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Clin Kidney J. 2016 Feb;9(1):135-41. doi: 10.1093/ckj/sfv109. Epub 2015 Nov 17.

Chronic kidney disease hotspots in developing countries in South Asia.

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Madras Medical Mission & Pondicherry Institute of Medical Science , Puducherry , India.
Christian Medical College , Vellore , India.
Tides IHMS , Chennai , India.
St. Johns Medical College , Bengaluru , India.
Stanley Medical College , Chennai , India.
The Kidney Foundation , Karachi , Pakistan.
University of Colombo , Colombo , Sri Lanka.
Kidney Foundation Hospital and Research Institute , Dhaka , Bangladesh.
Madras Medical College , Chennai , India.
National Kidney Center , Kathmandu , Nepal.


In many developing countries in the South Asian region, screening for chronic diseases in the community has shown a widely varying prevalence. However, certain geographical regions have shown a high prevalence of chronic kidney disease (CKD) of unknown etiology. This predominantly affects the young and middle-aged population with a lower socioeconomic status. Here, we describe the hotspots of CKD of undiagnosed etiology in South Asian countries including the North, Central and Eastern provinces of Sri Lanka and the coastal region of the state of Andhra Pradesh in India. Screening of these populations has revealed cases of CKD in various stages. Race has also been shown to be a factor, with a much lower prevalence of CKD in whites compared to Asians, which could be related to the known influence of ethnicity on CKD development as well as environmental factors. The difference between developed and developing nations is most stark in the realm of healthcare, which translates into CKD hotspots in many regions of South Asian countries. Additionally, the burden of CKD stage G5 remains unknown due to the lack of registry reports, poor access to healthcare and lack of an organized chronic disease management program. The population receiving various forms of renal replacement therapy has dramatically increased in the last decade due to better access to point of care, despite the disproportionate increase in nephrology manpower. In this article we will discuss the nephrology care provided in various countries in South Asia, including India, Bangladesh, Pakistan, Nepal, Bhutan, Sri Lanka and Afghanistan.


CKD; diabetes mellitus; glomerulonephritis; glomerulosclerosis; pediatrics

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