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Singh A, Verma M, Das M, Parija PP, Nayak S, Jha V. Prevalence and associated factors of impaired kidney functions among children and adolescents in India: insights from the Comprehensive National Nutrition Survey (CNNS) 2016-18. BMC Pediatr 2024; 24:429. [PMID: 38965471 PMCID: PMC11223285 DOI: 10.1186/s12887-024-04903-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/21/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a significant public health problem. The burden of CKD in children and adolescents in India is not well described. We used data from the recent Comprehensive National Nutrition Survey (CNNS) to estimate the prevalence of impaired kidney function (IKF) and its determinants in children and adolescents between the ages of 5 and 19. METHODS CNNS 2016-18 adopted a multi-stage sampling design using probability proportional to size sampling procedure after geographical stratification of urban and rural areas. Serum creatinine was tested once in 24,690 children and adolescents aged 5-19 years. The estimated glomerular filtration rate (eGFR) was derived using the revised Schwartz equation. The eGFR value below 60 ml/min/1.73 m2 is defined as IKF. Bivariate analysis was done to depict the weighted prevalence, and multivariable logistic regression examined the predictors of IKF. RESULTS The mean eGFR in the study population was 113.3 + 41.4 mL/min/1.73 m2. The overall prevalence of IKF was 4.9%. The prevalence in the 5-9, 10-14, and 15-19 year age groups was 5.6%, 3.4% and 5.2%, respectively. Regression analysis showed age, rural residence, non-reserved social caste, less educated mothers, Islam religion, children with severe stunting or being overweight/obese, and residence in Southern India to be predictors of IKF. CONCLUSIONS The prevalence of IKF among children and adolescents in India is high compared to available global estimates. In the absence of repeated eGFR-based estimates, these nationally representative estimates are intriguing and call for further assessment of socio-demographic disparities, genetics, and risk behaviours to have better clinical insights and public health preparedness.
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Affiliation(s)
- Angad Singh
- International Institute for Population Sciences, Mumbai, India
| | - Madhur Verma
- Community and Family Medicine, All India Institute of Medical Sciences Bathinda, Punjab, India.
| | - Milan Das
- International Institute for Population Sciences, Mumbai, India
| | - Pragyan Paramita Parija
- Community and Family Medicine, All India Institute of Medical Sciences Vijaypur, Jammu, India
| | - Saurabh Nayak
- Nephrology, All India Institute of Medical Sciences Bathinda, Punjab, India
| | - Vivekanand Jha
- The George Institute for Global Health India, UNSW, New Delhi, India
- Manipal Academy of Higher Education, Manipal, India
- Faculty of Medicine, Imperial College London, London, UK
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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2
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Francis A, Harhay MN, Ong ACM, Tummalapalli SL, Ortiz A, Fogo AB, Fliser D, Roy-Chaudhury P, Fontana M, Nangaku M, Wanner C, Malik C, Hradsky A, Adu D, Bavanandan S, Cusumano A, Sola L, Ulasi I, Jha V. Chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol 2024; 20:473-485. [PMID: 38570631 DOI: 10.1038/s41581-024-00820-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 04/05/2024]
Abstract
Early detection is a key strategy to prevent kidney disease, its progression and related complications, but numerous studies show that awareness of kidney disease at the population level is low. Therefore, increasing knowledge and implementing sustainable solutions for early detection of kidney disease are public health priorities. Economic and epidemiological data underscore why kidney disease should be placed on the global public health agenda - kidney disease prevalence is increasing globally and it is now the seventh leading risk factor for mortality worldwide. Moreover, demographic trends, the obesity epidemic and the sequelae of climate change are all likely to increase kidney disease prevalence further, with serious implications for survival, quality of life and health care spending worldwide. Importantly, the burden of kidney disease is highest among historically disadvantaged populations that often have limited access to optimal kidney disease therapies, which greatly contributes to current socioeconomic disparities in health outcomes. This joint statement from the International Society of Nephrology, European Renal Association and American Society of Nephrology, supported by three other regional nephrology societies, advocates for the inclusion of kidney disease in the current WHO statement on major non-communicable disease drivers of premature mortality.
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Affiliation(s)
- Anna Francis
- Department of Nephrology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Meera N Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Albert C M Ong
- Academic Nephrology Unit, Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Division of Nephrology & Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz UAM, RICORS2040, Madrid, Spain
| | - Agnes B Fogo
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Danilo Fliser
- Department of Internal Medicine IV, Renal and Hypertensive Disease & Transplant Centre, Saarland University Medical Centre, Homburg, Germany
| | - Prabir Roy-Chaudhury
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan
| | - Christoph Wanner
- Department of Clinical Research and Epidemiology, Renal Research Unit, University Hospital of Würzburg, Würzburg, Germany
| | - Charu Malik
- International Society of Nephrology, Brussels, Belgium
| | - Anne Hradsky
- International Society of Nephrology, Brussels, Belgium
| | - Dwomoa Adu
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Sunita Bavanandan
- Department of Nephrology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Ana Cusumano
- Instituto de Nefrologia Pergamino, Pergamino City, Argentina
| | - Laura Sola
- Centro de Hemodiálisis Crónica CASMU-IAMPP, Montevideo, Uruguay
| | - Ifeoma Ulasi
- Renal Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Enugu State, Nigeria
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India.
