Prevalence of chronic kidney disease in Peruvian primary care setting

Prevalence of hypertension and diabetes mellitus in Peruvian patients with chronic kidney disease: a systematic review and meta-analysis

BACKGROUND

Chronic Kidney Disease (CKD) represents a major challenge for public health, with hypertension and diabetes being the main causes of its occurrence. Therefore, this study aims to determine the prevalence of hypertension (HTN) and diabetes mellitus (DM) in Peruvian patients with CKD.

METHODS

A systematic search for studies about CKD in Peru was carried out in PubMed, Scopus, Embase, Web of Science, ScienceDirect, Google Scholar, Virtual Health Library (VHL), and Scielo from 2011 to December 2023. The protocol of this research was registered in the international registry of systematic reviews, the Prospective International Registry of Systematic Reviews (PROSPERO), with registration number CRD42023425118. Study selection, quality assessment, and data extraction were performed independently by two authors. Study quality was assessed using the Joanna Briggs Institute Statistical Meta-Analysis Assessment and Review Instrument. A random-effects model with inverse variance weighting was used to estimate the combined prevalence of HTN and DM in Peruvian patients with CKD. To analyze data heterogeneity, the I2 statistical test was used. Statistical analysis was performed with R version 4.2.3.

RESULTS

A total of 1425 studies were retrieved, of which 23 were included in the final meta-analysis. A total of 43,321 patients with CKD were evaluated, of whom 52.22% were male and 47.78% were female. The combined prevalence of HTN in Peruvian patients with CKD was 38% (95% CI: 30-46%; 41,131 participants; 21 studies, I2 = 99%, p = 0), while the combined prevalence of DM in Peruvian patients with CKD was 33% (95% CI: 26-40%; 43,321 participants; 23 studies, I2 = 99%, p = 0).

CONCLUSION

Approximately one-third of Peruvian patients with CKD have HTN and DM. These findings highlight the importance of implementing prevention and control measures for these chronic noncommunicable diseases in the Peruvian population, such as promoting healthy lifestyles, encouraging early detection and proper management of hypertension and diabetes, and improving access to medical care and health services.

Multicentre external validation of the prognostic model kidney failure risk equation in patients with CKD stages 3 and 4 in Peru: a retrospective cohort study

OBJECTIVES

To externally validate the four-variable kidney failure risk equation (KFRE) in the Peruvian population for predicting kidney failure at 2 and 5 years.

DESIGN

A retrospective cohort study.

SETTING

17 primary care centres from the Health's Social Security of Peru.

PARTICIPANTS

Patients older than 18 years, diagnosed with chronic kidney disease stage 3a-3b-4 and 3b-4, between January 2013 and December 2017. Patients were followed until they developed kidney failure, died, were lost, or ended the study (31 December 2019), whichever came first.

PRIMARY AND SECONDARY OUTCOME MEASURES

Performance of the KFRE model was assessed based on discrimination and calibration measures considering the competing risk of death.

RESULTS

We included 7519 patients in stages 3a-4 and 2798 patients in stages 3b-4. The estimated cumulative incidence of kidney failure, accounting for competing event of death, at 2 years and 5 years, was 1.52% and 3.37% in stages 3a-4 and 3.15% and 6.86% in stages 3b-4. KFRE discrimination at 2 and 5 years was high, with time-dependent area under the curve and C-index >0.8 for all populations. Regarding calibration in-the-large, the observed to expected ratio and the calibration intercept indicated that KFRE underestimates the overall risk at 2 years and overestimates it at 5 years in all populations.

CONCLUSIONS

The four-variable KFRE models have good discrimination but poor calibration in the Peruvian population. The model underestimates the risk of kidney failure in the short term and overestimates it in the long term. Further research should focus on updating or recalibrating the KFRE model to better predict kidney failure in the Peruvian context before recommending its use in clinical practice.

Association between glycemic control and albuminuria among Peruvian adults with diabetes mellitus 2: a cross-sectional analytical study

BACKGROUND

Albuminuria is a risk factor for microvascular and macrovascular complications in the diabetic population. However, few studies have correlated poor glycemic control and albuminuria prevalence in Hispanic populations.

