title: Prevalence of chronic kidney disease and risk factors for its progression: A cross-sectional comparison of Indians living in Indian versus U.S. cities.
abstract: BACKGROUND
  While data from the latter part of the twentieth century consistently showed that immigrants to high-income countries faced higher cardio-metabolic risk than their counterparts in low- and middle-income countries, urbanization and associated lifestyle changes may be changing these patterns, even for conditions considered to be advanced manifestations of cardio-metabolic disease (e.g., chronic kidney disease [CKD]).
  
  
  RESULTS
  Using cross-sectional data from the Center for cArdiometabolic Risk Reduction in South Asia (CARRS, n = 5294) and Mediators of Atherosclerosis in South Asians Living in America (MASALA, n = 748) studies, we investigated whether prevalence of CKD is similar among Indians living in Indian and U.S. cities. We compared crude, age-, waist-to-height ratio-, and diabetes- adjusted CKD prevalence difference. Among participants identified to have CKD, we compared management of risk factors for its progression. Overall age-adjusted prevalence of CKD was similar in MASALA (14.0% [95% CI 11.8-16.3]) compared with CARRS (10.8% [95% CI 10.0-11.6]). Among men the prevalence difference was low (prevalence difference 1.8 [95% CI -1.6,5.3]) and remained low after adjustment for age, waist-to-height ratio, and diabetes status (-0.4 [-3.2,2.5]). Adjusted prevalence difference was higher among women (prevalence difference 8.9 [4.8,12.9]), but driven entirely by a higher prevalence of albuminuria among women in MASALA. Severity of CKD--i.e., degree of albuminuria and proportion of participants with reduced glomerular filtration fraction--was higher in CARRS for both men and women. Fewer participants with CKD in CARRS were effectively treated. 4% of CARRS versus 51% of MASALA participants with CKD had A1c < 7%; and 7% of CARRS versus 59% of MASALA participants blood pressure < 140/90 mmHg. Our analysis applies only to urban populations. Demographic--particularly educational attainment--differences among participants in the two studies are a potential source of bias.
  
  
  CONCLUSIONS
  Prevalence of CKD among Indians living in Indian and U.S. cities is similar. Persons with CKD living in Indian cities face higher likelihood of experiencing end-stage renal disease since they have more severe kidney disease and little evidence of risk factor management.
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.|Centre for Chronic Disease Control, New Delhi, India.|Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, United States of America.
authors.forename: Shuchi
authors.initials: S
authors.lastname: Anand
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.|Centre for Chronic Disease Control, New Delhi, India.
authors.forename: Dimple
authors.initials: D
authors.lastname: Kondal
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, United States of America.
authors.forename: Maria
authors.initials: M
authors.lastname: Montez-Rath
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, United States of America.
authors.forename: Yuanchao
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.|Centre for Chronic Disease Control, New Delhi, India.
authors.forename: Roopa
authors.initials: R
authors.lastname: Shivashankar
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.|Centre for Chronic Disease Control, New Delhi, India.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Singh
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.|Centre for Chronic Disease Control, New Delhi, India.
authors.forename: Priti
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.|Centre for Chronic Disease Control, New Delhi, India.
authors.forename: Ruby
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.|Centre for Chronic Disease Control, New Delhi, India.
authors.forename: Vamadevan S
authors.initials: VS
authors.lastname: Ajay
authors.affiliation: Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, Chennai, India.
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Mohan
authors.affiliation: Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, Chennai, India.
authors.forename: Rajendra
authors.initials: R
authors.lastname: Pradeepa
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.|Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Tandon
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.|Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.
authors.forename: Mohammed K
authors.initials: MK
authors.lastname: Ali
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.|Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, United States of America.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.affiliation: Division of General Internal Medicine and Department of Preventive Medicine, Northwestern University, Chicago, IL, United States of America.
authors.forename: Namratha
authors.initials: N
authors.lastname: Kandula
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.|Centre for Chronic Disease Control, New Delhi, India.
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
authors.affiliation: Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States of America.
authors.forename: Alka M
authors.initials: AM
authors.lastname: Kanaya
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007194:India; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D014481:United States