Preventing renal and cardiovascular risk by renal function assessment: insights from a cross-sectional study in low-income countries and the USA
- Paolo Cravedi1,
- Sanjib Kumar Sharma2,
- Rodolfo Flores Bravo3,
- Nazmul Islam4,
- Irma Tchokhonelidze5,
- Madhav Ghimire2,
- Bishnu Pahari2,
- Sanjeev Thapa2,
- Anil Basnet2,
- Avtandil Tataradze5,
- Davitaia Tinatin6,
- Lela Beglarishvili5,
- Chyng-Wen Fwu7,
- Jeffrey B Kopp8,
- Paul Eggers9,
- Bogdan Ene-Iordache1,
- Sergio Carminati1,
- Annalisa Perna1,
- Antonietta Chianca1,
- William G Couser10,
- Giuseppe Remuzzi1,
- Norberto Perico1
- 1Clinical Research Center for Rare Diseases “Aldo e Cele Daccò”, Villa Camozzi, Ranica, and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Mario Negri Institute for Pharmacological Research, Bergamo, Italy
- 2Department of Medicine, BP Koirala Institute of Health Science, Dharan, Nepal
- 3Department of Medicine, Hospital Juan XXIII, La Paz, Bolivia
- 4Department of Nephrology, North East Medical College Hospital Sylhet, Sylhet, Bangladesh
- 5Dialysis, Nephrology and Transplantation Union of Georgia, National Center of Urology, Tbilisi, Georgia
- 6Department of Pediatrics, M. Iashvili Children Central Hospital, Tbilisi, Georgia
- 7Social & Scientific Systems, Inc., Silver Spring, Maryland, USA
- 8Kidney Disease Section, NIDDK, NIH, Bethesda, Maryland, USA
- 9Division of Kidney, Urologic and Hematologic Diseases, NIDDK, NIH, Bethesda, Maryland, USA
- 10Division of Nephrology, University of Washington, Seattle, Washington, USA
- Correspondence to Dr Giuseppe Remuzzi, Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Villa Camozzi, Ranica, and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Mario Negri Institute for Pharmacological Research, Via Stezzano, 87, Bergamo 24126, Italy;
- Received 3 May 2012
- Accepted 6 August 2012
- Published 22 September 2012
Objective To assess the prevalence of microalbuminuria and kidney dysfunction in low-income countries and in the USA.
Design Cross-sectional study of screening programmes in five countries.
Setting Screening programmes in Nepal, Bolivia, the USA (National Health and Nutrition Examination Survey (NHANES) 2005–2008) Bangladesh and Georgia.
Participants General population in Nepal (n=20 811), Bolivia (n=3436) and in the USA (n=4299) and high-risk subjects in Bangladesh (n=1518) and Georgia (n=1549).
Primary and secondary outcome measures Estimated glomerular filtration rate (eGFR)<60ml/min/1.73 m2 and microalbuminuria (defined as urinary albumin creatinine ratio values of 30–300 mg/g) were the main outcome measures. The cardiovascular (CV) risk was also evaluated on the basis of demographic, clinical and blood data.
Results The prevalence of eGFR<60ml/min/1.73 m2 was 19%, 3.2% and 7% in Nepal, Bolivia and the USA, respectively. In Nepal, 7% of subjects were microalbuminuric compared to 8.6% in the USA. The prevalence of participants with predicted 10-year CV disease (CVD) risk ≥10% was 16.9%, 9.4% and 17% in Nepal, Bolivia and in the USA, respectively. In Bangladesh and Georgia, subjects with eGFR<60 ml/min/1.73 m2 were 8.6% and 4.9%, whereas those with microalbuminuria were 45.4% and 56.5%, respectively. Predicted 10-year CVD risk ≥10% was 25.4% and 25% in Bangladesh and Georgia, respectively.
Conclusions Renal abnormalities are common among low-income countries and in the USA. Prevention programmes, particularly focused on those with renal abnormalities, should be established worldwide to prevent CVD and progression to end-stage renal disease.
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