- School of Public Health, Imperial College, London, UK.
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
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3
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Korsmo HW, Ekperikpe US, Daehn IS. Emerging Roles of Xanthine Oxidoreductase in Chronic Kidney Disease. Antioxidants (Basel) 2024; 13:712. [PMID: 38929151 PMCID: PMC11200862 DOI: 10.3390/antiox13060712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Xanthine Oxidoreductase (XOR) is a ubiquitous, essential enzyme responsible for the terminal steps of purine catabolism, ultimately producing uric acid that is eliminated by the kidneys. XOR is also a physiological source of superoxide ion, hydrogen peroxide, and nitric oxide, which can function as second messengers in the activation of various physiological pathways, as well as contribute to the development and the progression of chronic conditions including kidney diseases, which are increasing in prevalence worldwide. XOR activity can promote oxidative distress, endothelial dysfunction, and inflammation through the biological effects of reactive oxygen species; nitric oxide and uric acid are the major products of XOR activity. However, the complex relationship of these reactions in disease settings has long been debated, and the environmental influences and genetics remain largely unknown. In this review, we give an overview of the biochemistry, biology, environmental, and current clinical impact of XOR in the kidney. Finally, we highlight recent genetic studies linking XOR and risk for kidney disease, igniting enthusiasm for future biomarker development and novel therapeutic approaches targeting XOR.
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Affiliation(s)
| | | | - Ilse S. Daehn
- Department of Medicine, Division of Nephrology, The Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1243, New York, NY 10029, USA
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4
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Wijewickrama E, Alam MR, Bajpai D, Divyaveer S, Iyengar A, Kumar V, Qayyum A, Yadav SP, Yadla M, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Singh Shah D, Prasad N. Capacity for the management of kidney failure in the International Society of Nephrology South Asia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:123-135. [PMID: 38618495 PMCID: PMC11010620 DOI: 10.1016/j.kisu.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/10/2024] [Indexed: 04/16/2024] Open
Abstract
The South Asia region is facing a high burden of chronic kidney disease (CKD) with limited health resources and low expenditure on health care. In addition to the burden of CKD and kidney failure from traditional risk factors, CKD of unknown etiologies from India and Sri Lanka compounds the challenges of optimal management of CKD in the region. From the third edition of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), we present the status of CKD burden, infrastructure, funding, resources, and health care personnel using the World Health Organization's building blocks for health systems in the ISN South Asia region. The poor status of the public health care system and low health care expenditure resulted in high out-of-pocket expenditures for people with kidney disease, which further compounded the situation. There is insufficient country capacity across the region to provide kidney replacement therapies to cover the burden. The infrastructure was also not uniformly distributed among the countries in the region. There were no chronic hemodialysis centers in Afghanistan, and peritoneal dialysis services were only available in Bangladesh, India, Nepal, Pakistan, and Sri Lanka. Kidney transplantation was not available in Afghanistan, Bhutan, and Maldives. Conservative kidney management was reported as available in 63% (n = 5) of the countries, yet no country reported availability of the core CKM care components. There was a high hospitalization rate and early mortality because of inadequate kidney care. The lack of national registries and actual disease burden estimates reported in the region prevent policymakers' attention to CKD as an important cause of morbidity and mortality. Data from the 2023 ISN-GKHA, although with some limitations, may be used for advocacy and improving CKD care in the region.
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Affiliation(s)
- Eranga Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
- National Institute of Nephrology, Dialysis and Transplantation, Colombo, Sri Lanka
| | - Muhammad Rafiqul Alam
- Department of Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Divya Bajpai
- Department of Nephrology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Smita Divyaveer
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arpana Iyengar
- Department of Paediatric Nephrology, St. John’s National Academy of Health Sciences, Bangalore, India
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ahad Qayyum
- Department of Nephrology and Transplantation, Bahria Town International Hospital, Lahore, Punjab, Pakistan
| | - Shankar Prasad Yadav
- Department of Pediatrics, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Manjusha Yadla
- Department of Nephrology, Gandhi Medical College, Hyderabad, India
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dibya Singh Shah
- Department of Nephrology and Transplant Medicine, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, India
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Ranasinghe AV, Somatunga LC, Kumara GWGP, Karunarathna RH, De Silva AP, Gunawardena JMCN, Kumari SKCR, Sarjana MSF, De Silva MVC. Decreasing incidence of hospital diagnosed CKD/CKDu in North Central Province of Sri Lanka: is it related to provision of drinking water reverse osmosis plants? BMC Nephrol 2024; 25:91. [PMID: 38468233 PMCID: PMC10926649 DOI: 10.1186/s12882-024-03534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND We assessed the possible impact of provision of reverse osmosis (RO) water on the incidence of hospital diagnosed CKD/CKDu in North Central Province (NCP) of Sri Lanka. METHODS An ecological study was conducted on data from 2010-2020 on the incidence of hospital diagnosed CKD/CKDu, CKD/CKDu screening and provision of drinking water RO plants in NCP. Analysis was conducted using descriptive statistics, ANOVA and chi-square test. RESULTS The annual incidence of hospital diagnosed CKD/CKDu (per 100 000 population) in 2010-2013, 2014-2016 and 2017-2020 periods in Anuradhapura district were 129.07, 331.06 and 185.57 (p = 0.002) while in Polonnaruwa district these were 149.29, 326.12 and 296.73 (p = 0.04) respectively. In NCP provision of RO plants commenced after 2011 and the decline in the incidence of hospital diagnosed CKD/CKDu was seen in 25 of the 29 Divisional Secretary Divisions when more than 20% of the families received access to drinking RO water projects. CONCLUSIONS The annual incidence of hospital diagnosed CKD/CKDu increased in NCP from 2010 to 2016 and continuously decreased thereafter. Continuous declining of CKD/CKDu incidence was seen after more than 20% of the families received access to drinking water RO plants.
