Chronic kidney disease in Asia: Protocol for a collaborative overview

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Chronic kidney disease (CKD) is an important cause of morbidity and mortality around the world. It has been suggested that the incidence and prevalence of CKD and end stage kidney disease (ESKD) will rise sharply in the coming decades, predominately in Asia.1 Individuals with CKD have a reduced life expectancy, and those who progress to end‐stage kidney disease (ESKD) have 20‐fold higher mortality rates compared with age‐ and sex‐matched individuals with normal kidney function.5 The rising number of patients initiating renal replacement therapy in most Asian countries1 is placing a substantial burden on healthcare systems.
During the past few decades, epidemiological studies have provided much valuable information about CKD, its progression to ESKD and its associations with complications such as anaemia, cardiovascular disease and mortality. Cross‐sectional data indicate that the prevalence of CKD in the general population varies between 6 and 20%.1 However, most of the evidence has been generated from studies conducted in European and North America and less evidence has been derived from Asian populations. Disease patterns and distribution of risk factors differ markedly in many Asian compared to non‐Asian populations, as well as varying substantially within the region itself (for example, regional variations in the incidence of IgA nephropathy, CKD secondary to herbal therapy and of undetermined aetiology, lower blood cholesterol and body mass index, younger age of onset, among others).12 Even less is known about the factors that determine progression and development of complications amongst subjects with CKD in the region. Therefore, it is imperative that information specific to Asian populations is collected and analyzed to improve our understanding of the challenges, in order to more effectively manage this complex condition in the region.
Collaborative overviews (with meta‐analysis where appropriate), in which data from a number of observational studies are combined,17 provide useful information additional to that provided by the studies individually. The large number of participants will also facilitate discernment of important differences in the magnitude of associations between disease stages, geographical regions, and between patient subgroups.
The Asian Renal Collaboration (ARC) has been set up to enable these analyses using (where possible) individual participant data from observational studies or other sources, such as registries, in Asia on a broad range of risk factors and clinical outcomes. The main objectives of this project are to obtain information from a large number of subjects about the prevalence, manifestations and risk factors of CKD in Asia. Additionally, this study aims to provide insight into important clinical endpoints including progression of CKD, CKD complications such as anaemia, cardiovascular disease, mineral and bone disorder and mortality. It may be possible to produce estimates of the likely eventual effects on CKD of exposure levels of risk factors. Furthermore, we may be able to estimate the impact of initiatives aiming to prevent CKD progression and/or its complications including cardiovascular disease.” This report describes the protocol for the ARC project.
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