Do attributes of persons with chronic kidney disease differ in low-income and middle-income countries compared with high-income countries? Evidence from population-based data in six countries

Abstract

Kidney biopsies to elucidate the cause of chronic kidney disease (CKD) are performed in a minority of persons with CKD living in high-income countries, since associated conditions-that is, diabetes mellitus, vascular disease or obesity with pre-diabetes, prehypertension or dyslipidaemia-can inform management targeted at slowing CKD progression in a majority. However, attributes of CKD may differ substantially among persons living in low-income and middle-income countries (LMICs). We used data from population or community-based studies from five LMICs (China, urban India, Moldova, Nepal and Nigeria) to determine what proportion of persons with CKD living in diverse regions fit one of the three major clinical profiles, with data from the US National Health Nutrition and Examination Survey as reference. In the USA, urban India and Moldova, 79.0%-83.9%; in China and Nepal, 62.4%-66.7% and in Nigeria, 51.6% persons with CKD fit one of three established risk profiles. Diabetes was most common in urban India and vascular disease in Moldova (50.7% and 33.2% of persons with CKD in urban India and Moldova, respectively). In Nigeria, 17.8% of persons with CKD without established risk factors had albuminuria ≥300 mg/g, the highest proportion in any country. While the majority of persons with CKD in LMICs fit into one of three established risk profiles, the proportion of persons who have CKD without established risk factors is higher than in the USA. These findings can inform tailored CKD detection and management systems and highlight the importance of studying potential causes and outcomes of CKD without established risk factors in LMICs.

Keywords: cross-sectional survey; epidemiology; indices of health and disease and standardisation of rates.

Figure 1

Profiles of persons with CKD. In all countries except Nigeria, a majority of persons (>60%) fit one of the three predefined risk profiles. Diabetes and CKD were most common in urban India; vascular disease and CKD were most common in Moldova; obesity with prehypertension, pre-diabetes or dyslipidaemia was most common in China. CKD, chronic kidney disease; CV, cardiovascular.

Figure 2

Characteristics of persons with CKD without established risk factors versus those with CKD and diabetes. (A) Among participants of population-based studies. (B) Among participants of International Society of Nephrology Kidney Disease Data Center studies. Persons without established CKD risk factors were younger and more likely female; about one-third had hypertension. Within each country, the distribution of albuminuria and eGFR <60 mL/min/1.73 m² did not differ substantially between the two profiles. ACR, albumin:creatinine ratio; CKD, chronic kidney disease; eGFR, estimated glomerular filtration; NHANES, National Health and Nutrition Examination Survey.