. 2018 USRDS Annual Data Report, Volume 1.