Hypertension (HTN) is an important cause for chronic kidney disease (CKD). There is a paucity of studies exploring the association of HTN with CKD from rural India. The objective of the study was to determine the prevalence and the determinants for HTN in a rural population in South India, focusing on the association with CKD. In a cross-sectional study on 2984 adults in three villages, demographic and anthropometric data were collected. Blood pressure was recorded on all individuals and prevalence was estimated. Proteinuria, microalbuminuria (MA) and estimated glomerular filtration rate (eGFR) were determined in a subgroup of 1331 subjects and the relation with HTN was analysed. Prevalence of HTN was 30.4% (95% CI 28.75-32.05%). In all, 78.08% had stage 1 HTN while 22% had stage 2 HTN. In total, 27.4% (249/908) subjects were aware of their hypertensive status. Of them, only 14.4% had adequate control of blood pressure. Age>50 years, diabetes, body mass index >25 and eGFR<60 ml min were independent significant predictors of HTN (P<0.05). HTN was found to be an important risk factor for CKD even after adjusting for age, diabetes and cardiovascular risk factors (OR 2.22, 95% CI 1.46-3.36, P<0.001). The high prevalence of HTN, very low level of awareness and control, and the significant association with kidney disease indicate a need for stronger public health initiative with better penetration for awareness and screening for HTN and CKD in India's villages.

Introduction:There is a high prevalence of chronic kidney disease (CKD) in the rural agrarian population of South India and it often appears unrelated to major known causes such as diabetes or glomerulonephritis.Methods:In a matched case–control study conducted in a rural population in Shivamogga district in South India, the association of heavy metals – lead (Pb), arsenic (As), cadmium (Cd) – and pesticides in CKD was studied. Blood and spot urine samples were tested quantitatively for heavy metals and qualitatively for pesticides.Results:In all, 69 matched pairs (40 female, 58%) were recruited. The mean estimated glomerular filtration rate (mL/min/1.73 m2) was 60.1 (14.2) in cases and 83.4 (13.4) in controls. Elevated blood lead level >5 μg/dL was seen in 15 cases and 25 controls, respectively [P = 0.035, matched odds ratio (MOR) 0.5, 95% confidence interval (CI) 0.22–1.05]. Urinary Pb was elevated in 16 cases and 13 controls, respectively (P = 0.28, MOR 1.25, 95% CI 0.58–2.73). There was no significant association with As and Cd, while pesticide residues were undetectable in cases as well as controls. These results did not change even after excluding CKD cases with diabetes, stage 2 hypertension, and significant proteinuria.Conclusions:There was no statistical significant association between any of the studied heavy metals and CKD, although there was a significant burden of heavy metals in the studied subjects.

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