Population Estimates of GFR and Risk Factors for CKD in Guatemala

Abstract

Introduction Chronic kidney disease (CKD) is an emerging public health priority in Central America. However, data on the prevalence of CKD in Guatemala, Central America’s most populous country, are limited, especially for rural communities. Methods We conducted a population-representative survey of 2 rural agricultural municipalities in Guatemala. We collected anthropometric data, blood pressure, serum and urine creatinine, glycosylated hemoglobin, and urine albumin. Sociodemographic, health, and exposure data were self-reported. Results We enrolled 807 individuals (63% of all eligible, 35% male, mean age 39.5 years). An estimated 4.0% (95% confidence interval [CI] 2.4–6.6) had CKD, defined as an estimated glomerular filtration rate (eGFR) less than 60 ml/min per 1.73 m 2 . Most individuals with an eGFR below 60 ml/min per 1.73 m 2 had diabetes or hypertension. In multivariable analysis, the important factors associated with risk for an eGFR less than 60 ml/min per 1.73 m 2 included a history of diabetes or hypertension (adjusted odds ratio [aOR] 11.21; 95% CI 3.28–38.24), underweight (body mass index [BMI] <18.5) (aOR 21.09; 95% CI 2.05–217.0), and an interaction between sugar cane agriculture and poverty (aOR 1.10; 95% CI 1.01–1.19). Conclusions In this population-based survey, most observed CKD was associated with diabetes and hypertension. These results emphasize the urgent public health need to address the emerging epidemic of diabetes, hypertension, and CKD in rural Guatemala. In addition, the association between CKD and sugar cane in individuals living in poverty provides some circumstantial evidence for existence of CKD of unknown etiology in the study communities, which requires further investigation.

Indexing Estimates of GFR to Body Surface Area in Low-Resource Settings With a High Burden of Malnutrition: Evidence From Guatemala

“…Full details of the sample have previously been published, and additional analysis is included in the Supplementary Methods. 9 We first compared the distribution of height, weight, body mass index, and BSA data from our sample as compared with the original CKD-EPI development cohort. 1 There were marked differences in baseline anthropometrics.…”

“…Next, we evaluated the impact of deindexing on the Kidney Disease Improving Global Outcomes kidney disease risk map including both individuals with and without established CKD, comparing the percentage of individuals falling into each risk category (Supplementary Figure S1). 9 For the original CKD-EPI equation, 3.3% of individuals were classified as stage G3a or higher and 19.5% as stage G2. After deindexing for BSA, these proportions increased to 6.6% and 33.5%, respectively (Supplementary Figure 1A).…”

“…8 In this brief research report, we assessed the impact of deindexing BSA on eGFR estimates obtained with the CKD-EPI equation in a population-representative sample from rural Guatemala. 9…”

Implementation of a Diabetes Self-Management Education and Support Intervention in Rural Guatemala: A Mixed-Methods Evaluation Using the RE-AIM Framework

“…We conducted an explanatory sequential mixed-methods evaluation ( 21 ) guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) mixed-methods framework ( 13 ). The project evaluation plan and data sources are available elsewhere (Appendixes 3–4 [ 16 ]).…”

“…Mixed methods. We integrated our findings using a joint display of quantitative and qualitative findings and meta-inferences ( 21 ). Meta-inferences are interpretations that emerge from the integrated analysis of the quantitative and qualitative data.…”