A Systematic Study of the Prevalence and Risk Factors of CKD in Uddanam, India

Abstract

Introduction Despite reports of a high prevalence of chronic kidney disease (CKD) from the coastal Uddanam region of Andhra Pradesh, India, there are no accurate data on the distribution of kidney function abnormalities and CKD risk factors in this region. Methods A total of 2419 participants were recruited through multistage cluster random sampling from 67 villages. Serum creatinine and urine protein creatinine ratio were measured using validated methodologies. All abnormal estimated glomerular filtration rate (eGFR) and urine protein creatinine ratio values were reconfirmed after 3 months. A range of sociodemographic factors were evaluated for their association with CKD using Poisson regression. Results Of 2402 eligible subjects (mean ± SD age, 45.67 ± 13.29 years; 51% female), 506 (21.07%) had CKD (mean ± SD age, 51.79 ± 13.12 years; 41.3% female). A total of 246 (10.24%) had eGFR <60 ml/min/1.73 m 2 , whereas 371 (15.45%) had an elevated urine protein creatinine ratio (>0.15 g/g). The poststratified estimates, adjusted for age and sex distribution of the region for CKD prevalence, are 18.7% (range, 16.4%–21.0%) overall and 21.3% (range, 18.2%–24.4% ) and 16.2% (range, 13.7%–18.8%) in men and women, respectively. Older age, male sex, tobacco use, hypertension, and family history of CKD were independently associated with CKD. Compared with those with higher eGFR, those with eGFR <60 ml/min/1.73m 2 were older, were more likely to be uneducated, manual laborers/farmers, or tobacco users, and were more likely to have hypertension, a family history of CKD, a diagnosis of heart disease, and a lower body mass index. Among those with low eGFR, there was no difference between those with urine protein creatinine ratio <0.15 or >0.15, except a lower frequency of males in the former. Conclusion We confirmed the high prevalence of CKD in the adult population of Uddanam. The cause was not apparent in a majority. Subjects with a low eGFR with or without elevated proteinuria were phenotypically distinct from those with proteinuria and preserved eGFR. Our data suggest the need to apply a population-based approach to screening and prevention and studies to understand the causes of CKD in this region.

Catastrophic Health Expenditure and Distress Financing Among Patients With Nondialysis Chronic Kidney Disease in Uddanam, India

“…However, a lot needs to be done to improve non-communicable disease (NCD) care. Our previous study had shown a 42% and 13% population prevalence of hypertension and diabetes, respectively, in the region in addition to the 21% CKD prevalence 5 . Most of these conditions were previously undiagnosed.…”

“…Our data are of policy relevance because almost one out of every five adult residents in the region has CKD 5 . The current focus of government spending on the care of patients with kidney disease is almost entirely on dialysis.…”

Chronic Kidney Disease of Unknown Etiology in India: What Do We Know and Where We Need to Go

“…The STOP-CKDu study also found a high (42%) prevalence of hypertension (33% recent/new onset) and proteinuria (A3 7%, A1-A2 8.4%). 15 Clusters with high CKD burden have also been reported from other districts in AP, in particular, Nalagonda, Prakasam and Nellore, suggesting this problem is likely more widespread than originally assumed. [16][17][18] The STOP-CKDu investigators are following up their cohort to estimate the incidence of CKD as well as the rate and risk factors of disease progression.…”

“…The published definitions CKDu developed for epidemiological purposes are used by clinicians to provide a quick label and cut-short patient work-up. Gummidi et al found widespread diagnostic and therapeutic nihilism, with most patients not undergoing even the basic diagnostic workup -only 10% of cases had even undergone renal ultrasound 15 . There are no published kidney biopsy studies on CKDu from India.…”

Seasonal Changes in Kidney Function in CKD of Uncertain Etiology

“…We have described a new CKDu hotspot -Tondaimandalam Nephropathy -from the northern coastal districts of Tamil Nadu, India 4 . The other CKDu hotspots from India include the Uddhanam, Andhra Pradesh and Narsinghpur and Badamba blocks of Odisha 5,6 . The changes in kidney function associated with seasons are often considered physiological and have not been extensively evaluated.…”