• Sharon H Saydah, Hui Xie, Giuseppina Imperatore, Nilka Ríos Burrows, and Meda E Pavkov.
• Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
• Am. J. Kidney Dis. 2018 Nov 1; 72 (5): 644-652.

Rationale & ObjectiveAlbuminuria and low estimated glomerular filtration rate (eGFR) define chronic kidney disease in adults and youth. Different from adults, the burden of abnormal kidney markers among youth in the general United States population is largely unknown.Study DesignSerial cross-sectional national surveys.Setting & ParticipantsAdolescents aged 12 to 18 years participating in the National Health and Nutrition Examination Surveys 1988 to 2014. Surveys were grouped into three 6-year periods.PredictorsDemographic and clinical determinants of kidney markers.OutcomePrevalence and trends in persistent albuminuria, low (< 60mL/min/1.73m2) and reduced (< 90mL/min/1.73m2) eGFRs.Analytical ApproachOutcomes defined as persistent albumin-creatinine ratio ≥ 30mg/g (persistent albuminuria), eGFR < 90mL/min/1.73m2 (reduced kidney function), and eGFR < 60mL/min/1.73m2 (low kidney function). Multiple imputation analysis was used to estimate missing follow-up values of albuminuria.ResultsPrevalences of persistent albuminuria were 3.64% (95% CI, 1.82%-5.46%) in 1988-1994 and 3.29% (95% CI, 1.94%-4.63%) in 2009-2014 (adjusted prevalence ratio, 0.93; 95% CI, 0.53-1.62; P=0.8 for trend). Prevalences of reduced eGFR were 31.46% (95% CI, 28.42%-34.67%) and 34.58% (95% CI, 32.07%-37.18%), respectively (adjusted prevalence ratio, 1.21; 95% CI, 1.00-1.46; P < 0.001 for trend). Prevalences of low eGFR were 0.32% (95% CI, 0.12%-0.84%) in 1988-1994 and 0.91% (95% CI, 0.58%-1.42%) in 2009-2014 (adjusted prevalence ratio, 3.10; 95% CI, 1.10-9.01; P = 0.09 for trend). Prevalences of albuminuria and/or low eGFR remained at 4.0% in 1988-1994 and 2009-2014 (adjusted prevalence ratio, 1.06; 95% CI, 0.64-1.77; P = 0.8 for trend).LimitationsPersistent albuminuria data were based on imputed values (for second assessment of albuminuria) in 91% of participants; lack of second eGFR assessment to confirm sustained reduction in kidney function.ConclusionsAlbuminuria prevalence has not changed significantly in the US adolescent population between 1988 and 2014. Prevalences of both reduced and low eGFRs were higher in the most recent study period; however, < 1% of adolescents had low eGFRs.Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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