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  • Prevalence of and risk factors for chronic kidney disease of unknown aetiology in India: secondary data analysis of three population-based cross-sectional studies

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Epidemiology
Research
Prevalence of and risk factors for chronic kidney disease of unknown aetiology in India: secondary data analysis of three population-based cross-sectional studies
  1. Cristina O’Callaghan-Gordo1,2,3,4,
  2. Roopa Shivashankar5,6,
  3. Shuchi Anand7,
  4. Shreeparna Ghosh5,
  5. Jason Glaser4,8,
  6. Ruby Gupta5,
  7. Kristina Jakobsson9,10,
  8. Dimple Kondal5,6,
  9. Anand Krishnan11,
  10. Sailesh Mohan5,
  11. Viswanathan Mohan12,13,
  12. Dorothea Nitsch14,
  13. Praveen P A6,15,
  14. Nikhil Tandon15,
  15. K M Venkat Narayan16,
  16. Neil Pearce4,17,
  17. Ben Caplin18,
  18. Dorairaj Prabhakaran5,6
  1. 1 ISGlobal, Barcelona, Spain
  2. 2 Universitat Pompeu Fabra (UPF), Barcelona, Spain
  3. 3 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  4. 4 Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
  5. 5 Public Health Foundation of India, Gurgaon, Haryana, India
  6. 6 Centre for Control of Chronic Conditions (4Cs), New Delhi, Haryana, India
  7. 7 StanfordUniversity School of Medicine, Stanford, CA, USA
  8. 8 LaIsla Network, Ada, Michigan, USA
  9. 9 Occupationaland Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
  10. 10 Occupationaland Environmental Medicine, Lund University, Lund, Sweden
  11. 11 Centrefor Community Medicine, All India Institute of Medical Sciences, New Delhi, Haryana, India
  12. 12 Diabetes Research, Madras Diabetes Research Foundation, Chennai, India
  13. 13 Dr.Mohan’s Diabetes Specialities Centre, Chennai, India
  14. 14 Departmentof Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  15. 15 Departmentof Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
  16. 16 EmoryGlobal Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA
  17. 17 Centrefor Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
  18. 18 Centrefor Nephrology, University College London Medical School, London, UK
  1. Correspondence to Dr Cristina O’Callaghan-Gordo; cristina.ocallaghan{at}isglobal.org

Abstract

Objectives To assess whether chronic kidney disease of unknown aetiology (CKDu) is present in India and to identify risk factors for it using population-based data and standardised methods.

Design Secondary data analysis of three population-based cross-sectional studies conducted between 2010 and 2014.

Setting Urban and rural areas of Northern India (states of Delhi and Haryana) and Southern India (states of Tamil Nadu and Andhra Pradesh).

Participants 12 500 individuals without diabetes, hypertension or heavy proteinuria.

Outcome measures Mean estimated glomerular filtration rate (eGFR) and prevalence of eGFR below 60 mL/min per 1.73 m2 (eGFR <60) in individuals without diabetes, hypertension or heavy proteinuria (proxy definition of CKDu).

Results The mean eGFR was 105.0±17.8 mL/min per 1.73 m2. The prevalence of eGFR <60 was 1.6% (95% CI=1.4 to 1.7), but this figure varied markedly between areas, being highest in rural areas of Southern Indian (4.8% (3.8 to 5.8)). In Northern India, older age was the only risk factor associated with lower mean eGFR and eGFR <60 (regression coefficient (95% CI)=−0.94 (0.97 to 0.91); OR (95% CI)=1.10 (1.08 to 1.11)). In Southern India, risk factors for lower mean eGFR and eGFR <60, respectively, were residence in a rural area (−7.78 (-8.69 to –6.86); 4.95 (2.61 to 9.39)), older age (−0.90 (–0.93 to –0.86); 1.06 (1.04 to 1.08)) and less education (−0.94 (-1.32 to –0.56); 0.67 (0.50 to 0.90) for each 5 years at school).

Conclusions CKDu is present in India and is not confined to Central America and Sri Lanka. Identified risk factors are consistent with risk factors previously reported for CKDu in Central America and Sri Lanka.

  • epidemiology
  • nephrology
  • chronic renal failure
  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2018-023353

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    Footnotes

    • CO’C-G and RS are joint first authors.

    • 36 BC and DP are joint last authors.

    • Contributors CO-G, BC, NP and DP designed the work; RS, SA, SG, RG, AK, SM, VM, PPA, NT and KMN collected the data; CO-G and DK conducted the analysis of the data; CO-G, RS, SA, JG, KJ, DN, SM, KMN, NP, BC and DP interpreted the data of the work. CO-G, RS, BC, and NP drafted the manuscript; RS, SA, SG, JG, RG, KJ, DK, AK, SM, VM, DN, PPA, NT, KMN and DP revised the manuscript for important intellectual content, provided comments and suggested revisions. All authors approved the final version for publication.

    • Funding This work was supported in part by grant MR/P02386X/1 from the United Kingdom Medical Research Council under the Global Challenges Research Fund. It was also supported by grants from the Colt Foundation and the La Isla Foundation. The CARRS study was funded with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, under Contract No. HHSN2682009900026C. UDAY study was funded by Eli Lilly Foundation. ICMR-CHD study was funded by the Indian Council Medical Research (ICMR). The Centre for Global NCDs is supported by the Wellcome Trust Institutional Strategic Support Fund (097834/Z/11/B). CO-G was supported by a Sara Borrell postdoctoral fellowship awarded from the Carlos III National Institute of Health, Spain (CD13/00072).

    • Competing interests None declared.

    • Ethics approval Participants from CARRS, UDAY and ICMR-CHD studies provided informed consent prior to participation. The three studies obtained ethical clearance from the corresponding institutions.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The datasets used and/or analysed during the current study are available from Public Health Foundation of India (PHFI) on reasonable request. Interested investigators should contact PHFI. Computing code can be obtained from the corresponding author.

    • Correction notice This article has been corrected since it first published. After the publication of this article, the authors noticed that the map of India showing the study sites needed correction. The borders of India shown in the map were inaccurate and the authors have therefore decided to withdraw this map from the publication. The article has therefore been republished without the original figure 1. Any readers with an academic interest in the information originally displayed in the figure may contact the authors directly in relation to this information.

    • Patient consent for publication Not required.

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