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

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

doi:10.1136/bmjgh-2017-000453

Cited by 11 publications

(6 citation statements)

References 36 publications

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“…Two national-level care models 17 18 integrated their efforts within a larger strategy to tackle chronic disease; for example, in the case of Malaysia 17 efforts were coled by an organisation tasked with diabetes management. Current data indicate most persons with CKD have coexisting conditions such as diabetes, vascular disease or obesity, 32 and an integrated strategy for screening and comanagement may be efficient and effective.…”

Section: Discussionmentioning

confidence: 99%

Chronic kidney disease care models in low- and middle-income countries: a systematic review

et al. 2018

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IntroductionThe number of persons with chronic kidney disease (CKD) living in low- and middle-income countries (LMIC) is increasing rapidly; yet systems built to care for them have received little attention. In order to inform the development of scalable CKD care models, we conducted a systematic review to characterise existing CKD care models in LMICs.MethodsWe searched PubMed, Embase and WHO Global Health Library databases for published reports of CKD care models from LMICs between January 2000 and 31 October 2017. We used a combination of database-specific medical subject headings and keywords for care models, CKD and LMICs as defined by the World Bank.ResultsOf 3367 retrieved articles, we reviewed the full text of 104 and identified 17 articles describing 16 programmes from 10 countries for inclusion. National efforts (n=4) focused on the prevention of end-stage renal disease through enhanced screening, public awareness campaigns and education for primary care providers. Of the 12 clinical care models, nine focused on persons with CKD and the remaining on persons at risk for CKD; a majority in the first category implemented a multidisciplinary clinic with allied health professionals or primary care providers (rather than nephrologists) in lead roles. Four clinical care models used a randomised control design allowing for assessment of programme effectiveness, but only one was assessed as having low risk for bias; all four showed significant attenuation of kidney function decline in the intervention arms.ConclusionsOverall, very few rigorous CKD care models have been reported from LMICs. While preliminary data indicate that national efforts or clinical CKD care models bolstering primary care are successful in slowing kidney function decline, limited data on regional causes of CKD to inform national campaigns, and on effectiveness and affordability of local programmes represent important challenges to scalability.

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Section: Discussionmentioning

confidence: 99%

Chronic kidney disease care models in low- and middle-income countries: a systematic review

et al. 2018

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“…Much of the rise in CKD-attributable deaths has occurred in low-income and middle-income countries (LMICs) 2 3. Few data exist to inform screening strategies for early detection and management of CKD in LMICs, where risk factors for CKD may differ from those in high-income countries 4…”

Section: Introductionmentioning

confidence: 99%

Early detection of chronic kidney disease in low-income and middle-income countries: development and validation of a point-of-care screening strategy for India

et al. 2019

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IntroductionAlthough deaths due to chronic kidney disease (CKD) have doubled over the past two decades, few data exist to inform screening strategies for early detection of CKD in low-income and middle-income countries.MethodsUsing data from three population-based surveys in India, we developed a prediction model to identify a target population that could benefit from further CKD testing, after an initial screening implemented during home health visits. Using data from one urban survey (n=8698), we applied stepwise logistic regression to test three models: one comprised of demographics, self-reported medical history, anthropometry and point-of-care (urine dipstick or capillary glucose) tests; one with demographics and self-reported medical history and one with anthropometry and point-of-care tests. The ‘gold-standard’ definition of CKD was an estimated glomerular filtration rate <60 mL/min/1.73 m2 or urine albumin-to-creatinine ratio ≥30 mg/g. Models were internally validated via bootstrap. The most parsimonious model with comparable performance was externally validated on distinct urban (n=5365) and rural (n=6173) Indian cohorts.ResultsA model with age, sex, waist circumference, body mass index and urine dipstick had a c-statistic of 0.76 (95% CI 0.75 to 0.78) for predicting need for further CKD testing, with external validation c-statistics of 0.74 and 0.70 in the urban and rural cohorts, respectively. At a probability cut-point of 0.09, sensitivity was 71% (95% CI 68% to 74%) and specificity was 70% (95% CI 69% to 71%). The model captured 71% of persons with CKD and 90% of persons at highest risk of complications from untreated CKD (ie, CKD stage 3A2 and above).ConclusionA point-of-care CKD screening strategy using three simple measures can accurately identify high-risk persons who require confirmatory kidney function testing.

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“…In other settings, emerging evidence suggests that the profile of people with CKD differs across LMICs. 47 Given the limited data on the epidemiology of CKD in Guatemala, 12 35 48 our findings show that it is imperative to better study the burden and risks factors of CKD in this setting through representative population-based surveys.…”

Section: Discussionmentioning

confidence: 88%

Screening for chronic kidney disease in a community-based diabetes cohort in rural Guatemala: a cross-sectional study

et al. 2018

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ObjectiveScreening is a key strategy to address the rising burden of chronic kidney disease (CKD) in low-income and middle-income countries. However, there are few reports regarding the implementation of screening programmes in resource-limited settings. The objectives of this study are to (1) to share programmatic experiences implementing CKD screening in a rural, resource-limited setting and (2) to assess the burden of renal disease in a community-based diabetes programme in rural Guatemala.DesignCross-sectional assessment of glomerular filtration rate (GFR) and urine albumin.SettingCentral Highlands of Guatemala.ParticipantsWe enrolled 144 adults with type 2 diabetes in a community-based CKD screening activity carried out by the sponsoring institution.Outcome measuresPrevalence of renal disease and risk of CKD progression using Kidney Disease: Improving Global Outcomes definitions and classifications.ResultsWe found that 57% of the sample met GFR and/or albuminuria criteria suggestive of CKD. Over half of the sample had moderate or greater increased risk for CKD progression, including nearly 20% who were classified as high or very high risk. Hypertension was common in the sample (42%), and glycaemic control was suboptimal (mean haemoglobin A1c 9.4%±2.5% at programme enrolment and 8.6%±2.3% at time of CKD screening).ConclusionsThe high burden of renal disease in our patient sample suggests an imperative to better understand the burden and risk factors of CKD in Guatemala. The implementation details we share reveal the tension between evidence-based CKD screening versus screening that can feasibly be delivered in resource-limited global settings.

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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

Cited by 11 publications

References 36 publications

Chronic kidney disease care models in low- and middle-income countries: a systematic review

Chronic kidney disease care models in low- and middle-income countries: a systematic review

Early detection of chronic kidney disease in low-income and middle-income countries: development and validation of a point-of-care screening strategy for India

Screening for chronic kidney disease in a community-based diabetes cohort in rural Guatemala: a cross-sectional study

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