OBJECTIVE

To evaluate the association between glycemic control and albuminuria among Peruvian adults with type 2 diabetes mellitus (T2DM).

DESIGN AND SETTING

Cross-sectional analytical study among adults with T2DM in Lima, Peru.

METHODS

We included adults over 18 years old who were in a clinical follow-up program at a private clinic in Lima in 2018. Poor glycemic control was defined as a serum value of glycosylated hemoglobin A1C (HbA1C) ≥ 7%. Albuminuria was defined as albumin values > 30 mg/dl in the first morning urine. We generated generalized linear regression models from the Poisson family with robust variance. We calculated the crude and adjusted prevalence ratios (PRs) with their 95% confidence interval (CI).

RESULTS

We analyzed 907 participants of median age 58 years (interquartile range, IQR 49 to 66), and 62.8% were males. The prevalence of poor glycemic control was 39.8%, and the prevalence of albuminuria was 22.7%. The prevalences of albuminuria in groups with poor glycemic control and adequate glycemic control were 32.7% and 16.1%, respectively. In the adjusted regression analysis, we found a statistically significant association between poor glycemic control and albuminuria (annual percentage rate, aPR = 1.70; 95% CI: 1.28-2.27).

CONCLUSIONS

The prevalence of poor glycemic control and albuminuria was high in our study population. Moreover, Peruvian T2DM adults with poor glycemic control were more likely to have albuminuria.

Epidemiology of chronic kidney disease in Peru and its relation to social determinants of health

BACKGROUND

Chronic kidney disease (CKD) is a growing public health problem and an important cause of morbidity and mortality. Disparities in CKD may be related to social determinants and health inequalities in low- and middle-income countries. This study determined how social determinants of health influence trends in the prevalence and mortality of CKD in Peru.

METHODS

This was an ecological study based on a secondary analysis of health care and death records obtained from the Ministry of Health of Peru for the period 2010-2016. The standardized prevalence and mortality rates of CKD were descriptively reported using geospatial exploratory analysis. We also determined the association with social determinants of health according to the domains suggested by Healthy People 2020.

RESULTS

In the studied period, CKD prevalence increased by 300% and was associated with the health insurance coverage rate (β=5.9 [95% CI 0.82 to 10.92]), proportion of people with a secondary education level (β=11.4 [95% CI 1.94 to 20.93]), mean age (β=-10.7 [95% CI -19.33 to -2.12]), monetary poverty rate (β=-2.2 [95% CI -3.88 to -0.60]) and gross domestic product per capita (β=-63.2 [95% CI -117.81 to -8.52]). The standardized mortality decreased by 10% and was associated with mean age (β=-0.6 [95% CI -1.22 to -0.06]) and the proportion of people with a primary education level (β=-0.5 [95% CI -0.9 to -0.05]).

CONCLUSIONS

During the period 2010-2016, the prevalence of CKD increased and the mortality associated with CKD decreased. The observed changes were associated with some social determinants of health, such as increased health coverage and education. The health system of Peru must be prepared to take on the challenge.

CKD and CKDu in northern Peru: a cross-sectional analysis under the DEGREE protocol

BACKGROUND

This study estimated the prevalence and risk factors for decreased estimated glomerular filtration rate (eGFR) in those without known hypertension, type 2 diabetes mellitus, or heavy proteinuria as a surrogate marker for chronic kidney disease of unknown cause (CKDu) among adults in the North of Peru.

METHODS

A cross-sectional study was conducted following the Disadvantaged Populations eGFR Epidemiology (DEGREE) Study protocol. Low eGFR was defined based on a single eGFR ≤60 mL/min/1.7m² estimated using the CKD-EPI equation. Environmental conditions related to CKDu (i.e., work in agriculture or sugarcane, water source, heat intolerance, and pesticide exposure) were evaluated, in addition to traditional risk factors for CKD (i.e., smoking, heavy drinking, physical activity, hypertension, type 2 diabetes mellitus, urolithiasis, among others).