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Wijewickrama E, Behera S, Garcia P, Avila-Casado C, Caplin B, Paolo VS, Courville K, Friedman D, Madero M, Jha V, Kambham N, Levin A, Anand S. Kidney biopsies among persons living in hotspots of CKDu: a position statement from the International Society of Nephrology's Consortium of Collaborators on CKDu. Kidney Int 2024; 105:464-469. [PMID: 38160755 DOI: 10.1016/j.kint.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/02/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Eranga Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Suman Behera
- Division of Nephrology, McMaster University, Hamilton, Ontario, Canada; Division of Nephrology, William Osler Health System, Brampton, Ontario, Canada
| | - Pablo Garcia
- Department of Medicine (Nephrology), University of New Mexico, Albuquerque, New Mexico, USA
| | - Carmen Avila-Casado
- Department of Laboratory Medicine & Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK; Department of Nephrology, Royal Free London NHS Foundation Trust, London, UK
| | - Vicente Sanchez Paolo
- Nephrology and Kidney Transplant Division, Social Security Guatemalan Institute, Concepción, Guatemala
| | - Karen Courville
- Section of Nephrology, Department of Medicine, Hospital Dr. Gustavo Nelson Collado, Chitré, Herrera, Panama; Instituto de Ciencias Médicas and Sistema Nacional de Investigación, Las Tablas, Los Santos, Panamá
| | - David Friedman
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Magdalena Madero
- Division of Nephrology, Instituto Nacional de Cardiologia Ignacio Chávez, Mexico City, Mexico
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Medical Education, Manipal, India
| | - Neeraja Kambham
- Department of Pathology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
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Nayak-Rao S. Profile of chronic kidney disease from a nephrology underserviced region in North Eastern India: a preliminary report from a single center in Assam. Int Urol Nephrol 2024; 56:1103-1108. [PMID: 37642796 DOI: 10.1007/s11255-023-03736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/06/2023] [Indexed: 08/31/2023]
Abstract
Chronic kidney disease (CKD) is a worldwide health problem affecting at least 10% of the world's population. CKD represents especially a large burden in low- to middle-income countries that are ill equipped to deal with its consequences. The burden of CKD is increasing in India as well. Although diabetes and hypertension account for much of this burden of CKD, there are regions where a surprisingly high rate of CKD of undetermined etiology (CKD-U) has been described in certain areas of the country. In our observational cross-sectional study, we attempted to look at burden and etiology of CKD in a predominantly rural referral center. Out of 334 patients with diagnosed CKD, of whom 70% were male, included from Oct 2021 to July 2022, CKD-U was the single largest cause of CKD in 154 (46.1%) followed by diabetic nephropathy in 148 (44.3%). 80% of CKD patients presented initially with advanced CKD (stages 4 and 5). Approximately, 2/3rd of CKD patients reported a family income of less than 10,000 Rs/month (< 130USD). Hypertension was seen in 89% of patients in total (73% in CKD-U vs. 100% in other cause CKD). Our initial study brings to focus another new and as yet unrecognized hotspot for CKD-U in the Indian subcontinent. Given the vast diversity in the population in this region and variable delivery health care resources, we believe that concerted efforts should be made by governmental and other agencies to better understand the nature of this undiagnosed CKD epidemic so that adequate preventative strategies can be envisaged.
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Gummidi B, Gautam V, John R, Joshi R, John O, Jha V. CKD is the Major Cause of Death in Uddanam: A Population-Representative Study Using Smart Verbal Autopsy. Kidney Int Rep 2024; 9:108-113. [PMID: 38312788 PMCID: PMC10831392 DOI: 10.1016/j.ekir.2023.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/03/2023] [Accepted: 10/23/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Uddanam is an agricultural area with a high burden of chronic kidney disease of unknown etiology (CKDu). Despite reports of many deaths due to CKD in the lay press, the exact contribution of CKD to deaths remains uncertain because most deaths occur outside medical care. Methods We used SmartVA automated verbal autopsy tool to ascertain the cause-specific mortality fractions among a 2419 subject-strong general population cohort of adult subjects in Uddanam between 2018 and 2022. Verbal autopsy interviews were conducted twice with the family members of the deceased. Results A total of 133 deaths were recorded, giving a crude death rate of 5.5%, 10 times higher than that recorded in national surveys. CKD was responsible for 45% of all deaths, followed by ischemic heart disease (15%) and respiratory disease (6%). Conclusion This study confirms CKD as the leading cause of mortality in this high CKD burden area and provides crucial data for public health decision-making and resource allocation.
