International prevalence patterns of low eGFR in adults aged 18-60 without traditional risk factors from a population-based cross-sectional disadvantaged populations eGFR epidemiology (DEGREE) study
Charlotte E Rutter, Mary Njoroge, Philip J. Cooper, Dorairaj Prabhakaran, Vivekanand Jha, Prabhdeep Kaur, Sailesh Mohan, Ravi Raju Tatapudi, Annibale Biggeri, Peter Rohloff, Michelle H Hathaway, Amelia C. Crampin, Meghnath Dhimal, Anil Poudyal, Antonio Bernabé‐Ortiz, Cristina O’Callaghan‐Gordo, Pubudu Chulasiri, Nalika Gunawardena, Thilanga Ruwanpathirana, S. C. Wickramasinghe, Sameera Senanayake, Chagriya Kitiyakara, Marvin González-Quiroz, Sandra Cortés, Kristina Jakobsson, Ricardo Correa‐Rotter, Jason Glaser, Ajay Singh, Sophie Hamilton, Devaki Nair, Aurora Aragón, Dorothea Nitsch, Steven Robertson, Ben Caplin, Neil Pearce, Neil Pearce, Wichai Aekplakorn, Shuchi Anand, Aurora Aragón, Antonio Bernabe-Ortiz, Annibale Biggeri, Emmanuel Burdmann, Ben Caplin, Dolores Catelan, Pubudu Chulasiri, Philip J. Cooper, Ricardo Correa-Rotter, Sandra Cortés, Amelia C. Crampin, Melissa de Santiago, Meghnath Dhimal, Samuel Dorevitch, Samuel Dorevitch, Catterina Ferreccio, Jason Glaser, Marvin Gonzalez-Quiroz, Emily Granadillo, Monsermin Gualan, Balaji Gummidi, Nalika Gunawardena, Sophie Hamilton, Michelle Hathaway, Kristina Jakobsson, Prashant Jarhyan, Vivekanand Jha, Oomen John, Richard J. Johnson, Prabhdeep Kaur, Chagriya Kitiyakara, Pornpimol Kongtip, Hans Kromhout, Adeera Levin, Magdalena Madero, Estelle McLean, J. Jaime Miranda, Joseph Mkandawire, Sailesh Mohan, Sharan Murali, Devaki Nair, Wisdom Nakanga, Dorothea Nitsch, Mary Njoroge, Moffat Nyirenda, Cristina O'Callaghan-Gordo, Neil Pearce, Anil Poudyal, Dorairaj Prabhakaran, Narayan Prasad, Lesliam Quirós-Alcalá, Giuseppe Remuzzi, Steven Robertson, Peter Rohloff, Natalia Romero-Sandoval, Andrea Ruiz-Alejos, Charlotte E. Rutter, Charlotte E. Rutter, Thilanga Ruwanpathirana, Manikandanesan Sakthivel, Rajiv Saran, Sameera Senanayake
Abstract
The disadvantaged populations eGFR (estimated glomerular filtration rate) epidemiology (DEGREE) study was designed to gain insight into the burden of chronic kidney disease (CKD) of undetermined cause (CKDu) using standard protocols to estimate the general-population prevalence of low eGFR internationally. Therefore, we estimated the age-standardized prevalence of eGFR under 60 ml/min per 1.73m 2 in adults aged 18-60, excluding participants with commonly known causes of CKD; an ACR (albumin/creatinine ratio) over 300 mg/g or equivalent, or self-reported or measured (HT) hypertension or (DM) diabetes mellitus, stratified by sex and location. We included population-representative surveys conducted around the world that were either designed to estimate CKDu burden or were re-analyses of large surveys. There were 60,964 participants from 43 areas across 14 countries, with data collected 2007- 2023. The highest prevalence was seen in rural men in Uddanam, India (14%) and Northwest Nicaragua (14%). Prevalence above 5% was generally only observed in rural men, with exceptions for rural women in Ecuador (6%) and parts of Uddanam (6%‒8%), and for urban men in Leon, Nicaragua (7%). Outside of Central America and South Asia, prevalence was below 2%. Our observations represent the first attempts to estimate the prevalence of eGFR under 60 without commonly known causes of CKD around the world, as an estimate of CKDu burden, and provide a starting point for global monitoring. It is not yet clear what drives the differences, but available evidence supports a high general-population burden of CKDu in multiple areas within Central America and South Asia, although the possibility that unidentified clusters of disease may exist elsewhere cannot be excluded.