Women and other risk factors for chronic kidney disease of unknown etiology in Thailand: National Health Examination V Survey

Sawitri Assanangkornchai,Wichai Aekplakorn,Anchalee Chittamma,Nareemarn Neelapaichit,Suwat Chariyalertsak,Pattapong Kessomboon,Chagriya Kitiyakara,Surasak Taneepanichskul

doi:10.1038/s41598-021-00694-9

Abstract

There are limited data on chronic kidney disease of unknown etiology (CKDu) from Southeast Asia. Initially described in working age men, a common approach to detect CKDu that includes all adults has recently been proposed. We determined the prevalence, and risk factors for CKDu using data from a cross-sectional, nationally representative survey of the adult population of Thailand. We used a proxy for CKDu as age < 70 with impaired kidney function (eGFR < 60) in the absence of diabetes and hypertension (CKDu1) and heavy proteinuria (CKDu2). Prevalence estimates were probability-weighted for the Thai population. The associations between risk factors and CKDu or elderly subjects with eGFR < 60 without traditional causes were assessed by multivariable logistic regression. Of 17,329 subjects, the prevalence were: eGFR < 60, 5.3%; CKDu1 0.78%; CKDu2, 0.75%. CKDu differed by 4.3-folds between regions. Women, farmers/laborers, older age, gout, painkillers, rural area, and stones were independent risk factors for CKDu. Women, age, rural, gout, painkillers were significant risk factors for both CKDu and elderly subjects. These data collected using standardized methodology showed that the prevalence of CKDu in Thailand was low overall, although some regions had higher risk. Unlike other countries, Thai women had a two-fold higher risk of CKDu.

Highlights

There are limited data on chronic kidney disease of unknown etiology (CKDu) from Southeast Asia
Mean age was 47 years. 52% were women, 55% were from rural areas, and 56% were farmers/laborers. (Table 1) Diabetes was present in 9.8% and hypertension in 28.5%
EGFR < 60 were older, more likely to live in the rural area with a higher prevalence of women, farmers/laborers, diabetes, hypertension, gout, stones, underweight, herbal medications, painkiller use, and cardiovascular diseases, and lower percentages of secondary education, and smokers compared to No CKD

Summary

Introduction

There are limited data on chronic kidney disease of unknown etiology (CKDu) from Southeast Asia. The ISN proxy for suspected CKDu did not set an upper age limit whereas initial reports of CKDu mostly focused on working-age adults, and excluded subjects above age 70 years o ld[7] These definitions given as examples by the ISN i3C and proposed by the Disadvantaged Populations eGFR Epidemiology (DEGREE) collaboration probably give us the best insight into the burden of CKDu, they have not yet been mandated by professional o rganizations[8]. We plan (1) to assess the prevalence, regional distribution, and risk factors of CKD and CKDu in the adult general population of Thailand from the National Health Examination V (NHES V) survey and compare these with elderly subjects (age ≥ 70) with decreased kidney function without traditional causes (hypertension, diabetes (or heavy proteinuria)), and (2) to evaluate the awareness of CKDu

Methods

Results

Conclusion