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PLoS One. 2017 Mar 15;12(3):e0173554. doi: 10.1371/journal.pone.0173554. eCollection 2017.

Prevalence of chronic kidney disease and risk factors for its progression: A cross-sectional comparison of Indians living in Indian versus U.S. cities.

Author information

1
Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.
2
Centre for Chronic Disease Control, New Delhi, India.
3
Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, United States of America.
4
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, Chennai, India.
5
Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India.
6
Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.
7
Division of General Internal Medicine and Department of Preventive Medicine, Northwestern University, Chicago, IL, United States of America.
8
Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States of America.

Abstract

BACKGROUND:

While data from the latter part of the twentieth century consistently showed that immigrants to high-income countries faced higher cardio-metabolic risk than their counterparts in low- and middle-income countries, urbanization and associated lifestyle changes may be changing these patterns, even for conditions considered to be advanced manifestations of cardio-metabolic disease (e.g., chronic kidney disease [CKD]).

METHODS AND FINDINGS:

Using cross-sectional data from the Center for cArdiometabolic Risk Reduction in South Asia (CARRS, n = 5294) and Mediators of Atherosclerosis in South Asians Living in America (MASALA, n = 748) studies, we investigated whether prevalence of CKD is similar among Indians living in Indian and U.S. cities. We compared crude, age-, waist-to-height ratio-, and diabetes- adjusted CKD prevalence difference. Among participants identified to have CKD, we compared management of risk factors for its progression. Overall age-adjusted prevalence of CKD was similar in MASALA (14.0% [95% CI 11.8-16.3]) compared with CARRS (10.8% [95% CI 10.0-11.6]). Among men the prevalence difference was low (prevalence difference 1.8 [95% CI -1.6,5.3]) and remained low after adjustment for age, waist-to-height ratio, and diabetes status (-0.4 [-3.2,2.5]). Adjusted prevalence difference was higher among women (prevalence difference 8.9 [4.8,12.9]), but driven entirely by a higher prevalence of albuminuria among women in MASALA. Severity of CKD--i.e., degree of albuminuria and proportion of participants with reduced glomerular filtration fraction--was higher in CARRS for both men and women. Fewer participants with CKD in CARRS were effectively treated. 4% of CARRS versus 51% of MASALA participants with CKD had A1c < 7%; and 7% of CARRS versus 59% of MASALA participants blood pressure < 140/90 mmHg. Our analysis applies only to urban populations. Demographic--particularly educational attainment--differences among participants in the two studies are a potential source of bias.

CONCLUSIONS:

Prevalence of CKD among Indians living in Indian and U.S. cities is similar. Persons with CKD living in Indian cities face higher likelihood of experiencing end-stage renal disease since they have more severe kidney disease and little evidence of risk factor management.

PMID:
28296920
PMCID:
PMC5351850
DOI:
10.1371/journal.pone.0173554
[Indexed for MEDLINE]
Free PMC Article

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