Indian Chronic Kidney Disease Research Articles

Reduced Kidney Function, Albuminuria, and Risks for All-cause and Cardiovascular Mortality in China: A Population-based Cohort Study

BackgroundPrevious studies have indicated that reduced kidney function and albuminuria are associated with increased risk of mortality and adverse cardiovascular outcomes, however, the evidence from the Asian population is limited. We investigated the association between the indicators of chronic kidney disease (CKD) and all-cause mortality, as well as cardiovascular mortality among a general population in China.MethodsWe conducted an observational study among 47,204 Chinese adults, from a cross-sectional survey, whose survival status is identified through December 31, 2013. Estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR) were used as indicators of CKD. We determined the rates of all-cause and cardiovascular mortality.ResultsThe incidence rates for both all-cause and cardiovascular mortality increased with the advanced stages of reduced eGFR or elevated ACR. Elevated ACR levels were found to be significantly associated with increased risk of both all-cause and cardiovascular mortality, as shown in the Cox proportional hazards regression model. The multivariable adjusted hazard ratios (HR) associated with all-cause mortality were 1.26 (95% confidence interval [CI]: 1.04–1.53) for those with ACR 30–299 mg/g and 2.07 (95% CI: 1.40–3.04) with ACR ≥ 300 mg/g, compared to those with ACR <30 mg/g. The corresponding HRs for the above ACR levels associated with cardiovascular mortality were 1.08 (95% CI: 0.77–1.50) and 2.32 (95% CI: 1.31–4.12), respectively. We did not identify reduced eGFR as a risk predictor in the multivariable adjusted model for the adverse outcomes in the population, however, an interaction between eGFR and age were detected. Stratified analyses revealed that the associations of reduced eGFR (<60 mL/min/1.73 m2) with all-cause mortality were prominent among participants aged less than 65 years.ConclusionsAlbuminuria was associated with an elevated risk of all-cause and cardiovascular mortality among the Chinese population, however, the association of reduced kidney function with all-cause mortality was not clear.

Comparison of Chronic Kidney Disease Epidemiology Collaboration Equations with Other Accepted Equations for Estimation of Glomerular Filtration Rate in Indian Chronic Kidney Disease Patients

Background and Aim: In routine clinical practice, the estimation of glomerular filtration rate (GFR) based on serum creatinine has been followed. However, the reliability of creatinine in estimation of GFR is biased and imprecise, leading to the misdiagnosis of chronic kidney disease (CKD). The serum cystatin C is an alternative marker for estimating GFR. Hence, we aimed to compare the newly proposed Chronic Kidney Disease Epidemiology Collaboration Equations (CKD-EPI) with four approved equations based on both creatinine and cystatin C with reference to Tc-99m-diethylenetriamine pentaacetate (Tc-99m-DTPA) considered as a standard.Materials and Methods:Two hundred and one patients were enrolled in the study from a private nephrology outpatient clinic(OPD), Tiruchirappalli, India. The serum creatinine and cystatin C were measured along with routine biochemistry tests. The measurement of GFR was done by Tc-99m-DTPA gates method. The estimated GFR (eGFR) were calculated using serum cystatin C and creatinine based formulae along with the new CKD-EPI formulae. All eGFR estimations were compared with the measured GFR by gates method.Results: The average measured GFR of end stage, severe, moderate, mild renal disease and normal patient groups were 10.17±2.47, 22.58±4.40, 39.05±7.06, 69.62±24.64 and 118.06±29.23 respectively. When comparing the diagnostic accuracy for predicting GFR using well established formulae, the cystatin C based formulae have shown to be highly accurate in all stages of CKD than creatinine based formulae. Among cystatin C based formulae, CKD-EPI Cystatin C had relatively better diagnostic accuracy for predicting GFR in all stages of CKD.Conclusion: CKD-EPI Cystatin C formula has unbiased and more accurate to predict GFR in all stages of CKD.Bangladesh Journal of Medical Science Vol.16(2) 2017 p.238-244

Lung function and impaired kidney function in relation to metabolic syndrome.

