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Anand S, Zheng Y, Montez-Rath ME, et al. Do attributes of persons with chronic kidney disease differ in low-income and middle-income countries compared with high-income countries? Evidence from population-based data in six countries. BMJ Glob Health. 2017;2(4):e000453doi: 10.1136/bmjgh-2017-000453.
Anand, S., Zheng, Y., Montez-Rath, M. E., Wei, W. J., Perico, N., Carminati, S., Narayan, K. V., Tandon, N., Mohan, V., Jha, V., Zhang, L., Remuzzi, G., Prabahkaran, D., & Chertow, G. M. (2017). Do attributes of persons with chronic kidney disease differ in low-income and middle-income countries compared with high-income countries? Evidence from population-based data in six countries. BMJ global health, 2(4), e000453. https://doi.org/10.1136/bmjgh-2017-000453
Anand, Shuchi, et al. "Do attributes of persons with chronic kidney disease differ in low-income and middle-income countries compared with high-income countries? Evidence from population-based data in six countries." BMJ global health vol. 2,4 (2017): e000453. doi: https://doi.org/10.1136/bmjgh-2017-000453
Anand S, Zheng Y, Montez-Rath ME, Wei WJ, Perico N, Carminati S, Narayan KV, Tandon N, Mohan V, Jha V, Zhang L, Remuzzi G, Prabahkaran D, Chertow GM. Do attributes of persons with chronic kidney disease differ in low-income and middle-income countries compared with high-income countries? Evidence from population-based data in six countries. BMJ Glob Health. 2017 Oct 09;2(4):e000453. doi: 10.1136/bmjgh-2017-000453. eCollection 2017. PMID: 29071132; PMCID: PMC5640036.
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BMJ Glob Health. 2017 Oct 09;2(4):e000453. doi: 10.1136/bmjgh-2017-000453. eCollection 2017.

Do attributes of persons with chronic kidney disease differ in low-income and middle-income countries compared with high-income countries? Evidence from population-based data in six countries.

BMJ global health

Shuchi Anand, Yuanchao Zheng, Maria E Montez-Rath, Wang Jin Wei, Norberto Perico, Sergio Carminati, Km Venkat Narayan, Nikhil Tandon, Viswanathan Mohan, Vivekanand Jha, Luxia Zhang, Giuseppe Remuzzi, Dorairaj Prabahkaran, Glenn M Chertow

Affiliations

  1. Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA.
  2. Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
  3. Peking University Institute of Nephrology, Beijing, China.
  4. Department of Biomedical and Clinical Sciences, Istitutodi Ricerche Farmacologiche Mario Negri, University of Milan, Milan, Province of Milan, Italy.
  5. Global Health and Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.
  6. All India Institute of Medical Sciences, New Delhi, India.
  7. Dr. Mohan's Diabetes Specialities Centre, Endocrinology, Madras Diabetes Research Foundation, Chennai, Tamil Naidu, India.
  8. George Institute for Global Health India, University of Oxford, New Delhi, India.
  9. Public Heath Foundation of India, New Delhi, India.

PMID: 29071132 PMCID: PMC5640036 DOI: 10.1136/bmjgh-2017-000453

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.

Keywords: cross-sectional survey; epidemiology; indices of health and disease and standardisation of rates

Conflict of interest statement

Competing interests: None declared.

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