02483nas a2200277   4500000000100000008004100001100001500042700001100057700002000068700002100088700001800109700001800127700001600145700002200161700001700183700001900200700002200219700001300241700002100254700002500275245019700300300001200497490000600509520167600515022001402191       2017                            d1 aNarayan Km1 aJha V.1 aPerico Norberto1 aRemuzzi Giuseppe1 aChertow Glenn1 aTandon Nikhil1 aZhang Luxia1 aMohan Viswanathan1 aAnand Shuchi1 aZheng Yuanchao1 aMontez-Rath Maria1 aWei Wang1 aCarminati Sergio1 aPrabahkaran Dorairaj00aDo attributes of persons with chronic kidney disease differ in low-income and middle-income countries compared with high-income countries? Evidence from population-based data in six countries.  ae0004530 v23 a<p>
Kidney biopsies to elucidate the cause of chronic kidney disease (CKD) are performed in a minority of persons with CKD living in high-income countries, since associated conditions-that is, diabetes mellitus, vascular disease or obesity with pre-diabetes, prehypertension or dyslipidaemia-can inform management targeted at slowing CKD progression in a majority. However, attributes of CKD may differ substantially among persons living in low-income and middle-income countries (LMICs). We used data from population or community-based studies from five LMICs (China, urban India, Moldova, Nepal and Nigeria) to determine what proportion of persons with CKD living in diverse regions fit one of the three major clinical profiles, with data from the US National Health Nutrition and Examination Survey as reference. In the USA, urban India and Moldova, 79.0%-83.9%; in China and Nepal, 62.4%-66.7% and in Nigeria, 51.6% persons with CKD fit one of three established risk profiles. Diabetes was most common in urban India and vascular disease in Moldova (50.7% and 33.2% of persons with CKD in urban India and Moldova, respectively). In Nigeria, 17.8% of persons with CKD without established risk factors had albuminuria ≥300 mg/g, the highest proportion in any country. While the majority of persons with CKD in LMICs fit into one of three established risk profiles, the proportion of persons who have CKD without established risk factors is higher than in the USA. These findings can inform tailored CKD detection and management systems and highlight the importance of studying potential causes and outcomes of CKD without established risk factors in LMICs.
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