This study aimed to assess the relationships between abnormal lung function and indicators of chronic kidney disease in relation to metabolic syndrome (MetS) by using data from the 2011-2013 Korea National Health and Nutrition Examination Survey. Using the data of 8551 Korean adults (3798 men, 4753 women, ≥40years), lung function categories [obstructive lung disease (OLD), restrictive lung disease (RLD), and non-obstructive/non-restrictive lung disease (reference group)] were defined for each gender. Albuminuria and low estimated glomerular filtration rate (eGFR) were defined as urine albumin-to-creatinine ratio ≥30mg/g and eGFR<60mL/min/1.73m2. Gender-specific logistic regression analysis was performed after adjusting for age, educational level, smoking, alcohol use, physical activity, and medication use for chronic diseases. Compared to the reference group, low eGFR was associated with higher odds for RLD in men and RLD or OLD in women when they did not have MetS. In those with MetS, low eGFR was associated with higher odds for OLD in men and RLD or OLD in women. Albuminuria was associated with higher odds for RLD in men who did not have MetS, while it was associated with higher odds for RLD or OLD in men and women who had MetS. Abnormal lung function was associated with increased odds for chronic kidney disease indicators, when combined with MetS in both gender. Even in those without MetS, RLD in men was associated with increased odds for low eGFR or albuminuria, while RLD or OLD in women was associated with increased odds for low eGFR.

Indian chronic kidney disease study: Design and methods.

The rate and factors that influence progression of chronic kidney disease (CKD) in developing countries like India are unknown. A pan-country prospective, observational cohort study is needed to address these knowledge gaps. The Indian Chronic Kidney Disease (ICKD) study will be a cohort study of approximately 5000 patients with mild to moderate CKD presenting to centres that represent different geographical regions in India. Time to 50% decline in baseline estimated glomerular filtration rate, need of renal replacement therapy or any new cardiovascular disease (CVD) event or death from CVD are the primary end points. This study will provide the opportunity to determine risk factors for CKD progression and development of CVD in Indian subjects and perform international comparisons to determine ethnic and geographical differences. A bio-repository will provide a chance to discover biomarkers and explore genetic risk factors.

Darbepoetin alfa: review in the management of anemia in patients with chronic kidney disease

Chronic kidney disease (CKD) is a significant clinical problem across the world including India. The SEEK (Screening and Early Evaluation of Kidney Disease) study from India reported the prevalence of CKD as 17.2%. Diabetic nephropathy, undetermined etiology, chronic glomerulonephritis and hypertensive nephrosclerosis are the common causes of CKD in India. Rising rates of diabetes and hypertension, late presentation of patients to nephrologists and limited number of nephrologists in India adds to the concerns related to management of CKD. Considering the pathophysiology of CKD, anemia is almost an inevitable complication in these patients. Untreated anemia significantly contributes to the morbidity and mortality associated with CKD. Early recognition, timely management with appropriate therapy helps to reduce the complications of anemia. Erythropoiesis-stimulating agents (ESAs) are one of the important measures for correction of anemia in CKD patients. Darbepoetin, an ESA is a valuable therapeutic option for the treatment of anemia in CKD patients and has played a vital role in enhancing anemia management. In this article we reviewed the efficacy and safety data along with key benefits and place of darbepoetin alfa in the management of anemia in CKD patients.

