Ethnic differences and determinants of proteinuria among South Asian subgroups in Pakistan

Jafar, Tazeen H.; Chaturvedi, Nish; Gul, Asma; Khan, Anwar; Schmid, Christopher H.; Levey, Andrew S.

doi:10.1046/j.1523-1755.2003.00212.x

Cited by 27 publications

(21 citation statements)

References 30 publications

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“…All independent predictors of proteinuria were retained in the final model. In addition, clinically important variables (systolic blood pressure) and those significantly associated with proteinuria (p<0.05) in the univariate analyses were forced in the models, and retained if they were significantly associated with proteinuria in the multivariate analyses [17]. Model fittings were tested in the final models by comparing the log likelihood ratios.…”

Section: Discussionmentioning

confidence: 99%

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Proteinuria in South Asian children: prevalence and determinants

et al. 2005

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Proteinuria in children is a marker of kidney disease and atherosclerosis, both which are known predictors of cardiovascular mortality. Recent evidence suggests that migrant South Asian populations living in the West may be at higher risk of kidney disease than native Caucasians. However, the determinants of proteinuria in South Asian children have not been explored. Previously, we reported ethnic variation in the prevalence of proteinuria in the adult population of Pakistan. However, it is not known whether ethnic predisposition to proteinuria appears during childhood or whether it is acquired later in life as a result of prolonged exposure to undiagnosed diabetes and hypertension. Analyses were based on a subset of data for 4977 children aged 5 to less than 15 years collected as part of the broad National Health Survey of Pakistan, conducted between 1990 and 1994. Proteinuria was defined as a dipstick positive for protein on a random urine sample. Ethnicity was reported as "mother-tongue", which is specific for each of the five major ethnic subgroups of Pakistan: Muhajir, Punjabi, Sindhi, Pashtun, and Baluchi. The overall prevalence (95% CI) of proteinuria in the children was 3.3% (2.7-3.9%). It was 6.2% in Sindhis, 3.6% in Muhajirs, 2.8% in Punjabis, 2.8% in Baluchis, and 1.0% in Pashtuns (p<0.001). In multivariable analyses, proteinuria was associated with greater height (p=0.007), urban dwelling (p=0.03), lower socioeconomic status (p=0.02), and certain ethnicities (p=0.005). The ethnic variation in proteinuria in South Asian children mirrors variation among ethnic groups in adults. This suggests variations in susceptibility or early exposure to causes of chronic kidney disease, rather than long-term exposure to undiagnosed diabetes or hypertension. Further studies are needed to determine factors in early life that may differentially predispose certain ethnic groups to proteinuria.

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Section: Discussionmentioning

confidence: 99%

“…Previously we reported differences among ethnic subgroups in the prevalence of proteinuria in the adult population of Pakistan, which could not be accounted for by the presence of hypertension, diabetes, and other sociodemographic risk factors [17]. The cause of ethnic variation in proteinuria in adults is not known.…”

Section: Introductionmentioning

confidence: 99%

Proteinuria in South Asian children: prevalence and determinants

et al. 2005

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“…equations with measured Ccr was not as good as reported in other populations, both equations performed better than serum creatinine. Although being reported for the first time, the alarmingly high prevalence of reduced GFR in adult men and women in Pakistan is not unexpected as the prevalence of risk factors of CKD including hypertension and diabetes is one of the highest reported worldwide (22). The National Health Survey of Pakistan (1990 to 1994) showed that one of three individuals aged 45 yr or older has hypertension.…”

