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High Prevalence and Low Awareness of Chronic Kidney Disease in Family Members of Hemodialysis Patients in Southern Taiwan
Jui-Hsin Chen, Szu-Chia Chen, Jer-Chia Tsai, Shang-Jyh Hwang, Hung-Chun Chen
Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University Hospital and Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan.

Background:
According to USRDS report, Taiwan has the highest incidence and the second place of prevalence of end-stage renal disease (ESRD) in the world. Lack of early detection of chronic kidney disease (CKD) is one of the important causes. Previous reports have shown that family members of patients with ESRD are at increased risk for the development of CKD. However, little is known about the prevalence and awareness of CKD in this population in Taiwan. The aim of this study was to investigate the prevalence, awareness and associated risk factors for CKD in family members of patients with ESRD in Southern Taiwan.

Methods:
A screening program for CKD was performed amongst 291 family members (mean age: 44.9ｱ15.9 years old, 139 males and 152 females) of 182 hemodialysis patients in Southern Taiwan. All subjects underwent a clinical examination, dipstick testing for albuminuria (urine albumin-to-creatinine ratio ｳ 30 mg/g) and serum creatinine estimation. The glomerular filtration rate was calculated by Cockroft-Gault formula. Late CKD was defined as a GFR less than 60 mL/min/1.73 m2. Risk factors related to CKD were also studied.

Results:
The prevalence of late CKD and albuminuria in these family members of ESRD were 13.4% and 17.5%, respectively; both were significantly higher than that in general population. Older age, diabetes mellitus, hypertension, and hyperuricemia (serum uric acid > 7 mg/dl) were significantly associated with late CKD. Awareness rates for CKD were low (15.4%) and was higher in those with serum creatinine > 1.8 mg/dl.

Conclusions:
Our study demonstrates higher prevalence and low awareness of late CKD and albuminuria among family members of patients with ESRD. Associated factors, like hypertension, diabetes mellitus, hyperuricemia, and older age may act as important factors contributing to the development of CKD. Periodic screening for kidney disease should be recommended and education about familial aggregation of ESRD should be offered to family members of those with ESRD in high prevalent area of South Taiwan.