Association of lipid abnormalities and oxidative stress with diabetic nephropathy

Chronic kidney disease (CKD) is characterized by progressive loss of renal function. Although the burden of CKD in India cannot be assessed accurately, its approximate prevalence is believed to be 800 per million populations (pmp), and the incidence of end-stage renal disease (ESRD) is 150–200 pmp. Diabetic nephropathy is a leading cause of ESRD worldwide. Another cause of ESRD is dyslipidemia, which is one of the most common quantitative lipid abnormalities in patients with CKD. In diabetes, the total cholesterol and triglyceride levels rise as the albumin excretion rate increases, leading to renal injury. Oxidative stress generated by hyperglycemia increases reactive oxygen species production, which causes cellular dysfunction and damage, and ultimately results in diabetic micro- and macro-vascular complications. Therefore, lipids may represent a useful clinical tool for not only identifying patients at a high risk of developing CVD but also assessing the development and progression of renal disease. In this review, we summarize the effects of lipid abnormalities and oxidative stress in patients with diabetes and nephropathy.

The Relationship between Metabolic Acidosis and Nutritional Parameters in Patients on Hemodialysis.

The progressive loss of kidney function is accompanied by metabolic acidosis. The relationship between metabolic acidosis, nutritional status, and oral bicarbonate supplementation has not been assessed in the Indian chronic kidney disease (CKD) population who are on maintenance hemodialysis (MHD). This is a single-center prospective study conducted in the Western part of India. Thirty-five patients, who were receiving MHD were assessed for metabolic acidosis along with various nutritional parameters at the baseline and at the follow-up after 3 months, postcorrection of acidosis with oral sodium bicarbonate supplements. The relationship between the correction of metabolic acidosis with oral bicarbonate supplements and changes in dietary and various nutritional parameters were evaluated. Metabolic acidosis at the baseline evaluation was found in 62.86% cases of the cohort with a mean serum bicarbonate value of 20.18 ± 4.93 mmol/L. The correction of acidosis with increment in the mean dosage of oral sodium bicarbonate supplements from 0.69 ± 0.410 mmol/kg/day at baseline to 1.04 ± 0.612 mmol/kg/day, significantly reduced the prevalence of metabolic acidosis to 23.33% cases at the follow-up. Improvement in serum bicarbonate level showed significant dietary, anthropometric, and nutritional improvements in these patients. Hence, we conclude that correction of metabolic acidosis with optimal oral bicarbonate supplementation plays a pivotal role in the treatment of malnourished CKD patients on MHD.

The impact of kidney foundations in alleviating the burden of CKD in India - an example, Tamilnad Kidney Research Foundation.

Chronic kidney disease (CKD) is a major public health problem in India. The CKD registry of India has been formed to understand the epidemiology of CKD in India. Due to health economics in India, the majority of CKD-affected patients cannot afford renal replacement therapy (RRT) services. There is an unmet need to improve the awareness of kidney disease in India, and the focus should be on prevention and early detection of CKD by screening high risk populations. The Tamilnad Kidney Research (TANKER) Foundation is a charitable trust established in 1993 with the aim to improve awareness and provide quality affordable treatment to underprivileged patients. TANKER is supported by contributions from well-wishers. It has three arms: i) treatment arm, ii) research arm, and iii) awareness and screening arm. TANKER Foundation offers free and subsidized dialysis twice weekly to 227 underprivileged patients. TANKER dialysis has been supported by state government funding schemes. TANKER actively supports and conducts research in nephrology. More than 100,000 people have benefitted from TANKER's kidney awareness programs. The screening programs have provided for early detection of CKD in both urban and rural areas. TANKER award functions are held annually to recognize research and exemplary service to society. The TANKER Foundation can be used as a model for developing countries to address the unmet needs in CKD management.

Hypertension is an important risk determinant for chronic kidney disease: results from a cross-sectional, observational study from a rural population in South India.