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Affiliation(s)
- Balaji Gummidi
- The George Institute for Global Health India, UNSW, New Delhi, India
| | - Vaishali Gautam
- The George Institute for Global Health India, UNSW, New Delhi, India
| | - Renu John
- The George Institute for Global Health India, UNSW, New Delhi, India
| | - Rohina Joshi
- The George Institute for Global Health India, UNSW, New Delhi, India
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Oommen John
- The George Institute for Global Health India, UNSW, New Delhi, India
- Manipal Academy of Higher Education, Manipal, India
| | - Vivekanand Jha
- The George Institute for Global Health India, UNSW, New Delhi, India
- Manipal Academy of Higher Education, Manipal, India
- Faculty of Medicine, Imperial College London, London, UK
- Faculty of Medicine, University of New South Wales, Sydney
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9
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Herojeet R, Dewangan RK, Naik PK, Verma JR. Probabilistic modelling is superior to deterministic approaches in the human health risk assessment: an example from a tribal stretch in central India. Sci Rep 2023; 13:19351. [PMID: 37935700 PMCID: PMC10630383 DOI: 10.1038/s41598-023-45622-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023] Open
Abstract
This case drew national attention in 2018. About 100 people died and more than 300 hospitalized in a span of few years in a village of 1200 people in a tribal stretch in central India. Medical teams visiting the area reported severe renal failure and blamed the local eating and drinking habits as causative factors. This human health assessment based on geochemical investigations finds nitrate (NO3-) and fluoride (F-) pollution as well in village's groundwater. Both deterministic and probabilistic techniques are employed to decipher the contamination pathways and extent of contamination. Source apportionments of NO3- and F- and their relationship with other ions in groundwater are carried out through chemometric modelling. Latent factors controlling the hydrogeochemistry of groundwater too are explored. While hazard quotients ([Formula: see text]) of the chemical parameters ([Formula: see text] and [Formula: see text]) identify ingestion as the prominent pathway, the calculated risk certainty levels (RCL) of the hazard index (HI) values above unity are compared between the deterministic and probabilistic approaches. Deterministic model overestimates the HI values and magnify the contamination problems. Probabilistic model gives realistic results that stand at infants ([Formula: see text] = 34.03%, [Formula: see text] = 24.17%) > children ([Formula: see text] = 23.01%, [Formula: see text] = 10.56%) > teens ([Formula: see text] = 13.17%, [Formula: see text] = 2.00%) > adults ([Formula: see text] = 11.62%, [Formula: see text] = 1.25%). Geochemically, about 90% of the samples are controlled by rock-water interaction with Ca2+-Mg2+-HCO3- (~ 56%) as the dominant hydrochemical facies. Chemometric modelling confirms Ca2+, Mg2+, HCO3-, F-, and SO42- to originate from geogenic sources, Cl- and NO3- from anthropogenic inputs and Na+ and K+ from mixed factors. The area needs treated groundwater for human consumption.
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Affiliation(s)
- Rajkumar Herojeet
- Department of Environmental Studies, Post Graduate Government College, Sector-11, Chandigarh, 160011, India
| | - Rakesh K Dewangan
- Central Ground Water Board, North Central Chhattisgarh Region, Ministry of Jal Shakti, Govt. of India, LK Corporates Tower, Dumartarai, Dhamtari Road, Raipur, 492015, India
| | - Pradeep K Naik
- Central Ground Water Board, North Central Chhattisgarh Region, Ministry of Jal Shakti, Govt. of India, LK Corporates Tower, Dumartarai, Dhamtari Road, Raipur, 492015, India.
- Centre for Hydrological Sciences and Communication, Bhubaneswar, India.
| | - Janak R Verma
- Central Ground Water Board, North Central Chhattisgarh Region, Ministry of Jal Shakti, Govt. of India, LK Corporates Tower, Dumartarai, Dhamtari Road, Raipur, 492015, India
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10
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Wijkström J, Annadata KC, Elinder CG, Kolla PK, Sarvepalli NR, Ring A, Swaminathan R, Gunabooshanam B, Söderberg M, Venugopal V, Wernerson A. Clinical findings and kidney morphology in chronic kidney disease of unknown cause in India. J Intern Med 2023; 294:492-505. [PMID: 37400986 DOI: 10.1111/joim.13690] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Chronic kidney disease of unknown cause (CKDu) is an emerging health problem in India and other countries worldwide. However, clinical descriptions, including kidney pathology, are scarce. METHODS This is a descriptive case series of patients with CKDu from an endemic region in India, with a focus on clinical and biochemical characteristics, kidney biopsy findings, and environmental exposure. Patients with suspected CKDu, aged 20-65, and eGFR 30-80 mL/min/1.73 m2 from rural areas with endemic prevalence of CKDu were included. The exclusion criteria were diabetes mellitus, uncontrolled hypertension, proteinuria >1 g/24 h, or other known kidney diseases. The participants underwent kidney biopsies, and blood and urine samples were collected. RESULTS Fourteen participants (3 females, 11 males) with a mean eGFR of 53 (range 29-78) mL/min/1.73 m2 were included. Kidney biopsies showed a combination of chronic tubulointerstitial damage, glomerulosclerosis, and glomerular hypertrophy, with varying degrees of interstitial inflammation. Eight participants had polyuria (diuresis ≥ 3 L/day). The urinary sediments were bland, with no haematuria. Serum potassium and sodium levels were, in most cases, normal but within the lower reference interval. CONCLUSION The kidney morphology and clinical characteristics in patients with CKDu in India were similar to those described for CKDu in Central America and Sri Lanka.