Section: Discussionmentioning

confidence: 99%

Serum Creatinine as Marker of Kidney Function in South Asians

Jafar¹,

Schmid²,

Levey³

2005

Journal of the American Society of Nephrology

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Migrant populations of South Asian origin have a higher risk for chronic kidney disease than the native whites. Several formulas have been developed to estimate kidney function from serum creatinine concentration. However, none of these has been validated in the South Asian population, which generally has different muscle mass composition than whites. A population-based cross-sectional study was performed on 262 individuals who were aged >40 yr in Karachi, Pakistan. Reduced GFR was defined as creatinine clearance (Ccr) measured in 24-h urine collection of <60 ml/min per 1.73 m 2 . Creatinine excretion was compared with age-and gender-matched white individuals by comparison of observed versus expected results on the basis of a formula using t test. The agreement among Cockcroft Gault (CG) Ccr and Modification of Diet in Renal Disease (MDRD) Study GFR equations was assessed by regression analyses, and the degree of accuracy of estimated versus measured GFR was determined. Mean (95% confidence interval) creatinine excretion was 1.7 (1.0 to 2.4) mg/kg per d lower than expected for age-and gender-matched white individuals (P < 0.001). The coefficient of determination for measured Ccr on the logarithmic scale was 66.7 and 55.6% for the CG and MDRD Study equations, respectively. The proportion of estimates within 20, 30, and 50% of measured Ccr values was 47.7 versus 32.8% (P < 0.001), 64.9 versus 49.6% (P < 0.001), and 79.4 versus 72.9 (P ‫؍‬ 0.07) for CG versus MDRD Study equations, respectively. Lower mean creatinine excretion in these individuals may explain, in part, suboptimal agreement between estimated versus measured GFR. Inclusion of terms for ethnic and racial groups other than white and black might improve the performance of GFR estimating equations.

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“…Studies from Pakistan (35) and South East Asia (36) demonstrate wide variations by ethnic subgroup in the prevalence of dipstick proteinuria. However, these studies do not have European comparators and do not provide evidence regarding determinants of micro-or macroalbuminuria in populations representative of our study group of first-generation migrants of largely Indian origin.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Microalbuminuria and Coronary Heart Disease Risk in an Ethnically Diverse UK Population

Tillin

Forouhi

McKeigue

et al. 2005

Journal of the American Society of Nephrology

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Microalbuminuria (MA) is a strong risk factor for subsequent chronic disease, both renal and coronary heart disease (CHD), in European origin populations, but CHD risks differ by ethnicity, and it was hypothesized that prevalence of MA and relations with CHD may also differ. Combined analyses of two population-based cohorts started in 1988 and consisted of 1460 Europeans (70% male), 946 South Asians (78% male), and 559 African Caribbeans (51% male) who resided in London and were aged 40 to 69. Baseline fasting blood, overnight urine collection, and clinical measurements were performed. Prevalent CHD was defined by clinical history or major electrocardiogram changes. Age-adjusted albumin excretion rates (AER; geometric means, g/min) were significantly higher in African Caribbeans (men: 6.1, 95% confidence interval [CI] 5.5 to 6.7; women: 5.7, 95% CI 5.2 to 6.2) than in South Asians (men: 4.3, 95% CI 4.0 to 4.5; women 3.4, 95% CI 3.0 to 3.8) and Europeans (men: 4.5, 95% CI 4.3 to 4.8; women: 3.3, 95% CI 3.1 to 3.6). MA was associated with both prevalent CHD and CHD mortality in South Asian men (hazard ratio 2.5; 95% CI 1.3 to 4.8) and in European women (hazard ratio 13.0; 95% CI 2.6 to 64.2) but not in any other group. Greater AER in African Caribbeans and the absence of association with CHD contrast with lower AER in South Asian men and European women, both strongly associated with CHD prevalence and mortality. These differences suggest that the pathogenesis of kidney disease and its link with CHD differ by ethnicity and gender.

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Ethnic differences and determinants of proteinuria among South Asian subgroups in Pakistan

Abstract: We conclude that unmeasured environmental or genetic factors account for ethnic variations in proteinuria, and deserve further study.

Cited by 27 publications

References 30 publications

Proteinuria in South Asian children: prevalence and determinants

Proteinuria in South Asian children: prevalence and determinants

Serum Creatinine as Marker of Kidney Function in South Asians

Microalbuminuria and Coronary Heart Disease Risk in an Ethnically Diverse UK Population

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