RESULTS

A total of 1514 subjects were included in the study, mean age 45.1 (SD: 16.4), and 55.2% were females. Overall, only 26 cases (1.7%; 95%CI: 1.1-2.5%) had an eGFR < 60 mL/min/1.7m² compatible with CKD definition; when those with hypertension and type-2 diabetes or heavy proteinuria were excluded, according to the DEGREE protocol, the estimate fell to 0.9% (95%CI: 0.4-1.5%). Low physical activity levels (OR = 1.99; 95%CI: 1.18-3.34), hypertension (OR = 2.07; 1.26-3.41), and urolithiasis (OR = 1.97; 95%CI: 1.18-3.27) were factors associated with low eGFR.

CONCLUSIONS

A low population-based prevalence of low eGFR (as a surrogate for CKDu), both in rural and urban settings areas, in the Northern Peru, was found. Low physical activity levels, hypertension and urolithiasis were factors associated with low eGFR. Interventions to prevent CKD cases may be focused on well-known CV risk factors and urolithiasis.

Use of medicinal plants in patients with chronic kidney disease from Peru

OBJECTIVE

To describe the use of medicinal plants in patients with chronic kidney disease (CKD) in public healthcare centers in Peru.

METHODS

A cross-sectional study was conducted in patients with CKD in healthcare centers of three Peruvian regions: Lima, Arequipa, and Ucayali. A structured questionnaire which included socio-demographic data, medical antecedents and characteristics of the use of medicinal plants was used. Prevalence ratios (PR) and 95 % confidence intervals (95% CI) were calculated using crude Poisson regressions with robust variances.

RESULTS

A total of 599 patients with CKD were evaluated, of which 300 (50.1%) reported the use of medicinal plants (160 [30.3%] used these plants for CKD), 379 reported that medicinal plants were not harmful, while 166 (27.8%) stopped using allopathic medicine to use medicinal plants only. In the adjusted analysis, the frequency of the use of medicinal plants for CKD was similar between Lima and Arequipa but was lower in Ucayali than in Lima (PR: 0.32, 95% CI: 0.14 - 0.76). In addition, a higher frequency of the use of medicinal plants for CKD was observed in patients with more advanced stages of CKD (PR: 1.55, 95% CI: 1.06-2.26) and in patients who were aware they had CKD (PR: 2.79 95% CI: 1.39-5.63).

CONCLUSIONS

Half of the patients used medicinal plants and about one-third used it for CKD. This use was lower in Ucayali and higher in both the patients who knew they had CKD and those with more advanced stages of the disease. Given these results, physicians should ask and inform regarding medicinal plants consumption to their CKD patients.

Early detection of chronic renal disease: coordinated work between primary and specialized care in an ambulatory renal network of Peru

INTRODUCTION

The aim of the study was to report the implementation of a functional network for the early diagnosis of chronic kidney disease (CKD) in patients with risk factors and the coordinated work between primary and specialized care in social security in Perú.

MATERIAL AND METHODS

A cross-sectional analysis of the data of patients evaluated in a health network in the city of Lima (2013 to 2016), older than 18 years, with risk factors for CKD, evaluated with serum creatinine and creatine albumin ratio in random urine (ACR). A multivariate logistic regression analysis was performed to evaluate the factors associated with the finding of CKD.

RESULTS

The implementation included training in renal health, installation of a digital database, organization of laboratories, and empowerment of primary care. We evaluated 42,746 patients of which 41.8% were men, with median age 69.2 years. The most frequent cause of detection was hypertension (HBP): 23,921 (55.9%). The prevalence of CKD was 12,132 (28.4%), the most frequent stage of CKD was 3a: 4735 (39.0%). Of the total, 6214 (14.5%) patients had microalbuminuria and 1335 (3.1%), macroalbuminuria. The risk of CKD increased 2.5 times (95% CI: 2.3-2.7) in patients with diabetes (DM) and HBP, in men (OR 1.2, 95% CI: 1.2-1.3) and as age increased (> 77 years: OR 2.7, 95% CI: 2.5-2.8). The identification of the disease in the primary care setting is 60% less likely than in specialized care.

CONCLUSIONS

One of every four patients are diagnosed with CKD, and the simultaneous diagnosis of DM and HBP and old age are the most important factors.