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Affiliation(s)
- Julia Wijkström
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | | | - Carl-Gustaf Elinder
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | | | | | - Anneli Ring
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Rajendiran Swaminathan
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Barathi Gunabooshanam
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Magnus Söderberg
- Clinical Pharmacology and Safety Sciences, AstraZeneca R&D, Gothenburg, Sweden
| | - Vidhya Venugopal
- Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Annika Wernerson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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11
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Venugopal V, Lennqvist R, Latha PK, Shanmugam R, Krishnamoorthy M, Selvaraj N, Balakrishnan R, Omprashant R, Purty AJ, Bazroy J, Glaser J, Jakobsson K. Occupational Heat Stress and Kidney Health in Salt Pan Workers. Kidney Int Rep 2023; 8:1363-1372. [PMID: 37441492 PMCID: PMC10334398 DOI: 10.1016/j.ekir.2023.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Work in heat affects millions of workers. Although kidney function in agricultural workers is increasingly researched, nonagricultural studies are scarce. In coastal salt pans, the absence of occupational exposures to pesticides and other toxicants allows assessment of heat stress alone. Methods Seven Indian salt pans were surveyed from 2017 to 2020. Job-specific workload was assessed. Heat stress was characterized as exceeding the wet bulb globe temperature (WBGT)-threshold limit value (TLV) for high and moderate workloads. Preshift and postshift heart rates (HRs), tympanic temperatures, and urine specific gravity (USG) were measured for 352 workers, as were sweat rates (SwR), serum creatinine (SCr), serum uric acid, and urine dipstick. Estimated glomerular filtration rate (eGFR; ml/min per 1.73 m2) was computed. Heat-strain symptoms were assessed using questionnaires. Results The mean WBGT was 30.5 ± 1.3 °C (summer) and 27.8 ± 1.9 °C (winter). Water intake during the workday was low, median was one Litre, and most workers (87%) exceeded the TLV for heat stress. Dehydration-related symptoms were frequent in those with high-heat stress, as were cross-shift increases in temperature (≥1°C; 15%), a high USG (≥1.020; 28%), and a high SwR (≥1 l/h; 53%). An eGFR of 60 to 89 ml/min per 1.73 m2 was observed in 41% of all workers examined, and 7% had eGFR below 60 ml/min per 1.73 m2. The odds ratio for eGFR <90 ml/min per 1.73 m2 in workers exceeding the TLV, compared to workers below this limit, adjusted for age and gender was 2.9 (95% CI: 1.3-6.4). Conclusion Workplace interventions to prevent heat stress and dehydration in the salt pans and other at-risk industries are urgently required. The findings strengthen the notion that high-heat stress and limited hydration is a risk factor for kidney dysfunction.
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Affiliation(s)
- Vidhya Venugopal
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Robin Lennqvist
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - PK Latha
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Rekha Shanmugam
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Manikandan Krishnamoorthy
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Nandhini Selvaraj
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Rajagurusamy Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - R. Omprashant
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Anil Jacob Purty
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Joy Bazroy
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | | | - Kristina Jakobsson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- La Isla Network, Washington, USA
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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12
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Abstract
PURPOSE OF REVIEW In the 1990s, a type of chronic kidney disease with unknown cause (CKDu) was identified in Central America and Sri Lanka. Patients lacked hypertension, diabetes, glomerulonephritis, or other usual causes of kidney failure. Affected patients are predominantly male agricultural workers aged 20-60 years, living in economically disadvantaged areas with poor access to medical care. Patients typically present late and progress to end-stage kidney disease within 5 years, resulting in social and economic hardship for families, regions, and countries. This review covers the current state of knowledge for this disease. RECENT FINDINGS The prevalence of CKDu is increasing in known endemic regions and across the globe, reaching epidemic proportions. There is primary tubulointerstitial injury with secondary glomerular and vascular sclerosis. No definitive etiologic factors have been identified, and these may vary or overlap in different geographic locations. The leading hypotheses include exposure to agrochemicals, heavy metals and trace elements, and kidney injury from dehydration/heat stress. Infections and lifestyle factors may play a role, but are likely not key. Genetic and epigenetic factors are beginning to be explored. SUMMARY CKDu is a leading cause of premature death in young-to-middle-aged adults in endemic regions and has become a public health crisis. Studies are underway to investigate clinical, exposome, and omics factors, and hopefully will provide insights into pathogenetic mechanisms resulting in biomarker discovery, preventive measures, and therapeutics.
