ASSESSMENT OF CAUSES OF DEATH IN A POPULATION-REPRESENTATIVE COHORT AT RISK OF CHRONIC KIDNEY DISEASE OF UNKNOWN ORIGIN, USING SMARTVA TECHNOLOGY

Introduction:

A high prevalence of chronic kidney disease (CKD) not associated with known risk factors, named as ‘Uddanam nephropathy’, has been reported from coastal districts of Andhra Pradesh, India. Over the last decade, over 4500 CKD-related deaths have been reported in the lay press. However, there has been no formal ascertainment of the cause of death in this population, which is critical for gaining actionable insights. We ascertained the cause-specific mortality fractions (CSMFs) for participants in the ongoing study to test and operationalize preventive approaches for chronic kidney disease of unknown etiology (STOP CKDu).

Methods:

A total of 2419 participants between 18 and 75 were recruited from 67 villages between May and December 2018. A validated electronic verbal autopsy (VA) questionnaire developed by the Population Health Metrics Research Consortium (PHMRC) was administered to the carer of the study participants who died over this period. Two independent, trained field supervisors administered the questionnaire during two distinct phases. The first phase covered participants who passed away between May 2018 and March 2022, while the second phase targeted those who died between April 2022 and July 2024. The cause of death (CoD) was established using the Tariff 2.0 approach. The CoD generated by the SmartVA tool was supplemented by separate narratives collected from family members and accessible medical records aggregated to arrive at a single cause of death for each person.

Results:

A total of 217 (133 in 1st phase and 84 in 2nd phase) participants (154 males, 63 females), aged 60 ± 12.9 years, died between May 2018 and July 2024. Thirty-nine (18%) deaths were in hospital, whereas 178 (82%) died at home. The algorithm assigned a specific COD for 95.7% of deaths. Chronic kidney disease (CKD) was the leading cause of death, accounting for 39.6% of all deaths (95% confidence interval: 33.1-46.2). Ischemic heart disease was the second leading cause of death at 18.9% (95% CI: 13.6-24.2), followed by chronic respiratory diseases at 8.5% (95% CI: 5.1-12.5), and cancers and strokes at 4% (95% CI: 1.5-6.7).

Conclusions:

CKD is responsible for 40% of all adult deaths in the Uddanam region. This rate is 16 times higher than the global estimate of as reported by the Global Burden of Disease (GBD) These findings underscore the need for the development of specific policies around population-based screening, prevention, and research to identify the causes of CKD in this area.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.