Abstract
BackgroundUrban migration is associated with an increased risk of hypertension, obesity and diabetes in Indian migrants. This study assessed the relationship between internal migration and renal function in the Hyderabad arm of the Indian Migration Study.MethodsWe assessed 841 subjects; urban non-migrants (n = 158), urban migrants (n = 424) and rural non-migrants (n = 259). Muscle mass was ascertained from DXA scanning. We derived urban life years for urban migrants and rural non-migrants. Multivariable linear regression was used to examine the association between tertiles of urban life years and 4-variable MDRD eGFR using Stata 11.ResultsMean eGFR was lower in urban non-migrants and urban migrants compared to rural non-migrants. The prevalence of CKD 3-5 was higher in the rural non-migrant population (5.0%) than in the urban non-migrant populations (2.5%) due to a negatively skewed distribution of eGFR in rural non-migrants. As urban life years increased, eGFR declined (p = 0.008) though there was no obvious dose response effect. After adjustment for muscle mass, the association was attenuated and the trend was consistent with chance (p = 0.08). Further adjustment for vascular risk factors weakened the association to a small degree (p = 0.11).ConclusionsThe high prevalence of reduced eGFR in rural areas requires further research. Urbanization was associated with reduced eGFR. This association appears mostly to be due to higher muscle mass with a small contribution from adverse vascular disease risk factors.
Highlights
Urban migration is associated with an increased risk of hypertension, obesity and diabetes in Indian migrants
917 individuals were eligible for analysis. 76 individuals were excluded from analyses due to discrepancies between urban life years and original migrant status
Mean estimated Glomerular Filtration Rate (eGFR) as estimated by Modification of Diet in Renal Disease (MDRD) was lower in urban nonmigrants and urban migrants compared to rural nonmigrants
Summary
Urban migration is associated with an increased risk of hypertension, obesity and diabetes in Indian migrants. Studies of renal function among South Asian populations living in the UK have shown higher acceptance rates for renal replacement treatment [10], which is probably secondary to a higher incidence of end-stage renal failure. This may be partly due to a higher prevalence of Type 2 diabetes and an increased risk of renal failure as a complication [11] but it is difficult in the UK to distinguish between the health effects of migration, and socio-cultural and ethnic differences in an epidemiological study. To date there has been no previous work published in this area
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