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Affiliation(s)
- Cynthia C Nast
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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13
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Jha V. Renal Revolution: Anticipating the Next 25 Years of India's Kidney Care. Indian J Nephrol 2023; 33:79-82. [PMID: 37234432 PMCID: PMC10208534 DOI: 10.4103/ijn.ijn_125_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 05/28/2023] Open
Affiliation(s)
- Vivekanand Jha
- Executive Director, The George Institute for Global Health, New Delhi, India, School of Public Health, Imperial College, London, UK, Manipal Academy of Higher Education, Manipal, India
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14
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Association of Single Nucleotide Polymorphisms in KCNA10 and SLC13A3 Genes with the Susceptibility to Chronic Kidney Disease of Unknown Etiology in Central Indian Patients. Biochem Genet 2023:10.1007/s10528-023-10335-7. [PMID: 36696070 DOI: 10.1007/s10528-023-10335-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023]
Abstract
Global rise in the prevalence of endemic chronic kidney disease of unknown etiology (CKDu) possess major health issues. The prevalence of CKDu is also rising in the Indian population. Besides environmental factors, genetic factors play an important role in the predisposition to CKDu. In the present study, we have analyzed the association of single nucleotide polymorphisms (SNPs) in three genes with the susceptibility to CKDu. This was a case-control study with a total of 180 adult subjects (CKD = 60, CKDu = 60, Healthy = 60) from central India. We performed KASP genotyping assay to determine the allele frequency of SNP genotypes. We used the odds ratio (OR) to assess the association of individual SNPs, rs34970857 of KCNA10, rs6066043 of SLC13A3, and rs2910164 of miR-146a with CKDu and CKD susceptibility. In the case of rs34970857 of the KCNA10 gene, we noted a significantly increased OR for CKDu versus healthy control (Dominant model; CKDu versus control, CT + CC versus TT, OR = 3.96, p = 0.004). In the recessive and homozygous model, we observed significantly increased OR for rs6066043 of SLC13A3 gene, CKDu versus healthy control {(Recessive model; CKDu versus control, GG versus AA + GA, OR = 2.41, p = 0.03; homozygous model, GG versus AA, OR = 3.54, p = 0.04)}. CC genotype of rs34970857 of the KCNA10 gene and the GG genotype of the SLC13A3 gene are significantly associated with the susceptibility of CKDu.
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15
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Vijayan M, Deshpande K, Anand S, Deshpande P. Risk Amplifiers for Vascular Disease and CKD in South Asians: When Intrinsic β-Cell Dysfunction Meets a High-Carbohydrate Diet. Clin J Am Soc Nephrol 2023; 18:01277230-990000000-00039. [PMID: 36758530 PMCID: PMC10278793 DOI: 10.2215/cjn.0000000000000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
South Asians, comprising almost one fourth of the world population, are at higher risk of type 2 diabetes mellitus, hypertension, cardiovascular disease, and CKD compared with other ethnic groups. This has major public health implications in South Asia and in other parts of the world to where South Asians have immigrated. The interplay of various modifiable and nonmodifiable risk factors confers this risk. Traditional models of cardiometabolic disease progression and CKD evaluation may not be applicable in this population with a unique genetic predisposition and phenotype. A wider understanding of dietary and lifestyle influences, genetic and metabolic risk factors, and the pitfalls of conventional equations estimating kidney function in this population are required in providing care for kidney diseases. Targeted screening of this population for metabolic and vascular risk factors and individualized management plan for disease management may be necessary. Addressing unhealthy dietary patterns, promoting physical activity, and medication management that adheres to cultural factors are crucial steps to mitigate the risk of cardiovascular disease and CKD in this population. In South Asian countries, a large rural and urban community-based multipronged approach using polypills and community health workers to decrease the incidence of these diseases may be cost-effective.
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Affiliation(s)
- Madhusudan Vijayan
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
- Institute for Critical Care Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Kavita Deshpande
- Department of Family Medicine, La Maestra Community Health Centers, San Diego, California
| | - Shuchi Anand
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Priya Deshpande
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
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16
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Gummidi B, Gautam V, John O, Ghosh A, Jha V. Patterns of multimorbidity among a community-based cohort in rural India. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565221149623. [PMID: 36644651 PMCID: PMC9832245 DOI: 10.1177/26335565221149623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
Background Multimorbidity estimates are expected to increase in India primarily due to the population aging. However, there is a lack of research estimating the burden of multimorbidity in the Indian context using a validated tool. We estimated the prevalence and determinants of multimorbidity amongst the adult population of the rural Uddanam region, Andhra Pradesh. Methods This community-based cross-sectional study was conducted as a part of an ongoing research program. Multistage cluster sampling technique was used to select 2419 adult participants from 40 clusters. Multimorbidity was assessed using Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC) tool, collecting information on 13 chronic diseases. Patient Health Questionnaire (PHQ-12) was used to screen for depression. Multiple logistic regression was conducted to identify the strongest determinants of multimorbidity. Results Of the 2419 participants, 2289 completed the MAQ-PC tool. Mean age (standard deviation) of participants was 48.1 (13.1) years. The overall prevalence of multimorbidity was 58.5% (95% CI 56.5-60.6); with 30.7%, 15.6%, and 12.2% reporting two, three, and four chronic conditions, respectively. Acid peptic disease-musculoskeletal disease (44%) and acid peptic disease-musculoskeletal disease-hypertension (14.9%) were the most common dyad and triad. Among metabolic diseases, diabetes-hypertension (28.3%) and diabetes-hypertension-chronic kidney disease (7.6%) were the most common dyad and triad, respectively. Advancing age, female gender, and being obese were the strongest determinates of the presence of multimorbidity. Depression was highly prevalent among the study population, and participants with higher PHQ-12 score had 3.7 (2.5-5.4) greater odds of having multimorbidity. Conclusions Our findings suggest that six of 10 adults in rural India are affected with multimorbidity. We report a higher prevalence of multimorbidity as compared with other studies conducted in India. We also identified vulnerable groups which would guide policy makers in developing holistic care packages for individuals with multimorbidity.
