CHANGES IN THE PREVALENCE AND MANAGEMENT OF CKD IN MEXICO CITY BETWEEN 1998-2004 AND 2015-2019

Chronic Kidney Disease (CKD) is a leading cause of morbidity and mortality in Mexico, a country where diabetes is common and often poorly controlled, and where population-based estimates of CKD prevalence are limited. We investigated the trends in prevalence and management of CKD among adults from Mexico City who were participants in a long-term prospective study.

From 1998 to 2004, 159,517 adults from Mexico City were recruited into a blood-based prospective study, and from 2015 to 2019, 10,143 survivors were resurveyed and had repeated measurements and blood samples obtained. Additionally, urine was collected for about one half of resurveyed participants. NMR spectroscopy metabolomics was used to quantify plasma creatinine (and other biomarkers) from baseline and resurvey blood samples. The glomerular filtration rate (eGFR) was estimated using the 2021 CKD-EPI equation. For the analyses comparing participants at baseline and resurvey, CKD was defined as either a self-reported diagnosis (previously diagnosed CKD) or, among those without a diagnosis, an eGFR <60 mL/min/1.73 m2 (undiagnosed CKD). These CKD prevalence estimates were age-standardised to the 2010 Mexican census. Additional analyses among resurvey participants with blood and urine samples combined eGFR and urinary albumin to creatinine ratio (ACR) to further identify individuals with CKD.

During 1998-2004 and 2015-2019, 102,678 (64%) and 9,345 (92%) participants were aged 45-84 years, of which 89,144 (87%) and 7,795 (83%) had complete data. The age-standardised prevalence at ages 45-84 years of previously diagnosed, undiagnosed, and overall CKD increased moderately from <1%, 4%, and 5% at baseline (1998-2004) to 1%, 5%, and 6% at resurvey (2015-2019) (Figure 1). While the prevalence of previously diagnosed CKD did not vary much with age, the prevalence of undiagnosed CKD was considerably higher at older (14% and 17% in those aged 75 to 84 years at baseline and resurvey) than at younger ages (<1% and 1% in those aged 45 to 54 years) Of those with CKD, the proportion with a previous diagnosis was very low and did not change much from baseline (19%) to resurvey (17%). The use of renin-angiotensin system (RAS) blocking agents in individuals with CKD increased from 34% at baseline to 52% at resurvey, as did the use of statins (from <1% to 11%) and aspirin (6% to 16%). Of the 2,259 participants with both eGFR and ACR measured at resurvey, 248 (11%) had an eGFR <60 mL/min/1.73 m2, 720 (32%) had an ACR ≥30 mg/g, and 813 (36%) had either. These figures were considerably higher among those with diabetes [144 (16%), 444 (50%), and 477 (54%), respectively] than among those without [104 (8%), 276 (20%), and 336 (24%)].

In this population-based study of adults from Mexico City, the prevalence of probable CKD did not change much between 1998-2004 and 2015-2019. However, most of those with CKD are unaware, and the management of CKD and associated comorbidities remains suboptimal. Widespread implementation of CKD screening using urinary albumin, particularly among those with diabetes, is likely to identify many individuals with early CKD stages and could help reduce the burden of CKD in Mexico.