GEORSPATIAL ANALYSIS OF CKD HOT SPOTS: INSIGHTS FROM 0.1 MILLION PARTICIPANTS SCREENING IN UDDANAM, INDIA

Introduction:

Geographic clusters with a high burden of chronic kidney disease (CKD) have been identified in several Indian states, including Andhra Pradesh, Odisha, Maharashtra, and Goa. The Uddanam region in Andhra Pradesh is the most prominent hotspot, exhibiting a pattern of CKD of unknown etiology (CKDu) like other global regions, primarily affecting young men. The World Health Organization (WHO) recognizes this as one of the three regions worldwide with the highest concentration of CKD, alongside Sri Lanka and Nicaragua. This region encompasses seven blocks with a population of approximately 0.25 million. Unpublished cross-sectional studies indicate that CKD prevalence in this area ranges from 30% to 60%, affecting an estimated 34,000 individuals and resulting in over 5,500 deaths in the last decade. In response, the Andhra Pradesh government has initiated a mass screening program targeting residents aged 20 and above to gather crucial data and plan research activities.

Methods:

To assess the burden of CKD in the Uddanam region, a three-pronged screening program was implemented. This program included pre-camp awareness campaigns, fixed-day screening camps, a total of 15 trained health teams, each team consisting of one medical officer, two ANMs, three ASHAs, phlebotomist and lab technician. The involvement of local community groups further boosted participation in these screening camps. Blood samples were collected and analysed for serum creatinine and blood urea nitrogen levels, data collected on gender, age, and self-reported health condition. In the second step, a team from the George Institute for Global Health, in collaboration with the Government of Andhra Pradesh, collected geo-coordinates of the villages, mapped the locations, created a shapefile, and analyzed the screening data. Individuals with elevated levels were referred to secondary health centres for further evaluation.

Results:

The combined population of these seven blocks is 267,493, with 173,512 (65%) adults (≥20 years) eligible for screening. Of these, 58% (101,593) were screened. After exclusions, data cleaning 92,255 participants were included in the analysis. The prevalence of self-reported hypertension was 9.2% (95% CI: 9.01-9.39), diabetes 3.3% (CI: 3.07-3.53), and kidney disease 2.1% (95% CI: 1.91-2.29). The mean serum creatinine was 1.04 mg/dL (CI:1.03-1.04), mean blood urea nitrogen was 23.3 mg/dL (23.22-23.37), and mean estimated glomerular filtration rate (eGFR) was 83.1 mL/min/1.73 m² (82.93-83.26). A significant proportion, 16.9% (16.64-17.16), had an eGFR below 60 mL/min/1.73 m², indicating potential kidney dysfunction. Figure 1 presents a GIS heat map showing the geographic distribution of participants with eGFR < 60 mL/min/1.73 m², highlighting hotspots in the central, southern, and northern villages near the coastal regions of Uddanam, indicating a higher prevalence of CKD in these areas.

Conclusions:

Mass screening of around 0.1 million adults in Uddanam revealed a 16.9% prevalence of potential kidney dysfunction (eGFR < 60 mL/min/1.73 m²), exceeding national average. This emphasizes highlighting the urgent need for targeted interventions and further research into environmental and occupational factors. Establishing a CKD registry will be vital for long-term monitoring and tailored prevention strategies.

I have no potential conflict of interest to disclose.

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