Study reveals characteristics, causes of CKD in Indian population
Phase I of the Indian Chronic Kidney Disease study shows diabetes and chronic interstitial disease are the leading causes of chronic kidney disease in the Indian population.
The findings, which were published in the Clinical Kidney Journal, not only advance the understanding of disease progression in this patient population but may support improved care globally, the researchers suggested.
“The progression of chronic kidney disease (CKD) and cardiovascular disease (CVD) in the setting of CKD is highly variable and the factors determining progression and complications are largely unknown. These may vary by demographic, geographic and genetic characteristics. To date, there are no large longitudinal studies comparing the differences in racially, geographically, and potentially, genetically different populations in low and lower-middle income countries and none in individuals of Indian origin. Given the prohibitively high costs of dialysis or kidney transplantation in India, it is critical to identify and intervene early in the course of chronic kidney disease,” Vivekanand Jha, MD, DM, FRCP, FAMS, executive director of the George Institute for Global Health India and chair of Global Kidney Health at Imperial College in London, told Healio Nephrology.
In a prospective, multicentric, cohort study, researchers analyzed 4,056 Indian patients (aged 50.3 ±11.8 years; 67.2% were men; 87% were hypertensive; 37% had diabetes; 22% had CVD; 6.7% had past history of AKI; 23% reported prior use of alternative drugs) to determine factors associated with CKD progression and development of kidney failure. All participants had an estimated glomerular filtration rate (eGFR) of 15 mL/min/1.73 m2 to 60 mL/min/1.73m 2 or greater than 60 mL/min/1.73 m2 with proteinuria.
Phase I of the Indian Chronic Kidney Disease (ICKD) study occurred between April 1, 2016 and March 31, 2020. Researchers intend to continue the study at 11 centers across India and follow the participants for a minimum of 10 years.
Using descriptive and quantitative analyses, researchers identified the sociodemographic, clinical and biochemical characteristics of participants at annual visits. Additionally, researchers compared characteristics between urban and rural participants.
Researchers found diabetes was the most common cause of CKD in the cohort (25%), followed by chronic interstitial disease (23.2%) and CKD-cause unknown (19.5%) in both rural and urban participants. Almost two-thirds of the cohort lived in rural areas, who self-reported as less educated, had lower insurance coverage and used tobacco more than participants who lived in urban areas. CKD due to unknown cause was more prevalent in rural participants, reinforcing differences in epidemiology of CKD between urban and rural regions.
“Findings from this study will significantly improve the prognosis and health-related [quality of life] QOL of CKD patients globally in three ways: 1) a more deliberate and focused application of existing diagnostic and therapeutic procedures (secondary prevention); 2) development of novel and more effective diagnostic and therapeutic procedures.; and 3) establishment of an improved basis for targeted interventional trials in CKD patients through the definition of subpopulations with a similar risk profile and the use of surrogate markers for clinically important end-points,” Jha said. “We also anticipate that the ICKD study will generate significant findings for understanding CVD progression in the general population, because CKD defines an extremely ‘high risk’ population for CVD complications and can therefore be considered a ‘human model’ to study accelerated atherosclerosis progression.”
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