Prevalence and Factors Associated with Chronic Kidney Disease in Karachi, Pakistan
Chronic kidney disease (CKD) is a major health problem globally and often neglected in the developing countries. However, representative data on the epidemiology of CKD from South Asian countries including Pakistan is scarce, especially using reliable estimates of kidney function. The objectives of the study were to determine the 1) prevalence of CKD; 2) socio-demographic and clinical factors associated with CKD; and 3) the existing management of these patients with regards to blood pressure control, and use of antihypertensive medications in Karachi, Pakistan.
METHODS:
Population based cross-sectional study was conducted in 12 randomly selected low- and middle-income communities in Karachi. The primary outcome was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 estimated by CKD-EPIPK (CKD-EPI with Pakistani correction factor, 0.686 × CKD-EPI1.059) or urinary albumin to creatinine ratio ≥30.0 mg/g. Socio-demographic and clinical determinants were identified using stepwise logistic regression modeling accounting for clustered data.
RESULTS: A total of 2873 adults aged ≥40 years (48% men) were screened. The overall prevalence (95% CI) of CKD in men and women was 11.6% (9.9 – 13.4%) and 13.3% (11.7 – 15.2%) respectively. The factors independently associated with CKD were older age, hypertension, diabetes, elevated systolic blood pressure, raised fasting plasma glucose, raised triglycerides, and history of stroke (p<0.05 for each). About 267 (74.4%, 95% CI: 69.5 – 78.8%) adults with CKD had concomitant hypertension. Of these, 48.7% (42.6 – 54.9%) were on antihypertensive medications, and less than 20% had their blood pressure controlled to conventional target of ≤140/90 mm Hg.
CONCLUSIONS:
Clinically significant CKD is common among Pakistani adults. The conventional risk factors for CKD and poor control of blood pressure among patients with CKD highlight the need to integrate CKD prevention and management in the primary care infrastructure along with other non-communicable diseases in Pakistan.