An estimation of the prevalence and progression of chronic kidney disease in a rural diabetic cambodian population.
BACKGROUND
To date, there are no known estimates of the prevalence of chronic kidney disease within Cambodia, the vast majority of whose citizens live in rural areas with limited access to renal replacement therapy.


METHODS
Observational analysis of patients from the Takeo province in Cambodia who presented to MoPoTsyo, a non-governmental organization, for screening and management of diabetes mellitus between 2010 and 2012 (n = 402; 75% females). Estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epi equation.


RESULTS
On average, women were younger, with a higher percentage of hypercholesterolemia but also high-density lipoprotein level. Men had a higher serum creatinine level (1.31 mg/dl) than that of women (1.13 mg/dl) at 95% CI. More than half of all screened patients had a reduced eGFR; 60% (95% CI 55%, 65%) had an eGFR<60 ml/min/1.73 m(2); 54% (49%, 59%) had an eGFR 30-60 ml/min/1.73 m(2), and 5.7% (3.4%, 8.0%) with eGFR 15-30 ml/min/1.73 m(2). Women had a greater prevalence of stage 3 CKD (57% women vs. 47% men) and stage 4 CKD (7.0% vs. 2.0%). The adjusted odds ratio for females compared to males having an eGFR <60 ml/min/1.73 m(2) was 3.19 (95% CI 1.78, 5.43; p value<0.001). Thirty-two percent of patients lost ≥ 5 ml/min/1.73 m2 eGFR during median follow-up time of 433 days (IQR 462 days) days.


CONCLUSIONS
Over one-half of Cambodians with diabetes mellitus had reduced eGFR, implying a point-prevalence of chronic kidney disease of 1.2% in among adult Cambodians within the country. This high burden of kidney disease in a society that lacks universal access to renal replacement therapy underscores the importance of early diagnosis - a largely unmet need in Cambodia.
Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, United States of America.
Bernadette
B
Thomas
MoPoTsyo Patient Information Centre, Phnom Penh, Cambodia.
Maurits
M
van Pelt
Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, United States of America.
Rajnish
R
Mehrotra
Kidney Research Institute, University of Washington, Seattle, Washington, United States of America.
Cassianne
C
Robinson-Cohen
Department of Medicine, University of Washington, Seattle, Washington, United States of America.
James
J
LoGerfo
D002160:Cambodia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors; D012424:Rural Population; D012737:Sex Factors