Short CommunicationChronic kidney disease prevalence in Rivas, Nicaragua: Use of a field device for creatinine measurement
Introduction
Rates of chronic kidney disease (CKD) are rising at an alarming rate in developing countries, presumably due to a global increase in conventional risk factors including hypertension, diabetes, aging, and the use of nephrotoxic drugs [1], [2]. Over the past decade, evidence emerged for an epidemic of CKD of unknown etiology (CKDu) affecting young, male agricultural workers along the Pacific rim of Mesoamerica [3]. The pathophysiology of CKDu has not been elucidated.
A number of studies conducted in northwestern Nicaragua and El Salvador between 2008 and 2012 have shown the prevalence of stage III or IV CKD (defined by estimated glomerular filtration rate or eGFR < 60 mL/min/1.73 m2) to be between 10 and 15% in men with lower rates in women. In these reports, higher rates of CKD were seen in male agriculture workers [4], [5], [6], [7], miners [5], older individuals, and participants living at altitudes less than 500 m above sea level [8], [9]. There are no data regarding the prevalence of CKD in other regions of Nicaragua.
The present pilot study determines the sensitivity and specificity of a point of care, hand held device (StatSensor Xpress, Nova Biomedical, Waltham, MA, USA) when used as a screening test for CKD. With appropriate performance characteristics the device could be used in the future to screen subjects in their homes.
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Material and methods
This study was performed in the Department of Rivas in southern Nicaragua over a one week period in March of 2013. Study subjects were recruited from the waiting rooms of the health center in San Juan del Sur (34 subjects) and the hospital in the municipality of Rivas (66 subjects). The study was approved by the Institutional Review Board of the Direccion General de Docencia e Investigaciones of the Ministry of Health of Nicaragua (MINSA). All study staff were trained on the protocol and in the
Results
Thirty percent of the total subjects were male. A total of 99 blood samples were run in duplicate on the CNDR machine by Jaffe kinetic method. The average CV across these samples (creatinine range of 0.5–3.6 mg/dL) was 1.28%. Duplicate StatSensor Xpress results were available for 64 subjects (creatinine range of 0.4–3.5 mg/dL) with a CV of 6.67%. One subject was dropped from the analysis due to laboratory error.
The median creatinine for the StatSensor Xpress was 1.04 mg/dL with an interquartile
Discussion
We demonstrate the utility of the StatSensor Xpress as a screening device for chronic kidney disease, as defined by a creatinine greater than 1.2 mg/dL, for use in point-of-care testing in low income countries. Results from the StatSensor Xpress show considerable variability compared to the standard laboratory measurement; however, the test characteristics are sufficient to provide adequate screening for use in the field. A confirmatory test to establish the precise value of creatinine is still
Acknowledgments
This project was funded entirely by private donations to the ‘Lowering Poverty and Disease in Southern Nicaragua Group’ (www.LPD.com) and the work was done in collaboration with the ‘Newton-San Juan Del Sur Sister City Project’ (http://sanjuandelsursistercityproject.wordpress.com/).
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