Abstract
BackgroundWe aimed to determine the prevalence of chronic kidney disease (CKD) and its cross-country variation among hypertensive individuals in rural Bangladesh, Pakistan and Sri Lanka. We also explored the factors associated with CKD in these populations.MethodWe studied baseline data from the Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan and Sri Lanka (COBRA-BPS) trial, an ongoing cluster randomized controlled trial on 2643 hypertensive adults ≥40 years of age from 30 randomly selected rural clusters, 10 in each of the three countries. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 or a urine albumin:creatinine ratio (UACR) ≥30 mg/g. Determinants for CKD were assessed using logistic regression analysis.ResultsThe overall prevalence of CKD was 38.1% (95% confidence interval 36.2–40.1%): 21.5% with eGFR <60 mL/min/1.73 m2 and 24.4% with UACR ≥30 mg/g. CKD prevalence varied across the three countries (58.3% in Sri Lanka, 36.4% Bangladesh and 16.9% Pakistan; P <0.001). The factors independently associated with higher odds of CKD were older age, being unmarried, higher 24-h urinary sodium excretion, presence of diabetes, elevated systolic blood pressure, diuretic use and living in Bangladesh or Sri Lanka (versus Pakistan).ConclusionsThe prevalence of CKD is alarmingly high in community-dwelling hypertensive adults, with significant cross-country variation in South Asia. Our findings underscore the urgency for further research into the etiology of CKD and address associated factors in targeted public health strategies with hypertension care outreach services in rural South Asia.ClinicalTrials.govNCT02657746
Highlights
Chronic kidney disease (CKD), defined as a reduced estimated glomerular filtration rate or the presence of albuminuria is associated with progression to end-stage renal disease (ESRD) and increased risks of premature mortality from cardiovascular disease (CVD) [1,2,3]
We demonstrated that simple strategies such as physician education on hypertension management coupled with home health education on a healthy lifestyle are effective in lowering blood pressure (BP) and preserving kidney function in individuals with hypertension in Pakistan [14, 15]
Ours is the first study of its kind using a robust common protocol across rural communities in three South Asian countries: Bangladesh, Pakistan and Sri Lanka
Summary
Chronic kidney disease (CKD), defined as a reduced estimated glomerular filtration rate (eGFR) or the presence of albuminuria is associated with progression to end-stage renal disease (ESRD) and increased risks of premature mortality from cardiovascular disease (CVD) [1,2,3]. We aimed to determine the prevalence of chronic kidney disease (CKD) and its cross-country variation among hypertensive individuals in rural Bangladesh, Pakistan and Sri Lanka. The factors independently associated with higher odds of CKD were older age, being unmarried, higher 24-h urinary sodium excretion, presence of diabetes, elevated systolic blood pressure, diuretic use and living in Bangladesh or Sri Lanka (versus Pakistan). The prevalence of CKD is alarmingly high in community-dwelling hypertensive adults, with significant cross-country variation in South Asia. Our findings underscore the urgency for further research into the etiology of CKD and address associated factors in targeted public health strategies with hypertension care outreach services in rural South Asia.
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