Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study.
BACKGROUND
Chronic kidney disease is an important cause of global mortality and morbidity. Data for epidemiological features of chronic kidney disease and its risk factors are limited for low-income and middle-income countries. The International Society of Nephrology's Kidney Disease Data Center (ISN-KDDC) aimed to assess the prevalence and awareness of chronic kidney disease and its risk factors, and to investigate the risk of cardiovascular disease, in countries of low and middle income.


METHODS
We did a cross-sectional study in 12 countries from six world regions: Bangladesh, Bolivia, Bosnia and Herzegovina, China, Egypt, Georgia, India, Iran, Moldova, Mongolia, Nepal, and Nigeria. We analysed data from screening programmes in these countries, matching eight general and four high-risk population cohorts collected in the ISN-KDDC database. High-risk cohorts were individuals at risk of or with a diagnosis of either chronic kidney disease, hypertension, diabetes, or cardiovascular disease. Participants completed a self-report questionnaire, had their blood pressure measured, and blood and urine samples taken. We defined chronic kidney disease according to modified KDIGO (Kidney Disease: Improving Global Outcomes) criteria; risk of cardiovascular disease development was estimated with the Framingham risk score.


RESULTS
75,058 individuals were included in the study. The prevalence of chronic kidney disease was 14·3% (95% CI 14·0-14·5) in general populations and 36·1% (34·7-37·6) in high-risk populations. Overall awareness of chronic kidney disease was low, with 409 (6%) of 6631 individuals in general populations and 150 (10%) of 1524 participants from high-risk populations aware they had chronic kidney disease. Moreover, in the general population, 5600 (44%) of 12,751 individuals with hypertension did not know they had the disorder, and 973 (31%) of 3130 people with diabetes were unaware they had that disease. The number of participants at high risk of cardiovascular disease, according to the Framingham risk score, was underestimated compared with KDIGO guidelines. For example, all individuals with chronic kidney disease should be considered at high risk of cardiovascular disease, but the Framingham risk score detects only 23% in the general population, and only 38% in high-risk cohorts.


CONCLUSIONS
Prevalence of chronic kidney disease was high in general and high-risk populations from countries of low and middle income. Moreover, awareness of chronic kidney disease and other non-communicable diseases was low, and a substantial number of individuals who knew they were ill did not receive treatment. Prospective programmes with repeat testing are needed to confirm the diagnosis of chronic kidney disease and its risk factors. Furthermore, in general, health-care workforces in countries of low and middle income need strengthening.


BACKGROUND
International Society of Nephrology.
IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy. Electronic address: bogdan.ene-iordache@marionegri.it.
Bogdan
B
Ene-Iordache
IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy.
Norberto
N
Perico
Department of Nephrology, A I Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia; Department of Nephrology Issues of Transplanted Kidney, Academician V I Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia.
Boris
B
Bikbov
IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy.
Sergio
S
Carminati
IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy; Department of Management, Information and Production and Engineering, University of Bergamo, Dalmine, Italy.
Andrea
A
Remuzzi
IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy.
Annalisa
A
Perna
Department of Nephrology, North East Medical College Hospital, Sylhet, Bangladesh.
Nazmul
N
Islam
Department of Medicine, Hospital Juan XXIII, La Paz, Bolivia.
Rodolfo Flores
RF
Bravo
Department of Nephrology, Dialysis and Kidney Transplantation, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
Mirna
M
Aleckovic-Halilovic
Department of Nephrology, Institute of Nephrology and Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
Hequn
H
Zou
Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China.
Luxia
L
Zhang
Department of Nephrology, Damanhour Medical National Institute, General Organization of Teaching Hospitals and Institutes, Damanhour, Egypt.
Zaghloul
Z
Gouda
Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia.
Irma
I
Tchokhonelidze
Tamilnad Kidney Research Foundation, Chennai, India.
Georgi
G
Abraham
Department of Nephrology, Tehran University of Medical Sciences, Research Center of Iranian Tissue Bank, Tehran, Iran.
Mitra
M
Mahdavi-Mazdeh
Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, University of Milan, Milan, Italy.
Maurizio
M
Gallieni
Transplant Agency of Moldova, Chisinau, Moldova.
Igor
I
Codreanu
Department of Nephrology, University of Mongolia, Ulaan Bataar, Mongolia.
Ariunaa
A
Togtokh
Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
Sanjib Kumar
SK
Sharma
Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
Puru
P
Koirala
School of Public Health and Department of Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
Samyog
S
Uprety
Renal Unit, Department of Medicine, College of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria.
Ifeoma
I
Ulasi
IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy; Department of Medicine, Unit of Nephrology and Dialysis, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
Giuseppe
G
Remuzzi
D000328:Adult; D000368:Aged; D001364:Awareness; D001459:Bangladesh / Q000453:epidemiology; D001838:Bolivia / Q000453:epidemiology; D017522:Bosnia and Herzegovina / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology*; D004534:Egypt / Q000453:epidemiology; D005260:Female; D005846:Georgia (Republic) / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D007194:India / Q000453:epidemiology; D007492:Iran / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D008966:Moldova / Q000453:epidemiology; D008986:Mongolia / Q000453:epidemiology; D009390:Nepal / Q000453:epidemiology; D009549:Nigeria / Q000453:epidemiology; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D012307:Risk Factors; D011795:Surveys and Questionnaires