Hypertension (HTN) is an important cause for chronic kidney disease (CKD). There is a paucity of studies exploring the association of HTN with CKD from rural India. The objective of the study was to determine the prevalence and the determinants for HTN in a rural population in South India, focusing on the association with CKD. In a cross-sectional study on 2984 adults in three villages, demographic and anthropometric data were collected. Blood pressure was recorded on all individuals and prevalence was estimated. Proteinuria, microalbuminuria (MA) and estimated glomerular filtration rate (eGFR) were determined in a subgroup of 1331 subjects and the relation with HTN was analysed. Prevalence of HTN was 30.4% (95% CI 28.75-32.05%). In all, 78.08% had stage 1 HTN while 22% had stage 2 HTN. In total, 27.4% (249/908) subjects were aware of their hypertensive status. Of them, only 14.4% had adequate control of blood pressure. Age>50 years, diabetes, body mass index >25 and eGFR<60 ml min-1 were independent significant predictors of HTN (P<0.05). HTN was found to be an important risk factor for CKD even after adjusting for age, diabetes and cardiovascular risk factors (OR 2.22, 95% CI 1.46-3.36, P<0.001). The high prevalence of HTN, very low level of awareness and control, and the significant association with kidney disease indicate a need for stronger public health initiative with better penetration for awareness and screening for HTN and CKD in India's villages.

Novel regulations of MEF2-A, MEF2-D, and CACNA1S in the functional incompetence of adipose-derived mesenchymal stem cells by induced indoxyl sulfate in chronic kidney disease.

Indoxyl sulfate (IS) is a digestive intermediate product that is a known indicator of chronic kidney disease. Its toxicity has also been suggested to accelerate chronic kidney disease. Recently, mesenchymal stem cells (MSCs) have been confirmed as a potential treatment in kidney regeneration. To determine the universal alteration in gene expression, we combined high-throughput microarray technology and in vitro culture of adipose-derived mesenchymal stem cells at different doses of IS (20, 40, 60mg/l). We found that indoxyl sulfate has a remarkable interconnection with stem cell and calcium/calmodulin-dependent kinase pathways. In vitro results showed that indoxyl sulfate exerts anti-proliferation and anti-migration effects on ADMSCs. In addition, IS effects lead to increase in apoptotic cells and cells arrested at the G1 phase. Moreover, MEF2-A, MEF2-D and CACNA1S expression significantly decreased after indoxyl sulfate treatment. It can be speculated that following treatment with indoxyl sulfate, the function of ADMSCs is decreased and ADMSCs' ability to support renal tubule regeneration in chronic kidney disease patients may be lower.

Evaluation of Interleukin 8 gene polymorphism for predicting inflammation in Indian chronic kidney disease and peritoneal dialysis patients

Background and aimPrevious studies have observed the association between inflammation and chronic kidney disease (CKD). The role played by Interleukin 8 (IL8) gene polymorphism has not been studied yet. Hence, the present study has been designed as the first attempt to identify the possible associations between polymorphism of the IL-8 gene and patients with diabetic CKD and on continuous ambulatory peritoneal dialysis (CAPD). Materials and methodsA total of 150 participants were selected from a private nephrology outpatient clinic. The subjects were divided into three groups: healthy individuals without any renal complications (group 1, control, n=50), patients with diabetic chronic kidney disease of stages 3 and 4 (group 2, n=50) and CAPD (group 3, n=50). Blood deoxyribo nucleic acid (DNA) isolated from the members of the study group, was confirmed by agarose gel electrophoresis and primers specific for IL8 gene were designed, using primer3 software tool. ResultsRestriction digestion of the amplicons with Escherichia coli restriction enzyme I (EcoRI) ended up in 203 base pairs (bp) band in control and 108bp band in all diabetic and non-diabetic CKD. This indicated the presence of polymorphism in +781 Cytosine/Thymine (C/T) of IL-8 gene in diabetic CKD and CAPD patients. Statistical analysis of the distribution of frequencies of alleles C and T by chi square test confirmed the presence of polymorphism at +781 C/T of IL-8 gene in patient groups compared to control. ConclusionThe polymorphism in +781 C/T of IL-8 gene studied in this work suggests its possible role as an inflammatory marker for both chronic kidney disease and CAPD.

Impact of Type 2 Diabetes on Impaired Kidney Function in Sub-Saharan African Populations.

