title: An observational, cross-sectional study to assess the prevalence of chronic kidney disease in type 2 diabetes patients in India (START -India).
abstract: OBJECTIVE
  The primary objective of this study is to estimate the prevalence of chronic kidney disease (CKD) among type 2 diabetes mellitus (T2DM) patients in India.
  
  
  METHODS
  This cross-sectional, observational, epidemiological, multi-center, study is enrolling T2DM patients of either gender aged 30 years or above. This study aimed to enroll a total of 3000 T2DM patients at 30 participating hospitals/clinics across India and the data from a planned interim analysis of 1500 patients are presented here. The primary endpoint of the study is to estimate proportion of T2DM patients with CKD (glomerular filtration rate [GFR] <60 ml/min/1.73 m(2) or albumin creatinine ratio [ACR] ≥30 mg/g or ≥3 mg/mmol or both). Routine treatment, as administered by the treating physician, was continued without any study specific intervention. Patients' data pertaining to demographic characteristics, medical history, current medication and physical examination were recorded. The blood/plasma and urine samples, were collected for estimation of hemoglobin A1c, microalbuminuria, serum creatinine, urine creatinine, and routine urine analysis. ACR was calculated from urine creatinine and albumin while GFR was estimated by using a modification of diet in the renal disease equation.
  
  
  RESULTS
  Study recruited 1500 patients from 18 centers across India. The study population included 840 (56.05%) males. Mean age, body mass index and systolic blood pressure were 55.1 years, 27.4 kg/m(2) and 134.5 mmHg respectively. The mean duration of diabetes was 102.2 months. History of co-morbid diseases such as dyslipidemia, hypertension, microvascular complications and macrovascular complications was present in 657 (43.8%), 655 (43.7%), 268 (17.9%) and 104 (6.93%), respectively. This interim analysis revealed that about 46% of the T2DM patients had CKD (urinary albumin creatinine ratio (UACR) ≥30 mg/g and/or estimated GFR [eGFR] <60 mL/min/1.73 m(2)). The renal dysfunction as per eGFR criteria (<60 mL/min/1.73 m(2)) was reported in about 23% while as per UACR criteria (≥30 mg/g) it was reported in about 35% patients.
  
  
  CONCLUSIONS
  This interim analysis results suggests that over 40% of T2DM patients have CKD. Despite this high number of T2DM patients with CKD, eGFR analysis shows there are almost 80% of T2DM patients still have reasonably good renal function (eGFR above 60 ml/min), which ensures less restrictions in selecting oral anti-diabetic drugs. Full study results from Start-India study will provide detail insights into the occurrence of CKD in patients with T2DM in India.
authors.affiliation: Senior Consultant Endocrinologist, Center for Diabetes and Endocrine Care, Bangalore, Karnataka, India.
authors.forename: M
authors.initials: M
authors.lastname: Prasannakumar
authors.affiliation: Senior Professor and Head, Department of Endocrinology, PGIMS, Rohtak, Haryana, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Rajput
authors.affiliation: Head, Department of Endocrinology, Sri Ramchandra Medical College, Chennai, Tamil Nadu, India.
authors.forename: Krishna
authors.initials: K
authors.lastname: Seshadri
authors.affiliation: Consultant Diabetologist, Talwalkar Diabetes Clinic, Mumbai, Maharashtra, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Talwalkar
authors.affiliation: Consultant Endocrinologist, Hormone Care and Research Centre, Ghaziabad, Uttar Pradesh, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Agarwal
authors.affiliation: Head, Department of Nephrology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India.
authors.forename: G
authors.initials: G
authors.lastname: Gokulnath
authors.affiliation: Medical Affairs, AstraZeneca Pharma India Limited, Bangalore, Karnataka, India.
authors.forename: Bhavesh
authors.initials: B
authors.lastname: Kotak
authors.affiliation: Medical Affairs, AstraZeneca Pharma India Limited, Bangalore, Karnataka, India.
authors.forename: Ammar
authors.initials: A
authors.lastname: Raza
authors.affiliation: Medical Affairs, AstraZeneca Pharma India Limited, Bangalore, Karnataka, India.
authors.forename: Hardik
authors.initials: H
authors.lastname: Vasnawala
authors.affiliation: Medical Affairs, AstraZeneca Pharma India Limited, Bangalore, Karnataka, India.
authors.forename: Chirag
authors.initials: C
authors.lastname: Teli
keywords: Albumin creatinine ratio; chronic kidney disease; diabetes mellitus; glomerular filtration rate; renal dysfunction