Introduction:
A high prevalence of chronic kidney disease (CKD) not associated with known risk factors has been reported from coastal districts of Andhra Pradesh, India, and dubbed Uddanam nephropathy. No data are available on the rate of change of kidney function in the inhabitants of the region. Aim of this study was undertaken to evaluate the incidence of CKD and the annual rate of estimated glomerular filtration rate (eGFR) change in the adult residents of the Uddanam region of Andhra Pradesh, as part of the who are participating in the STOP-CKDu study.
Methods:
A population-representative cohort of 2419 adult subjects (age 18 - 75 years) was created through a multistage cluster random sampling methodology between May and December 2018 from 67 villages. Serum creatinine and urine protein creatinine ratio were estimated at baseline and then in 2022 and 2024 in all subjects. All abnormal eGFR (estimated using the CKD-EPI equation) and proteinuria values were reconfirmed after three months. CKD was defined as eGFR <60 ml/min/1.73 m².
Results:
A total of 2419 subjects were recruited, with a mean age of 45.7 ± 13.3 years, and 51% were women. A plurality (38.3%) had not received formal education, and 75.6% were manual workers or farmers. Regarding traditional CKD risk factors, 998 (41.6%) had hypertension, with 215 (8.9%) having the diagnosis for ≥5 years, 317 (13.1%) had diabetes, and 334 (13.9%) had a family history of CKD. The mean eGFR among the population at baseline was 103.6 ± 26.13 ml/min/1.73 m² and 263 (10.9%) subjects had an eGFR <60 ml/min/1.73 m². Over a median follow-up of 5.3 years, the annual incidence rate of CKD was 4.5 per 100 population. At baseline, 263 (10.9%) subjects had an eGFR <60 ml/min/1.73 m². Over a mean follow-up of 5.9 years, the annual rate of eGFR decline was 3.78 ml/min/1.73 m².
Conclusions:
This study highlights a concerningly high CKD incidence rate in young adults in Uddanam, suggesting a rapidly progressing form of the disease likely driven by unidentified environmental or genetic factors. The alarmingly high annual eGFR decline signifies rapid progression towards kidney failure, emphasizing the need for urgent public health interventions. Addressing this issue requires accelerated research, extensive screening, and targeted interventions to manage and prevent CKD effectively in Uddanam.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.