Diabetes is a leading risk factor for impaired kidney function, an indicator of chronic kidney disease. The aim of this study was to examine the association between type 2 diabetes (T2D) and impaired kidney function among adults in sub-Saharan Africa (SSA). Participants were enrolled from Ghana, Kenya, and Nigeria. Impaired kidney function was based on an estimated glomerular filtration rate <60 ml/min/1.73 m(2). Using logistic regression models, we conducted case-control analyses to estimate the multivariate-adjusted association of T2D and kidney function. We used data from 4815 participants for whom the mean (SD) age was 48 (15) years, 41% were male and 46% had T2D. Those with T2D were more likely to have impaired kidney function [13.4% (95% CI: 11.9-14.7)] compared to those without T2D [4.8% (95% CI: 4.0-5.6)], p-value <0.001. The multivariate odds ratio of impaired kidney function among those with type 2 diabetes was 1.50 (95% CI: 1.17-1.91) p-value = 0.001, compared to those without T2D. Also, individuals with T2D who were at least 60 years old, obese, hypertensive or dyslipidemic were more likely to have impaired kidney function compared to those without T2D. T2D was associated with 50% increased risk of impaired kidney function in this sample of adults from SSA. Interventions targeted at prevention, early diagnosis, and management of T2D are likely to reduce the burden of kidney disease in SSA.

Where now for proteinuria testing in chronic kidney disease?: Good evidence can clarify a potentially confusing message.

Although the value of testing for proteinuria may be undisputed and understood by nephrologists and diabetologists, the lack of clarity about the rationale for testing and the optimal way of doing so in primary care has caused confusion for many practitioners.1 Issues such as variation in proteinuria definition, laboratory measurement, and reporting methods, along with conflicting messages about who, how, and when to test, have led to uncertainty and under-testing.1,2 There have been long-standing debates about the use of various dipsticks, the role of proteinuria in urinary tract infection, the use of urinary protein:creatinine ratio (PCR) versus albumin:creatinine ratio (ACR), and the number of tests needed for identification versus quantification of proteinuria. Reporting variations include some laboratories using non-numeric results such as ‘ratio too low to calculate’ making visualisation of results and accurate audit of ACR testing challenging for busy practitioners. Urinary dipsticks have important limitations in terms of their accuracy in detecting and quantifying albuminuria.3 In this context, GPs and other clinicians could be forgiven for being uncertain about the clinical utility of its identification. Chronic kidney disease (CKD) has been included in the Quality and Outcomes Framework (QOF) since 2006–2007, and, from 2009–2010, included a proteinuria indicator (‘The percentage of patients on the CKD register whose notes have a record of a urine albumin:creatinine ratio [or protein:creatinine ratio] test in the preceding 12 months’). Currently, several CKD indicators are in the process of being ‘retired’, including the one relating to proteinuria testing. This increases the potential for uncertainty about the role of proteinuria testing and is likely to lead to a fall in ACR tests in England, particularly in people without diabetes, unless it is seen as valuable in its own right. It may also serve to reinforce the suggestion that labelling people …

Prevalence and Predictors of Medication Non-Adherence in Patients of Chronic Kidney Disease: Evidence from A Cross Sectional Study