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Affiliation(s)
- Balaji Gummidi
- The George Institute for Global
Health, New Delhi, India
| | | | - Oommen John
- The George Institute for Global
Health, New Delhi, India,Manipal Academy of Higher
Education, Manipal, India
| | - Arpita Ghosh
- The George Institute for Global
Health, New Delhi, India,Manipal Academy of Higher
Education, Manipal, India
| | - Vivekanand Jha
- The George Institute for Global
Health, New Delhi, India,Manipal Academy of Higher
Education, Manipal, India,Faculty of
Medicine, Imperial College
London, London, UK,University of New South
Wales, Sydney, Australia,Vivekanand Jha, George Institute for Global
Health, 308, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre,
New Delhi 110025 India.
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17
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Jagannathan R, Anand S, Hogan J, Mandal S, Kondal D, Gupta R, Patel SA, Anjana RM, Deepa M, Ali MK, Mohan V, Tandon N, Narayan KV, Prabhakaran D. Estimated glomerular filtration rate trajectories in south Asians: Findings from the cardiometabolic risk reduction in south Asia study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 6:100062. [PMID: 37383342 PMCID: PMC10305991 DOI: 10.1016/j.lansea.2022.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background Few longitudinal data characterize kidney function decline among South Asians, one of the world's largest population groups. We aimed to identify estimated glomerular filtration rate (eGFR) trajectories in a population-based cohort from India and assess predictors of rapid kidney function decline. Methods We used 6-year longitudinal data from participants of a population-representative study from Delhi and Chennai, India who had at least two serum creatinine measures and baseline CKD-EPI eGFR> 60 ml/min/1.73m2 (n=7779). We used latent class trajectory modeling to identify patterns of kidney function trajectory (CKD-EPI eGFR) over time. In models accounting for age, sex, education, and city, we tested the association between 15 hypothesized risk factors and rapid kidney function decline. Findings Baseline mean eGFR was 108 (SD 16); median eGFR was 110 [IQR: 99-119] ml/min/1.73m2. Latent class trajectory modeling and functional characterization identified three distinct patterns of eGFR: class-1 (no decline; 58%) annual eGFR change 0.2 [0.1, 0.3]; class-2 (slow decline; 40%) annual eGFR change -0.2 [-0.4, -0.1], and class-3 (rapid decline; 2%) annual eGFR change -2.7 [-3.4, -2.0] ml/min/1.73m2. Albuminuria (>30 mg/g) was associated with rapid eGFR decline (OR for class-3 vs class-1: 5.1 [95% CI: 3.2; 7.9]; class-3 vs. class-2: 4.3 [95% CI:2.7; 6.6]). Other risk factors including self-reported diabetes, cardiovascular disease, peripheral arterial disease, and metabolic biomarkers such as HbA1c and systolic blood pressure were associated with rapid eGFR decline phenotype but potential 'non-traditional' risk factors such as manual labor or household water sources were not. Interpretation Although mean and median eGFRs in our population-based cohort were higher than those reported in European cohorts, we found that a sizeable number of adults residing in urban India are experiencing rapid kidney function decline. Early and aggressive risk modification among persons with albuminuria could improve kidney health among South Asians. Funding The CARRS study has been funded with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, under Contract No. HHSN2682009900026C and P01HL154996. Dr. Anand was supported by NIDDK K23DK101826 and R01DK127138.
