Chronic kidney disease hotspots in developing countries in South Asia

Abstract

In many developing countries in the South Asian region, screening for chronic diseases in the community has shown a widely varying prevalence. However, certain geographical regions have shown a high prevalence of chronic kidney disease (CKD) of unknown etiology. This predominantly affects the young and middle-aged population with a lower socioeconomic status. Here, we describe the hotspots of CKD of undiagnosed etiology in South Asian countries including the North, Central and Eastern provinces of Sri Lanka and the coastal region of the state of Andhra Pradesh in India. Screening of these populations has revealed cases of CKD in various stages. Race has also been shown to be a factor, with a much lower prevalence of CKD in whites compared to Asians, which could be related to the known influence of ethnicity on CKD development as well as environmental factors. The difference between developed and developing nations is most stark in the realm of healthcare, which translates into CKD hotspots in many regions of South Asian countries. Additionally, the burden of CKD stage G5 remains unknown due to the lack of registry reports, poor access to healthcare and lack of an organized chronic disease management program. The population receiving various forms of renal replacement therapy has dramatically increased in the last decade due to better access to point of care, despite the disproportionate increase in nephrology manpower. In this article we will discuss the nephrology care provided in various countries in South Asia, including India, Bangladesh, Pakistan, Nepal, Bhutan, Sri Lanka and Afghanistan.

A clinico-epidemiological study of cutaneous changes in chronic kidney disease

“…Uraemic foetor is an ammoniacal odour attributable to the breakdown of urea in saliva to ammonia. Though uraemic foetor has been reported in 8 to 16.7% patients in some studies [6,8] we did not observe any patient with uraemic fetor in our study. The specific dermatoses of CKD that were not observed in the present study include bullous dermatoses, calcific uraemic arteriolopathy and nephrogenic systemic fibrosis.…”

“…1 In developing countries CKD primarily affects the young and the middle aged with limited access to renal replacement and hence the burden of the disease is considerable higher. 6 In the present study the age of the patients ranged between 18 and 78 years the highest prevalence being in the 40 to 49 years age group.…”

“…6 In an epidemiological study in Delhi and its surrounding areas the burden of CKD was found to be 13.3% as compared to a study near Shimoga, Karnataka in which the burden of CKD was found to be 16.54 % by the Cockcroft Gault (CG) equation. 1,7 Data from these CKD epidemiological studies however is unreliable due to the absence of equations validated for the South Asian population.…”

Glomerulonephritis Contributing to Chronic Kidney Disease

“…It is reported to be around 10-15% worldwide, with a sharp increase in Asian countries [2][3][4][5]. CKD is associated with increased mortality, impaired quality of life, and most importantly, increased healthcare expenditures [6][7][8][9][10].…”

Chronic Kidney Disease in India

“…Large numbers of patients below the poverty line, low gross domestic product, and low monetary allocations for health care have led to suboptimal outcomes. Moreover, CKD and other noncommunicable diseases have often been ignored in the face of persistent challenges from and competition for resources for communicable diseases and high infant and maternal mortality (1).…”