title: Burden of chronic kidney disease in resource-limited settings from Peru: a population-based study.
abstract: BACKGROUND
  The silent progression of chronic kidney diseases (CKD) and its association with other chronic diseases, and high treatment costs make it a great public health concern worldwide. The population burden of CKD in Peru has yet to be fully described.
  
  
  METHODS
  We completed a cross sectional study of CKD prevalence among 404 participants (total study population median age 54.8 years, 50.2 % male) from two sites, highly-urbanized Lima and less urbanized Tumbes, who were enrolled in the population-based CRONICAS Cohort Study of cardiopulmonary health in Peru. Factors potentially associated with the presence of CKD were explored using Poisson regression, a statistical methodology used to determine prevalence ratios.
  
  
  RESULTS
  In total, 68 participants (16.8 %, 95 % CI 13.5-20.9 %) met criteria for CKD: 60 (14.9%) with proteinuria, four (1%) with eGFR < 60 mL/min/1.73 m2 , and four (1%) with both. CKD prevalence was higher in Lima (20.7 %, 95 % CI 15.8-27.1) than Tumbes (12.9 %, 95 % CI 9.0-18.5). Among participants with CKD, the prevalence of diabetes and hypertension was 19.1 % and 42.7 %, respectively. After multivariable adjustment, CKD was associated with older age, female sex, greater wealth tertile (although all wealth strata were below the poverty line), residence in Lima, and presence of diabetes and hypertension.
  
  
  CONCLUSIONS
  The high prevalence rates of CKD identified in Lima and Tumbes are similar to estimates from high-income settings. These findings highlight the need to identify occult CKD and implement strategies to prevent disease progression and secondary morbidity.
authors.affiliation: Penn State College of Medicine, Hershey, PA, USA. ebf111@gmail.com.|Office of Global Health Education, Weill Cornell Medical College, New York, NY, USA. ebf111@gmail.com.|Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. ebf111@gmail.com.|CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru. ebf111@gmail.com.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Francis
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. ckuojhsph@gmail.com.|Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan. ckuojhsph@gmail.com.
authors.forename: Chin-Chi
authors.initials: CC
authors.lastname: Kuo
authors.affiliation: CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru. antonio.bernabe@upch.pe.|School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru. antonio.bernabe@upch.pe.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bernabe-Ortiz
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. nessel@mail.med.upenn.edu.
authors.forename: Lisa
authors.initials: L
authors.lastname: Nessel
authors.affiliation: CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru. gilmanbob@gmail.com.|Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA. gilmanbob@gmail.com.|Área de Investigación y Desarrollo, Asociación Beneficia PRISMA, Lima, Peru. gilmanbob@gmail.com.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.affiliation: CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru. wcheckl1@jhmi.edu.|Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA. wcheckl1@jhmi.edu.|Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. wcheckl1@jhmi.edu.
authors.forename: William
authors.initials: W
authors.lastname: Checkley
authors.affiliation: CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru. jaime.miranda@upch.pe.|Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru. jaime.miranda@upch.pe.
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Miranda
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. hfeldman@mail.med.upenn.edu.|Departments of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. hfeldman@mail.med.upenn.edu.|Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. hfeldman@mail.med.upenn.edu.
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D050171:Dyslipidemias / Q000453:epidemiology*; D005260:Female; D006295:Health Resources / Q000600:supply & distribution; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D011507:Proteinuria / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D014505:Urban Population / Q000706:statistics & numerical data