Article Text
Abstract
Kidney biopsies to elucidate the cause of chronic kidney disease (CKD) are performed in a minority of persons with CKD living in high-income countries, since associated conditions—that is, diabetes mellitus, vascular disease or obesity with pre-diabetes, prehypertension or dyslipidaemia—can inform management targeted at slowing CKD progression in a majority. However, attributes of CKD may differ substantially among persons living in low-income and middle-income countries (LMICs). We used data from population or community-based studies from five LMICs (China, urban India, Moldova, Nepal and Nigeria) to determine what proportion of persons with CKD living in diverse regions fit one of the three major clinical profiles, with data from the US National Health Nutrition and Examination Survey as reference. In the USA, urban India and Moldova, 79.0%–83.9%; in China and Nepal, 62.4%–66.7% and in Nigeria, 51.6% persons with CKD fit one of three established risk profiles. Diabetes was most common in urban India and vascular disease in Moldova (50.7% and 33.2% of persons with CKD in urban India and Moldova, respectively). In Nigeria, 17.8% of persons with CKD without established risk factors had albuminuria ≥300 mg/g, the highest proportion in any country. While the majority of persons with CKD in LMICs fit into one of three established risk profiles, the proportion of persons who have CKD without established risk factors is higher than in the USA. These findings can inform tailored CKD detection and management systems and highlight the importance of studying potential causes and outcomes of CKD without established risk factors in LMICs.
- epidemiology
- indices of health and disease and standardisation of rates
- cross-sectional survey
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Footnotes
Handling editor Seye Abimbola
Contributors SA and GMC conceived the analysis. GR, VJ, DP, LZ and MEM-R provided feedback on the analysis plan. YZ led the analyses. WJW, NP and SC assisted with data cleaning and merging. KMVN, NT and VM reviewed multiple drafts. SA led the writing. All authors reviewed and approved the final draft.
Funding SA is supported by the National Institute for Diabetes and Digestive and Kidney Health (grant no. K23 DK101826). GMC is supported by the National Institute for Diabetes and Digestive and Kidney Health (grant no. K24 DK 085446). The Center for Cardiometabolic Risk Reduction in South Asia (CARRS) study was supported by the National Heart, Lung and Blood Institute (contract no. HHSN2682009900026C, CARRS study). The China study was supported by the Ministry of Science and Technology. The International Society of Nephrology (ISN) Kidney Disease Data Center screening programs in Moldova, Nepal and Nigeria were funded partly by a dedicated grant from the ISN Research and Prevention Committee.
Competing interests None declared.
Ethics approval All individual studies collated in this analysis underwent IRB approval at their respective institutions. Only de-identified data were used in this analysis.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement De-identified data used in this analysis are available to collaborators after review by steering committee members of the individual studies.