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Affiliation(s)
- Ram Jagannathan
- Emory University School of Medicine, Division of Hospital Medicine, Atlanta, GA, United States
| | - Shuchi Anand
- Centers for Chronic Disease Control, India
- Stanford University School of Medicine, Division of Nephrology
| | - Julien Hogan
- Department of Surgery, Emory Transplant Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Siddhartha Mandal
- Centers for Chronic Disease Control, India
- Public Health Foundation of India, New Delhi, India
| | | | - Ruby Gupta
- Centers for Chronic Disease Control, India
| | - Shivani A. Patel
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Ranjit Mohan Anjana
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Mohan Deepa
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Mohammed K. Ali
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
- Madras Diabetes Research Foundation, Chennai, India
| | - Viswanathan Mohan
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, Delhi, India
| | - K.M. Venkat Narayan
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Dorairaj Prabhakaran
- Centers for Chronic Disease Control, India
- Public Health Foundation of India, New Delhi, India
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18
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Aoun M, Chelala D. Where do you live and what do you do? Two questions that might impact your kidney health. FRONTIERS IN NEPHROLOGY 2022; 2:1011964. [PMID: 37675017 PMCID: PMC10479685 DOI: 10.3389/fneph.2022.1011964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/13/2022] [Indexed: 09/08/2023]
Abstract
In many cases the social determinants of health need to be assessed through their interaction with environmental factors. This review looks at the impact of physical location and occupation of individuals on their kidney health. It examines the effect of living at high altitude on kidney function and the relationship between extreme cold or hot temperatures and the incidence of kidney injury. It reviews as well the many occupations that have been linked to kidney disease in high-income and low-and-middle-income countries. As a conclusion, this overview proposes preventive recommendations that could be individualized based on weather, altitude, socio-economic level of the country and occupation of the individual.
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Affiliation(s)
- Mabel Aoun
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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19
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Chronic Kidney Disease of Uncertain Etiology in Sri Lanka: Curing between Medicine and Traditional Culture. SOCIAL SCIENCES 2022. [DOI: 10.3390/socsci11010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic Kidney Disease of unknown origin (CKDu) has appeared across Sri Lanka’s North Central Province (NCP) since the 1990s as an epidemic, unexplained by conventional associated risk factors. During the past few decades, a large number of studies attempted to determine the unknown etiology of CKDu. Despite these investigations, no concrete conclusions were developed, though a number of contradictory hypotheses emerged. The present ethnographic study was carried out in two endemic areas, labelled as “CKDu hotspots”, and illuminates how curing takes place between biomedicine and traditional cultural practices. Our ethnographic study thoroughly scrutinized three decades of lived experience, lay-perceptions and local discourses on CKDu. We used a qualitative study design with a transcendental phenomenological approach and employed a mixture of ethnographic methods. Data collection techniques included participant observation, in-depth interviews, focus group discussions and key informant interviews. Data was analysed by using an interpretive thematic analysis model. Findings revealed that lay people have constructed a popular discourse on CKDu, and we explored their views on the origin, etiology and prevalence of CKDu in their locality over the past few decades. Patients’ narratives revealed that there were currently a number of gaps in service delivery. These were mainly due to distant relationships between healthcare providers and CKDu patients. Lay people in affected communities were marginalized throughout the investigation process to determine the unknown etiology, their involvement marginalized to merely acting as objects for scientific instigation. The affected communities strongly believed that CKDu was a recent phenomenon resulting from the mismanagement of the natural environment due to social and lifestyle changes. These findings highlight local dynamics of healthcare seeking behaviours which demand complementary medicine system, particularly given the number of limitations in the biomedical system. Empirical evidence generated from this study suggests a conceptual shift to an ethno-medical model to address CKDu. Improving cultural competency and communication skills among healthcare providers in public health are crucial in order to apply a “bio-psychosocial perspective” in healthcare delivery system and bridging the gap between hospital and the community.
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20
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Wan ET, Darssan D, Karatela S, Reid SA, Osborne NJ. Association of Pesticides and Kidney Function among Adults in the US Population 2001-2010. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10249. [PMID: 34639548 PMCID: PMC8507643 DOI: 10.3390/ijerph181910249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 11/17/2022]
Abstract
Chronic kidney disease of unknown cause is prevalent in a range of communities; however, its etiology remains unclear. We examined the association between pesticide exposures and the risk of kidney function loss using four waves of the National Health and Nutrition Examination Survey (NHANES) to identify a pathological pathway. We pooled data from four cross-sectional waves of NHANES, with 41,847 participants in total. Exposure to malathion increased the risk of low kidney function (aOR = 1.26, 95% CI = 1.01-1.56) in the adjusted model. Increased risk of low kidney function was not found among those exposed to 2,4-D (aOR = 0.88, 95% CI = 0.72-1.09), 3,5,6-trichloropyridinol (aOR = 0.96, 95% CI = 0.83-1.12), and 3-PBA (aOR = 1.03, 95% CI = 0.94-1.13). Our findings provide evidence of altered kidney function in people exposed to malathion, highlighting the potential of organophosphate pesticides' role in renal injury.
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Affiliation(s)
- En-Tzu Wan
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (E.-T.W.); (D.D.); (S.K.); (S.A.R.)
- Department of Strategy Planning, Far Eastern Memorial Hospital, Banqiao District, New Taipei City 22060, Taiwan
| | - Darsy Darssan
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (E.-T.W.); (D.D.); (S.K.); (S.A.R.)
| | - Shamshad Karatela
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (E.-T.W.); (D.D.); (S.K.); (S.A.R.)
- Australian Institute of Tropical Health and Medicine (AITHM), James Cook University, Townsville 4870, Australia
| | - Simon A. Reid
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (E.-T.W.); (D.D.); (S.K.); (S.A.R.)
| | - Nicholas John Osborne
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (E.-T.W.); (D.D.); (S.K.); (S.A.R.)
- European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK
- School of Population Health, University of NSW, Kensington 2052, Australia
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