Introduction: A high level of adherence to prescribed medication is essential to obtain the desired outcomes in patients of chronic kidney disease (CKD). Non-adherence to medication leads to increased morbidity and mortality. Non-adherence to medication has not been studied extensively in patients of CKD in India. Objective: To study the prevalence and predictors of medication non-adherence in patients of CKD. Method: Medication non-adherence was studied with the help of Morisky 8-item Medication Adherence Scale (MMAS-8) through a cross sectional study. Patients, aged 18 yrs or more, diagnosed with CKD according to Kidney Disease: Improving Global Outcomes (KDIGO) definition, and willing to participate in the study were included. On the basis of MMAS-8 scores, patients were classified to have high, medium and low adherence. Binary logistic regression was used to determine the various factors affecting adherence to drug therapy in CKD patients. Results: A total of 150 patients were included in study. Only 22% of the patients had high adherence to medications. Of all, 55% and 23% of the patients belonged to low and medium adherence, respectively. Adherence to drug therapy was found significantly different in different stages of CKD, gender, Body Mass Index (BMI) categories, hemodialysis status, co-morbidities, treatment funding and in patients of different socioeconomic status. Forgetfulness was found to be most common reason for non-adherence, while maximum non-adherence were reported for antihypertensive medications. Pill burden, age, literacy, reimbursement, medication by caregivers was found to significantly affecting the medication adherence. Conclusion: Medication non adherence was found to be highly prevalent in patients of CKD.

Prevalence and severity of disordered mineral metabolism in patients with chronic kidney disease: A study from a tertiary care hospital in India.

Background:Disordered mineral metabolism is common complications of chronic kidney disease (CKD). However, there are limited data on the pattern of these disturbances in Indian CKD population.Materials and Methods:This was a prospective observational study of CKD-mineral and bone disorder (CKD-MBD) over a period of 3 years. The biochemical markers of CKD-MBD, namely, calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (iPTH), and 25-hydoxyvitamin Vitamin D3 (25OHD), were measured in newly diagnosed CKD Stage 3–5 and prevalent CKD Stage 5D adult patients.Results:A total of 462 patients of CKD Stage 3–5D were studied. The frequency of various biochemical abnormalities was hypocalcemia (23.8%), hypercalcemia (5.4%), hypophosphatemia (2.8%), hyperphosphatemia (55.4%), raised alkaline phosphatase (56.9%), secondary hyperparathyroidism (82.7%), and hypoparathyroidism (1.5%). 25OHD was done in 335 (72.5%) patients and 90.4% were found to have Vitamin D deficiency. About 70.6% of the patients had iPTH levels were above kidney disease outcomes quality initiative (KDOQI) target range. Nondiabetic CKD as compared to diabetic CKD had a higher alkaline phosphatase (P = 0.016), a higher iPTH (P = 0.001) a higher proportion of patients with iPTH above KDOQI target range (P = 0.09), and an elevated alkaline phosphatase (P = 0.004). The 25OHD levels were suggestive of severe Vitamin D deficiency in 33.7%, Vitamin D deficiency in 45.4%, and Vitamin D insufficiency in 11.3% patients. There was a significant positive correlation between iPTH with alkaline phosphatase (r = 0.572, P = 0.001), creatinine (r = 0.424, P = 0.001), and phosphorus (r = 0.241, P = 0.001) and a significant negative correlation with hemoglobin (r = −0.325, 0.001), age (r = −0.169, P = 0.002), and 25OHD (r = −0.126, P = 0.021). On multivariate logistic regression analysis, an elevated alkaline phosphatase was a significant predictor of hyperparathyroidism (odds ratio 9.7, 95% confidence interval 4.9–19.2, P = 0.001).Conclusions:There was a high prevalence of CKD-MBD in Indian CKD patients. CKD-MBD is more common and more severe and has an early onset as compared to the western populations.

Neck Circumference as a Predictive Indicator of CKD for High Cardiovascular Risk Patients.

Background. Neck circumference (NC) is an anthropometric measure of obesity for upper subcutaneous adipose tissue distribution which is associated with cardiometabolic risk. This study investigated whether NC is associated with indicators of chronic kidney disease (CKD) for high cardiometabolic risk patients. Methods. A total of 177 consecutive patients who underwent the outpatient departments of cardiology were prospectively enrolled in the study. The patients were aged >20 years with normal renal function or with stages 1–4 CKD. A linear regression was performed using the Enter method to present an unadjusted R 2, standardized coefficients, and standard error, and the Durbin-Watson test was used to assess residual independence. Results. Most anthropometric measurements from patients aged ≧65 were lower than those from patients aged <65, except for women's waist circumference (WC) and waist hip ratio. Female NC obtained the highest R 2 values for 24 hr CCR, uric acid, microalbuminuria, hsCRP, triglycerides, and HDL compared to BMI, WC, and hip circumference. The significances of female NC with 24 hr CCR and uric acid were improved after adjusted age and serum creatinine. Conclusions. NC is associated with indicators of CKD for high cardiometabolic risk patients and can be routinely measured as easy as WC in the future.

