Prevalence of and risk factors for chronic kidney disease of unknown aetiology in India: Secondary data analysis of three population-based cross-sectional studies

• Type of Material: Article
• Authors: Christina O'Callaghan-Gordo, Instituto de Salud Global de Barcelona; Roopa Shivashankar, Public Health Foundation of India; Shuchi Anand, Stanford University; Shreeparna Ghosh, Public Health Foundation of India; Jason Glaser, London School of Hygiene and Tropical Medicine; Ruby Gupta, Public Health Foundation of India; Kristina Jakobsson, Göteborg University; Dimple Kondal, Public Health Foundation of India; Anand Krishnan, All India Institute of Medical Sciences; Sailesh Mohan, Public Health Foundation of India; Viswanathan Mohan, Madras Diabetes Research Foundation; Dorothea Nitsch, London School of Hygiene and Tropical Medicine; P A Praveen, Centre for Control of Chronic Conditions; Nikhil Tandon, All India Institute of Medical Sciences; KM Venkat Narayan, Emory University; Kabayam Venkat Narayan, Emory University; Neil Pearce, London School of Hygiene and Tropical Medicine; Ben Caplin, University College London; Dorairaj Prabhakaran, Public Health Foundation of India
• Language: English
• Date: 2019-03-01
• Publisher: BMJ Publishing Group: Open Access
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2019.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjopen-2018-023353
• Title of Journal or Parent Work: BMJ Open
• ISSN: 2044-6055
• Volume: 9
• Issue: 3
• Start Page: e023353
• End Page: e023353
• Grant/Funding Information: The Centre for Global NCDs is supported by the Wellcome Trust Institutional Strategic Support Fund (097834/Z/11/B).; This work was supported in part by grant MR/P02386X/1 from the United Kingdom Medical Research Council under the Global Challenges Research Fund.; UDAY study was funded by Eli Lilly Foundation.; The CARRS study was funded with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, under Contract No. HHSN2682009900026C.; CO-G was supported by a Sara Borrell postdoctoral fellowship awarded from the Carlos III National Institute of Health, Spain (CD13/00072).; It was also supported by grants from the Colt Foundation and the La Isla Foundation.
• Keywords: public health; chronic renal failure; nephrology; epidemiology
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Objectives:To assess whether chronic kidney disease of unknown aetiology (CKDu) is present in India and to identify risk factors for it using population-based data and standardised methods. Design:Secondary data analysis of three population-based cross-sectional studies conducted between 2010 and 2014. Setting Urban and rural areas of Northern India (states of Delhi and Haryana) and Southern India (states of Tamil Nadu and Andhra Pradesh). Participants 12 500 individuals without diabetes, hypertension or heavy proteinuria. Outcome measures Mean estimated glomerular filtration rate (eGFR) and prevalence of eGFR below 60 mL/min per 1.73 m 2 (eGFR <60) in individuals without diabetes, hypertension or heavy proteinuria (proxy definition of CKDu). Results: The mean eGFR was 105.0±17.8 mL/min per 1.73 m 2. The prevalence of eGFR <60 was 1.6% (95% CI=1.4 to 1.7), but this figure varied markedly between areas, being highest in rural areas of Southern Indian (4.8% (3.8 to 5.8)). In Northern India, older age was the only risk factor associated with lower mean eGFR and eGFR <60 (regression coefficient (95% CI)=a '0.94 (0.97 to 0.91); OR (95% CI)=1.10 (1.08 to 1.11)). In Southern India, risk factors for lower mean eGFR and eGFR <60, respectively, were residence in a rural area (a '7.78 (-8.69 to -6.86); 4.95 (2.61 to 9.39)), older age (a '0.90 (-0.93 to -0.86); 1.06 (1.04 to 1.08)) and less education (a '0.94 (-1.32 to -0.56); 0.67 (0.50 to 0.90) for each 5 years at school). Conclusions: CKDu is present in India and is not confined to Central America and Sri Lanka. Identified risk factors are consistent with risk factors previously reported for CKDu in Central America and Sri Lanka.