Abstract: SA-PO405

Regional Differences in Prevalence and Determinants of CKD among Individuals with Hypertension in Rural Communities in South Asia

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 302 CKD: Estimating Equations, Incidence, Prevalence, Special Populations

Authors

  • Feng, Liang, Duke-NUS Medical School, Singapore, Singapore
  • Jafar, Tazeen H., Duke-NUS Medical School, Singapore, Singapore
Background

The objectives of the study were to determine the regional burden and differences in prevalence and determinants of chronic kidney disease (CKD) in rural Bangladesh, Pakistan, and Sri Lanka.

Methods

We conducted a cross-sectional study on 2349 participants aged ≥ 40 years with hypertension in 30 randomly selected rural communities, 10 each in Bangladesh, Pakistan, and Sri Lanka. The primary outcome was CKD defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 estimated by CKD Epidemiology Collaboration (CKD-EPI) or urinary albumin to creatinine ratio ≥ 30 mg/g

Results

The mean (SD) age of participants was 58.8 (11.3) years, and 36% were men, 27% had diabetes, and 10% were current smokers. The age-standardized prevalence (95% CI) of primary outcome of CKD was 38.4% (34.1 to 42.8%) in Bangladesh, 19.1% (15.7 to 22.5%) in Pakistan, and 49.8% (45.1 to 54.6%) in Sri Lanka. The factors independently associated with CKD were older age ( OR=1.06,95%CI(1.05,1.07) for every 1 year increase), diabetes (OR=2.03,95%CI(1.63,2.52)), elevated systolic blood pressure (OR=1.06,95%CI(1.04,1.09), per 5 mm Hg increase), current vs non-smoker ( OR=1.42,95%CI(1.01,2.00)), and country (OR=0.57,95%CI(0.40,0.80) for Bangladesh vs Sri Lanka, and OR=0.18,95%CI(0.12,0.26) for Pakistan vs Sri Lanka). A significant interaction with p<0.001 was detected between age and country indicating that the association between older age and higher prevalence of CKD was stronger in Sri Lanka compared to the other two countries.

Conclusion

CKD is common among individuals with hypertension in rural South Asia with alarmingly high rates of reduced kidney function in Sri Lanka. Our findings underscore the urgency of addressing the key determinants of CKD, and establishing CKD detection and management programs as a public health priority in the South Asian region.

Table 1. Crude prevalence of CKD (n=2349)
CKD n (%, 95% CI)Total
N=2349
Bangladesh
N=818
Pakistan
N=685
Sri Lanka
N=796
CKD (eGFR <60 ml/min/1.73m2 or UACR≥30mg/g)908 (38.6, (36.7,40.7))316(36.4 (33.2,39.7))127 (18.5 (15.6,21.5))465 (58.4(54.9,61.9))
eGFR <60 ml/min/1.73m2 only519 (22.1,(20.4,23.8))102 (11.8 (9.6,14.0)34 (5.0 (3.3,6.7))383 (48.1 (44.6,51.7))
UACR≥30 mg/g only573 (24.4,(22.6,26.2)257 (29.6 (26.5,32.7))110 (16.1 (13.2,18.9))206 (25.9 (22.8,29.0))

Funding

  • Government Support - Non-U.S.