Hong Kong Journal of Nephrology
Volume 10, Issue 1 , Pages 27-33, April 2008

Is There a Chronic Kidney Disease Epidemic? Profile of Chronic Kidney Disease in an Urban Renal Camp in Southern India

  • Venkata Dakshinamurty Kaligotla

      Affiliations

    • Departments of Nephrology and Nizam's Institute of Medical Sciences University, Hyderabad
    • Corresponding Author InformationCorrespondence to: Dr. K.V. Dakshinamurty, Department of Nephrology, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad 500 082, India. Fax: (+91) 40-23307899;
    • ,
  • Shyam Chirravoori

      Affiliations

    • Department of Nephrology, Dr. RML Hospital, and All India Institute of Medical Sciences, New Delhi, India.
    • ,
  • Malati Tangirala

      Affiliations

    • Departments of Biochemistry, Nizam's Institute of Medical Sciences University, Hyderabad
    • ,
  • Gangadhar Taduri

      Affiliations

    • Departments of Nephrology and Nizam's Institute of Medical Sciences University, Hyderabad
    • ,
  • Sreenivas Vishnubhatla

      Affiliations

    • Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
    • ,
  • Ram Rapur

      Affiliations

    • Departments of Nephrology and Nizam's Institute of Medical Sciences University, Hyderabad

Article Outline

Background

The incidence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) is growing at an alarming rate. It is widely believed that the rising ESRD population is just the tip of the CKD iceberg. Data on early-stage CKD and the prevalence of CKD in India are very limited. Therefore, data from a renal camp organized in connection with World Kidney Day were looked at for renal function.

Methods

This was a cross-sectional study. A renal camp was advertised using a set of eight questions; any person who answered yes to one or more questions were advised to attend the camp. Body weight, height, blood pressure, blood sugar and serum creatinine were measured. Urine examination for sugar, albumin and blood was carried out. Renal function was assessed by calculating the glomerular filtration rate (GFR) using the Cockcroft-Gault (C-G) and Modified Diet in Renal Disease (MDRD) formulas. Kidney function was classified according to estimated GFR (eGFR) and Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines.

Results

A total of 123 people (82.1% male) were studied; 9% were less than 20 years old and 26% were aged 60 years or older. The distribution of eGFR was symmetrical, with the majority of people in the 70–79 mL/min category; 69.9% of the study population had eGFR < 100 mL/min. There was a gradual increase in eGFR from the < 20-year-old group to the 30–39-year-old group (which had the highest eGFR of about 110 mL/min), and then a gradual decline with increasing age. An inverse relation between eGFR and age was observed: eGFR declined by 1 mL/min/year (95% confidence interval, 0.7–1.3). C-G eGFR indicated that about 69% of the study population was normal and 31% had CKD stage I to V. MDRD eGFR indicated that 7.3% had CKD stage III to V. Only in CKD stages IV and V could elevated levels of serum creatinine be seen.

Conclusion

The results indicate low GFR levels and, consequently, a high burden of CKD in the Indian population. It is not clear whether such observations are the result of the transportability problems associated with the GFR prediction equations or with the suitability of K/DOQI guidelines for the classification of CKD in the Indian population or both. Well-planned, larger, community-and hospital-based studies are warranted to clarify these issues.

Key words:  chronic kidney disease , Cockcroft-Gault formula , estimated GFR , K/DOQI guidelines, simplified Modified Diet in Renal Disease formula

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Kidney Disease Outcomes Quality Initiative  . K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification . Am J Kidney Dis . 2002;39:S1–246
  2. Coresh J , Wei GL , Mcquillen G , Brancati FL , Levey AS , Jones C , et al.   Prevalence of high blood pressure and elevated serum creatinine level in United States: findings from the third National Health and Nutrition Examination Survey (1984-1994) . Arch Intern Med . 2001;161:1207–1216
  3. Kher V . End-stage renal disease in developing countries . Kidney Int . 2002;62:350–362
  4. Mani MK . Experience with a program for prevention of chronic renal failure in India . Kidney Int Suppl . 2005;Apr;S75–S78
  5. Dash SC , Agarwal SK . Incidence of chronic kidney disease in India . Nephrol Dial Transplant . 2006;21:232–233
  6. Agarwal SK , Dash SC , Irshad M , Raju S , Singh R , Pandey RM . Prevalence of chronic renal failure in adults in Delhi, India . Nephrol Dial Transplant . 2005;20:1638–1642
  7. Modi GK , Jha V . The incidence of end-stage renal disease in India: a population-based study . Kidney Int . 2006;70:2131–2133
  8. Cockgroft DW , Gault MH . Prediction of creatinine clearance from serum creatinine . Nephron . 1976;16:31–41
  9. Levey AS , Greene T , Kusek JW , Beck GJ . Simplified equation to predict glomerular filtration rate from serum creatinine . J Am Soc Nephrol . 2000;11:828(A)
  10. Wesson LG . Renal hemodynamics in physiolocal states . In:  Wesson LG editors. Physiology of the Human Kidney . New York: Grune & Stratton; 1969;p. 96–108
  11. Lin J , Knight EL , Hogan ML , Singh AK . A comparison of prediction equations for estimating glomerular filtration rate in adults without kidney disease . J Am Soc Nephrol . 2003;14:2573–2580
  12. Clase CM , Garg AX , Kiberd BA . Prevalence of low glomerular function rate in non-diabetic Americans: Third National Health and Nutrition Examination Survey (NHANES III) . J Am Soc Nephrol . 2002;13:1338–1349
  13. Coresh J , Astor BC , Greene T , Knoyan G , Levey AS . Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey . Am J Kidney Dis . 2003;41:1–12
  14. Chadban SJ, Briganti EM, Kerr PG, Dunstan DW, Welborn TA, Zimmet PZ, et al. Prevalence of kidney damage in Australian adults: the AusDiab Kidney Study . J Am Soc Nephrol . 2003;14:S131–S138
  15. Justice AC , Covinsky KE , Berlin JA . Assessing the generalizability of prognostic information . Ann Intern Med . 1999;130:515–524
  16. Coresh J , Toto RD , Kirk KA , Whelton PK , Massry S , Jones C , et al.   Creatinine clearance as a measure of GFR in screenees for the African-American Study of Kidney Disease and Hypertension pilot study . Am J Kidney Dis . 1998;32:32–42
  17. Froissart M , Rossert J , Jacquot C , Paillard M , Houillier P . Predictive performance of the modification of diet in renal disease and Cockcroft-Gault equations for estimating renal function . J Am Soc Nephrol . 2005;16:763–773
  18. Lindeman RD , Tobin JD , Shock NW . Association between blood pressure and rate of decline in renal function with age . Kidney Int . 1984;26:861–868
  19. Lindeman RD , Tobin J , Shock NW . Longitudinal studies on the rate of decline in renal function with age . J Am Geriatr Soc . 1985;33:278–285
  20. Wasler M , Drew HH , LaFrance ND . Creatinine measurements often yielded false estimates of progression in chronic renal failure . Kidney Int . 1988;34:412–418
  21. Duncan L , Heathcoat J , Djurdev O , Levin A . Screening for renal disease using serum creatinine: who are we missing? . Nephrol Dial Transplant . 2001;16:1042–1046

PII: S1561-5413(08)60015-0

doi:10.1016/S1561-5413(08)60015-0

Hong Kong Journal of Nephrology
Volume 10, Issue 1 , Pages 27-33, April 2008

Article Tools