Introduction: The burden of chronic kidney disease (CKD) is growing rapidly around the world. However, there is limited information on the overall regional prevalence of CKD, as well as the variations in national prevalence within Asia. We aimed to consolidate available data and quantify estimates of the CKD burden in this region.Methods: We systematically searched MEDLINE, Embase and Google Scholar for observational studies and contacted national experts to estimate CKD prevalence in countries of Asia (Eastern, Southern and South Eastern Asia). CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² or the presence of proteinuria. For countries without reported data, we estimated CKD prevalence using agglomerative average-linkage hierarchical clustering, based on country-level risk factors and random effects meta-analysis within clusters. Published CKD prevalence data were obtained for 16 countries (of the 26 countries in the region) and estimates were made for 10 countries.Results: There was substantial variation in overall and advanced (eGFR <30 mL/min/1.73 m²) CKD prevalence (range: 7.0%–34.3% and 0.1%–17.0%, respectively). Up to an estimated 434.3 million (95% CI 350.2 to 519.7) adults have CKD in Asia, including up to 65.6 million (95% CI 42.2 to 94.9) who have advanced CKD. The greatest number of adults living with CKD were in China (up to 159.8 million, 95% CI 146.6 to 174.1) and India (up to 140.2 million, 95% CI 110.7 to 169.7), collectively having 69.1% of the total number of adults with CKD in the region.Conclusion: The large number of people with CKD, and the substantial number with advanced CKD, show the need for urgent collaborative action in Asia to prevent and manage CKD and its complications.

Summary: Background and objectives: Hyperuricemia is an independent risk factor for mortality, cardiovascular disease, and renal disease in general population. However, the relationship between hyperuricemia with clinical outcomes in CKD remains controversial.Design, setting, participants, & measurements: The study investigated the association between uric acid with all-cause mortality, cardiovascular events, renal replacement therapy, and rapid renal progression (the slope of estimated GFR was less than −6 ml/min per 1.73 m²/y) in 3303 stages 3–5 CKD patients that were in the integrated CKD care system in one medical center and one regional hospital in southern Taiwan.Results: In all subjects, the mean uric acid level was 7.9±2.0 mg/dl. During a median 2.8-year follow-up, there were 471 (14.3%) deaths, 545 (16.5%) cardiovascular events, 1080 (32.3%) participants commencing renal replacement therapy, and 841 (25.5%) participants with rapid renal progression. Hyperuricemia increased risks for all-cause mortality and cardiovascular events (the adjusted hazard ratios for quartile four versus quartile one of uric acid [95% confidence interval] were 1.85 [1.40–2.44] and 1.42 [1.08–1.86], respectively) but not risks for renal replacement therapy (0.96 [0.79–1.16]) and rapid renal progression (1.30 [0.98–1.73]).Conclusions: In stages 3–5 CKD, hyperuricemia is a risk factor for all-cause mortality and cardiovascular events but not renal replacement therapy and rapid renal progression.

Background. Glomerular filtration rate (GFR) and co-morbidity at dialysis initiation in relation to mortality in end-stage renal disease is still controversial. We studied factors potentially related to the mortality in incident haemodialysis (HD) patients.

Background. Quality of life (QOL) may be associated with morbidity and survival in end-stage renal disease (ESRD), and is considered to be an important outcome measure for patients with chronic kidney disease (CKD). However, the prognostic role of QOL for survival in CKD remains unclear. We studied the relationship between QOL and risks of ESRD and mortality in CKD patients. Methods. From 1 January 2007 to 31 December 2007, we prospectively used the Taiwan version of World Health Organization Quality-of-Life Questionnaire (Taiwan version) (WHOQOL-BREF(TW)) with 568 CKD patients at a medical centre in southern Taiwan, and patients were followed up for 1–2 years after enrollment. The primary outcome was the time to dialysis or death. We used Kaplan–Meier curve and Cox proportional hazard model for survival analyses. Results. Of the 568 patients enrolled, 423 were able to complete the questionnaires, and their data were analysed. The median follow-up time was 410 days. Progressive decreases in scores of QOL in all domains were noted with decrease in eGFR. In unadjusted analysis, dialysis and death were associated with lower scores of total and all four domains of WHOQOL-BREF(TW). In adjusted analysis, the total scores and scores of both physical and psychological domains predicted dialysis and mortality (every 1-point decrease hazard ratio (HR): 1.050, 95% CI: 1.008–1.095, P = 0.020; HR: 1.179, CI: 1.033–1.346, P = 0.014; HR: 1.167, CI: 1.016–1.339, P = 0.028, respectively). The adjusted risks of ESRD and mortality also increased in patients in the lowest tertile of psychological domain (P < 0.01), and physical domain and total scores (P < 0.05). Conclusions. Physical, psychological and total scores of QOL are significantly correlated with increased risks of ESRD and death in CKD patients. QOL should be considered as an independent predictor of risks of ESRD and mortality.

Background/Aims: Taiwan has the highest incidence of end-stage renal disease, which requires renal replacement therapy. Chronic kidney disease (CKD) contributes to this burden. However, the current data on the epidemiologic features of CKD in Taiwan are incomplete. Therefore, we aimed to investigate the prevalence and incidence of CKD in a population-based study and then estimate the average dwelling time (ADT) in the main clinical burden of CKD (stages 3–5). Methods: A prospective cohort study was designed with an integrated community-based multiple screening program of 106,094 individuals aged ≥20 years in Keelung, Taiwan, in 1999–2009. Prevalence was estimated as the percentage of CKD stages among individuals attending the first screening, and incidence was expressed as the ratio of total desired events in the following period to the total observational time. Finally, ADT was estimated from the ratio of prevalence to incidence. Results: The participants’ mean age was 47.7 ± 15.4 years. The estimated prevalence was 15.46% for total CKD and 9.06% for CKD stages 3–5. The incidence was 27.21/1,000 person-years (PY) for total CKD and 16.89/1,000-PY for CKD stages 3–5. Older patients, males, and those patients with comorbidities of diabetes mellitus (DM), hypertension, and metabolic syndrome (MetS) exhibited higher prevalence and incidence rates than their opposing counterparts. Moreover, the ADT of CKD stages 3–5 was 5.37 years (95% CI 5.17–5.57). Males and those with comorbidities of DM or MetS had shorter ADTs in CKD stages 3–5 than their opposing counterparts. Interestingly, the ADT of participants with hypertension was longer than those without. Conclusions: The prevalence and incidence of CKD in Taiwan are high. Moreover, ADT in CKD stages 3–5 varied according to sex, age, and comorbidity. Further exploration of the factors associated with the shifting of this duration will shed light on effective CKD management.