Prevalence of chronic kidney disease in India - Where are we heading?

Prevalence of chronic kidney disease in India - Where are we heading?

Cinacalcet Hydrochloride: a new dose schedule in the Management of Secondary Hyperparathyroidism in Indian Chronic Kidney Disease Patients

Analgesic Nephropathy: A neglected cause of Chronic Kidney DiseaseYusra Habib Khan, Azmi Sarriff, Amer Hayat Khan, Azreen Syazril Adnan, Tauqeer Hussain Mallhi

Prevalence of chronic kidney disease and associated factors among the Chinese population in Taian, China

BackgroundThis study was designed to assess the prevalence of chronic kidney disease (CKD) and associated risk factors among the Chinese population in Taian, China.MethodsA primary care-based cross-sectional study was conducted in Taian, China, from September to December 2012. Participants selected by a multi-stage stratified cluster sampling procedure were interviewed and tested for hematuria, albuminuria, estimated glomerular filtration rate (eGFR) and other clinical indices. Factors associated with CKD were analyzed by univariate and multivariate logistic regression analysis.ResultsA total of 14,399 subjects were enrolled in this study. The rates of hematuria, albuminuria and reduced eGFR were 4.20%, 5.25% and 1.89%, respectively. Approximately 9.49% (95% CI: 8.93%–10.85%) of the participants had at least one indicator of CKD, with an awareness of 1.4%. Univariate analyses showed that greater age, body mass index, and systolic and diastolic blood pressure; higher levels of serum creatinine, uric acid, fasting blood glucose, triglycerides, total cholesterol and low-density lipoprotein cholesterol; and lower eGFR were associated with CKD (p < 0.05 each). Multivariate analysis showed that age, female gender, educational level, smoking habits, systolic blood pressure, and history of diabetes mellitus, hyperlipidemia, hypercholesterolemia and hyperuricemia were independent risk factors for CKD.ConclusionsThe prevalence of CKD in the primary care population of Taian, China, is high, although awareness is quite low. Health education and policies to prevent CKD are urgently needed among this population.

Increasing access to kidney transplantation in countries with limited resources: the Indian experience with kidney paired donation.

According to the Indian chronic kidney disease registry, in 2010 only 2% of end stage kidney disease patients were managed with kidney transplantation, 37% were managed with dialysis and 61% were treated conservatively without renal replacement therapy. In countries like India, where a well-organized deceased donor kidney transplantation program is not available, living donor kidney transplantation is the major source of organs for kidney transplantation. The most common reason to decline a donor for directed living donation is ABO incompatibility, which eliminates up to one third of the potential living donor pool. Because access to transplantation with human leukocyte antigen (HLA)-desensitization protocols and ABO incompatible transplantation is very limited due to high costs and increased risk of infections from more intense immunosuppression, kidney paired donation (KPD) promises hope to a growing number of end stage kidney disease patients. KPD is a rapidly growing and cost-effective living donor kidney transplantation strategy for patients who are incompatible with their healthy, willing living donor. In principle, KPD is feasible for any centre that performs living donor kidney transplantation. In transplant centres with a large living donor kidney transplantation program KPD does not require extra infrastructure, decreases waiting time, avoids transplant tourism and prevents commercial trafficking. Although KPD is still underutilized in India, it has been performed more frequently in recent times. To substantially increase donor pool and transplant rates, transplant centres should work together towards a national KPD program and frame a uniform acceptable allocation policy.