BackgroundThere are no national data on the magnitude and pattern of chronic kidney disease (CKD) in India. The Indian CKD Registry documents the demographics, etiological spectrum, practice patterns, variations and special characteristics.MethodsData was collected for this cross-sectional study in a standardized format according to predetermined criteria. Of the 52,273 adult patients, 35.5%, 27.9%, 25.6% and 11% patients came from South, North, West and East zones respectively.ResultsThe mean age was 50.1 ± 14.6 years, with M:F ratio of 70:30. Patients from North Zone were younger and those from the East Zone older. Diabetic nephropathy was the commonest cause (31%), followed by CKD of undetermined etiology (16%), chronic glomerulonephritis (14%) and hypertensive nephrosclerosis (13%). About 48% cases presented in Stage V; they were younger than those in Stages III-IV. Diabetic nephropathy patients were older, more likely to present in earlier stages of CKD and had a higher frequency of males; whereas those with CKD of unexplained etiology were younger, had more females and more frequently presented in Stage V. Patients in lower income groups had more advanced CKD at presentation. Patients presenting to public sector hospitals were poorer, younger, and more frequently had CKD of unknown etiology.ConclusionsThis report confirms the emergence of diabetic nephropathy as the pre-eminent cause in India. Patients with CKD of unknown etiology are younger, poorer and more likely to present with advanced CKD. There were some geographic variations.

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Background High prevalence of type 2 diabetes in one subdivision of a district in south India prompted us to look at the prevalence of other major coronary risk factors, and relate these to random blood sugar values.Design Cross-sectional survey of all adult residents of four wards (clusters of households) of a subdivision. Detailed investigation for diabetes and blood lipids in a selected subsample with random blood sugar (RBS) 4109 mg/dl by glucometer.Methods From the selected wards, we conducted a standard oral glucose tolerance test and serum lipids in all those who had RBS above 109 mg/dl by glucometer. Risk factors such as smoking, obesity (body mass index 4 29.9), high blood pressure (systolic pressure 4 139; diastolic pressure 4 89 mmHg) and sedentary habits were assessed in all irrespective of RBS.Results Prevalence of all risk factors increases with age. Mean RBS ranges from 92.9 7 15.7 to 108.8 7 35.7 mg/dl in males and 88.6 7 16.0 to 117.3 7 61.6 mg/dl in females, between the age groups 20-29 to 4 69. Risk factor prevalence varied with area of residence, with urban population reporting highest prevalence for type 2 diabetes and obesity, and coastal population for hypertension. For increasing levels of fasting plasma glucose (FPG o 100, 100-124 and 4 125 mg/dl), serum total cholesterol values were 5.21 7 1.08 mM/l, 5.38 7 0.86 mM/l and 5.63 7 1.37 mM/l for males. For females, corresponding values were 5.23 7 1.11 mM/l, 5.54 7 1.15 mM/l, and 5.49 7 1.10 mM/l respectively.Conclusions Risk factor prevalence varies with area of residence within the study population. Mean plasma lipid levels are high among both sexes, tending to rise with increasing mean fasting plasma glucose levels.

BackgroundUnidentified depression in primary care is a public health concern, globally. There is a need for brief, valid and easily administered tools in primary care.AimsTo estimate reliability and validity of the newly developed Primary care Screening Questionnaire for Depression (PSQ4D), a four-item tool, with ‘yes’ or ‘no’ options.MethodPSQ4D was administered verbally (time required, <1 min) by primary care physicians to adult outpatients (n=827) in six primary care settings in Kerala, India. A psychiatrist evaluated each patient on the same day, using ICD-10 Diagnostic Criteria for Research, based on unstructured clinical interview.ResultsThe Cronbach’s alpha for internal consistency reliability was 0.80; kappa coefficient for test–retest reliability was 0.9 and that for interrater reliability was 0.72. At a score ≥2, sensitivity was 0.96, specificity was 0.87, positive predictive value was 0.74, negative predictive value was 0.98, positive likelihood ratio was 7.4 and negative likelihood ratio was 0.05.ConclusionsWhen physician administered, PSQ4D has good reliability. At a cut-off score of ≥2, it has high sensitivity and specificity to identify depressive disorder in primary care.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.