CKD and CKDu in northern Peru: a cross-sectional analysis under the DEGREE protocol

J Jaime Miranda,Ben Caplin,Andrea Ruiz-Alejos,Antonio Bernabé-Ortiz,Neil Pearce

doi:10.1186/s12882-021-02239-8

Abstract

BackgroundThis study estimated the prevalence and risk factors for decreased estimated glomerular filtration rate (eGFR) in those without known hypertension, type 2 diabetes mellitus, or heavy proteinuria as a surrogate marker for chronic kidney disease of unknown cause (CKDu) among adults in the North of Peru.MethodsA cross-sectional study was conducted following the Disadvantaged Populations eGFR Epidemiology (DEGREE) Study protocol. Low eGFR was defined based on a single eGFR ≤60 mL/min/1.7m2 estimated using the CKD-EPI equation. Environmental conditions related to CKDu (i.e., work in agriculture or sugarcane, water source, heat intolerance, and pesticide exposure) were evaluated, in addition to traditional risk factors for CKD (i.e., smoking, heavy drinking, physical activity, hypertension, type 2 diabetes mellitus, urolithiasis, among others).ResultsA total of 1514 subjects were included in the study, mean age 45.1 (SD: 16.4), and 55.2% were females. Overall, only 26 cases (1.7%; 95%CI: 1.1–2.5%) had an eGFR < 60 mL/min/1.7m2 compatible with CKD definition; when those with hypertension and type-2 diabetes or heavy proteinuria were excluded, according to the DEGREE protocol, the estimate fell to 0.9% (95%CI: 0.4–1.5%). Low physical activity levels (OR = 1.99; 95%CI: 1.18–3.34), hypertension (OR = 2.07; 1.26–3.41), and urolithiasis (OR = 1.97; 95%CI: 1.18–3.27) were factors associated with low eGFR.ConclusionsA low population-based prevalence of low eGFR (as a surrogate for CKDu), both in rural and urban settings areas, in the Northern Peru, was found. Low physical activity levels, hypertension and urolithiasis were factors associated with low eGFR. Interventions to prevent CKD cases may be focused on well-known CV risk factors and urolithiasis.

Highlights

This study estimated the prevalence and risk factors for decreased estimated glomerular filtration rate in those without known hypertension, type 2 diabetes mellitus, or heavy proteinuria as a surrogate marker for chronic kidney disease of unknown cause (CKDu) among adults in the North of Peru
A total of 274 (18.1%) participants self-reported a previous diagnosis of CKD, mean creatinine was 0.7 (SD: 0.2) mg/dl, and urolithiasis was reported in 15.7% of the total sample (Supplementary Table 3)
Main findings The findings of this study are interesting because this has been conducted in a setting with high frequency of environmental exposures that have been hypothesized to be associated with Chronic kidney disease of unknown cause (CKDu) in other populations

Summary

Introduction

This study estimated the prevalence and risk factors for decreased estimated glomerular filtration rate (eGFR) in those without known hypertension, type 2 diabetes mellitus, or heavy proteinuria as a surrogate marker for chronic kidney disease of unknown cause (CKDu) among adults in the North of Peru. Age-related noncommunicable diseases (NCDs) and conditions such as hypertension (HTN) and type 2 diabetes mellitus (T2DM) are the main risk factors associated with CKD; in addition, other causes include autoimmune disease, congenital abnormalities of the urinary tract, and obstructive uropathy. The causes of CKDu are unknown [7], but the hypothesized causes include pesticide exposure and heavy metal poisoning associated with agriculture work, as well as heat stress in low-altitude areas. The latter hypothesis proposes that environmental heat, in combination with recurrent dehydration and high-levels of physical exertion, lead to recurrent acute kidney injury episodes and eventually CKD [8]. CKDu has not been reported in other countries where this combination of risk factors could be found [9, 10]

Objectives

Methods

Results

Discussion

Conclusion