Chronic kidney disease among diabetes and hypertensive patients in a remote rural area of south India: A population-based cross-sectional study
Ariarathinam Newtonraj, Stephen Tovia, Ganesan Girija, Mani Manikandan, Antony Vincent
Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
|Date of Submission||04-Jun-2020|
|Date of Acceptance||29-Aug-2020|
|Date of Web Publication||16-Feb-2021|
Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry - 605 014
Source of Support: None, Conflict of Interest: None
|How to cite this URL:|
Newtonraj A, Tovia S, Girija G, Manikandan M, Vincent A. Chronic kidney disease among diabetes and hypertensive patients in a remote rural area of south India: A population-based cross-sectional study. Indian J Nephrol [Epub ahead of print] [cited 2021 Jun 18]. Available from: https://www.indianjnephrol.org/preprintarticle.asp?id=309554
Chronic Kidney disease (CKD) is one of the leading public health problems in India. Diabetes (DM) is the major cause for CKD and end-stage kidney disease (ESKD) in India, which is accounting for one-third of the causes, followed by hypertension (HT) (13%), glomerulonephritis (14%) and others. Burden of CKD is high in rural India where there is poor literacy rate and low socioeconomic status. Even though there is a lot of scope for research and strengthening of rural community health, there is subtle information available about the data on CKD among HT and DM patients in the remote rural area of South India, at the population level.
We conducted a study among high-risk patients for CKD (diabetes and hypertension) covering ten villages surrounding our Rural Health and Training Centre (RHTC), under the Department of Community Medicine. This study was conducted in August and September 2017, using a pretested questionnaire with the help of interns and Medical Social Workers under the supervision of faculty from Community Medicine after Institute Ethics Board Clearance (Ref No RC 18/55). After line listing of DM and HT cases from our electronic family record, participants were approached house to house and enrolled in the study. Blood samples were collected in appropriate tubes at their doorsteps and were transferred to the NABL accredited laboratory in the main campus, where all the analysis were done. A detailed methodology was described elsewhere. Estimated Glomerular Filtration Rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula and the patients having eGFR ≤60 ml/min/1.73m2 were classified as CKD.
In total 303 individuals were screened among them 102 (34%) were hypertension patients, 76 (25%) were diabetes patients and 125 (41%) were having both hypertension and diabetes. Among these 303 individuals, 41 [14% (CI 10–17)] individuals were found to have CKD (eGFR <60 ml/min/1.73m2). In this 14 [14% (7–20)] were hypertension patients, 8 [11%( 4–17)] were diabetes patients and 19 [15%(9–21)] were having both Hypertension and Diabetes. The prevalence of CKD is little lower (11%) in DM only cases than hypertensive patients (14% and 15%) in our study. After adjustment for risk factors showing near significance (P < 0.2); increase in age [aPR 1.07 (1.03–1.1)], male gender [aPR (3.8 (1.8–8.3)], under-weight [aPR (2.1 (1-5.3)] and overt hypothyroidism [aPR (3.5 (1.0–13)] were likely to have increased risk for CKD. Association between CKD and other independent significant risk factors among HT and DM patients, after adjustment are shown in [Table 1] and the factors like occupation, education, income, alcohol use, salt intake, anaemia, triglycerides, low-density lipoprotein and HT & DM status didn't show any significant association with CKD.
|Table 1: Relationship between chronic kidney disease and other risk factors among diabetes and hypertensive patients in a rural area of South India|
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This is one of a very few population-based studies done in a remote rural population of South India.Under NPCDCS Programme these HT and DM individuals were taken care by the nearby PHCs, through NCD clinic. This screening could be easily incorporated in the Primary Care setting through National Health Programme (NPCDCS) and it is feasible and economical.This initial diagnosis on CKD will lead to appropriate and early intervention with the support of tertiary care and Nephrology experts and the back referral by tertiary care to PHC for regular follow up and treatment adherence could also be possible. By this, we provide an addition evidence to reach the unreached in early diagnosis. An important finding in this study was prevalence of CKD (14%) was found to be two times higher thana rural South Indian study among the general population (6.3%). Another important finding was overt hypothyroidism (TSH >10 mIU/L) patients have 3.5 times more likely to have CKD, which is noticed in few other studies. Other studies have found that the prevalence of CKD is higher among the rural population because of the illiteracy, poor access to health care, weak health system, lack of knowledge among high-risk people and even among primary health care providers.
One of the limitations in our study was, we couldn't able to further confirm the diagnosis with imaging and total urinary protein. Second, in our study most of the participants were females, as they are available in the home at the time of our field visit and in most of the houses males leave the home to attend their job. Third, this is a cross-sectional study among high-risk population. A comparative study with general population may be yield more evidences. The main strength in our study was it is a population-based screening in a remote rural area covering twenty villages and added strength to the Public Health and Primary Health Care setting. To conclude, the prevalence of CKD among the high-risk patients (DM and HT) was 14% and is significantly associated with an increase in age, Male gender, underweight and hypothyroidism.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Rajapurkar MM, John GT, Kirpalani AL, Abraham G, Agarwal SK, Almeida AF, et al
. What do we know about chronic kidney disease in India: First report of the Indian CKD registry. BMC Nephrol 2012;13:10.
Newtonraj A, Selvaraj K, Purty AJ, Nanda SK, Arokiaraj MC, Vincent A, et al
. Feasibility and outcome of community-based screening for cardiovascular disease risk factors in a remote rural area of South India: The Chunampet rural–Cardiovascular health assessment and management program. Indian J Endocrinol Metab 2019;23:628.
Levey AS, Stevens LA, Schmid CH, Zhang Y (Lucy), Castro AF, Feldman HI, et al
. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604.
Anupama YJ, Uma G. Prevalence of chronic kidney disease among adults in a rural community in South India: Results from the kidney disease screening (KIDS) project. Indian J Nephrol2014;24:214–21.
] [Full text]
Chandra A. Prevalence of hypothyroidism in patients with chronic kidney disease: A cross-sectional study from North India. Kidney Res Clin Pract 2016;35:165-8.
Jessani S, Bux R, Jafar TH. Prevalence, determinants, and management of chronic kidney disease in Karachi, Pakistan-A community based cross-sectional study. BMC Nephrol 2014;15:90.