Screening for chronic kidney disease in a community-based diabetes cohort in rural Guatemala: a cross-sectional study

Abstract

Objective: Screening is a key strategy to address the rising burden of chronic kidney disease (CKD) in low-income and middle-income countries. However, there are few reports regarding the implementation of screening programmes in resource-limited settings. The objectives of this study are to (1) to share programmatic experiences implementing CKD screening in a rural, resource-limited setting and (2) to assess the burden of renal disease in a community-based diabetes programme in rural Guatemala.

Design: Cross-sectional assessment of glomerular filtration rate (GFR) and urine albumin.

Setting: Central Highlands of Guatemala.

Participants: We enrolled 144 adults with type 2 diabetes in a community-based CKD screening activity carried out by the sponsoring institution.

Outcome measures: Prevalence of renal disease and risk of CKD progression using Kidney Disease: Improving Global Outcomes definitions and classifications.

Results: We found that 57% of the sample met GFR and/or albuminuria criteria suggestive of CKD. Over half of the sample had moderate or greater increased risk for CKD progression, including nearly 20% who were classified as high or very high risk. Hypertension was common in the sample (42%), and glycaemic control was suboptimal (mean haemoglobin A1c 9.4%±2.5% at programme enrolment and 8.6%±2.3% at time of CKD screening).

Conclusions: The high burden of renal disease in our patient sample suggests an imperative to better understand the burden and risk factors of CKD in Guatemala. The implementation details we share reveal the tension between evidence-based CKD screening versus screening that can feasibly be delivered in resource-limited global settings.

Keywords: chronic renal failure; general diabetes; international health services.

Figure 1

Risk of chronic kidney disease (CKD) progression. (Top panel) Risk map for CKD progression. Cells coded by Kidney Disease: Improving Global Outcomes (KDIGO) risk level as follows: green, low risk; yellow, moderately increased risk; orange, high risk; red, very high risk. Glomerular filtration rate (GFR) was calculated using CKD-Epidemiology Collaboration equation. KDIGO designations are as follows: A1, normal to mildly increased albuminuria; A2, moderately increased albuminuria; A3, severely increased albuminuria; G1, normal or high GFR; G2, mildly decreased GFR; G3a, mildly to moderately decreased; G3b, moderately to severely decreased GFR; G4, severely decreased GFR; G5, kidney failure. (Bottom panel) Waffle chart of KDIGO CKD risk progression categories. Each rectangle denotes a single patient in the sample (n=144). Cells are coded by KDIGO risk as in the top panel.