COMMUNITY BASED SCREENING, TREATMENT GAP AND RISK FACTOR OF CHRONIC KIDNEY DISEASE IN LMIC- NEPAL

 

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https://storage.unitedwebnetwork.com/files/1099/1652679b2acc1ec6ad9cef11982641cc.pdf
COMMUNITY BASED SCREENING, TREATMENT GAP AND RISK FACTOR OF CHRONIC KIDNEY DISEASE IN LMIC- NEPAL

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Aarjav
Sharma
Aarjav Sharma aarjav.drn01@gmail.com BP Koirala Institute of Health Sciences Department of Internal Medicine Dharan Nepal *
Urza Bhattarai bhattaraiurza@gmail.com BP Koirala Institute of Health Sciences Department of Internal Medicine Dharan Nepal - KHDC Nepal KHDC Nepal Dharan Nepal
Ujwal Gautam ujwal.gautam@gmail.com BP Koirala Institute of Health Sciences Department of Public Health Dentistry Dharan Nepal -
Arun Gautam arungautam5990@gmail.com BP Koirala Institute of Health Sciences Department of Internal Medicine Dharan Nepal - KHDC Nepal KHDC Nepal Dharan Nepal
Mahim Pyakurel mahimpyakurel@gmail.com KHDC Nepal KHDC Nepal Dharan Nepal -
Anup Ghimire ghimire.anup@gmail.com BP Koirala Institute of Health Sciences School of Public Health and Community Medicine Dharan Nepal -
Sanjib Kumar Sharma drsanjib@yahoo.com BP Koirala Institute of Health Sciences Department of Internal Medicine Dharan Nepal -
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The Chronic Kidney Disease (CKD) is a major public health problem with its prevalence increasing especially in low-middle income countries (LMIC). Most of the cases of CKD are detected in the later stages and the patient may not have the resources for the treatment of End Stage Renal Disease (ESRD) in LMIC like Nepal. The early detection and treatment in the community is a crucial step in preventing the progression to ESRD. The study aims at identifying the prevalence of CKD through community screening, identifying various risk factors and its treatment received.

The data was collected from the database of Kidney Hypertension Diabetes Cardiovascular Disease (KHDC) which is a community outreach program working for prevention, early detection and management of CKD, Hypertension, Diabetes and Cardiovascular disease in the community of Eastern Nepal. The total number of participants were 17,082 in the period of 2009-2019. The structured questionnaire was used to obtain demographic data, risk factors, health status and physical examination along with the measurement of blood pressure. Dipstick was used to detect proteinuria and subsequently confirmed though Albumin Creatinine Ratio (ACR). Blood was collected to measure fasting blood glucose and serum creatinine. e-GFR was calculated using MDRD equation.

Mean age of participant was 56.80 years. Female constituted 60.6%. Hypertension, diabetes mellitus (DM), overweight, obesity and family history of kidney disease were found in 12%, 5.8%, 17%, 30.4% and 2.2% respectively. 11.7% of the participants were smokers. Proteinuria was detected in 3.5% and e-GFR ≤ 60 was detected in 18.6%. Both proteinuria and e-GFR ≤ 60 was detected in 1.2%. The participants with DM and hypertension who were receiving treatment were found to be 4.3% and 7.9% respectively. CKD was detected in 0.51% of participants with DM and in 0.84% with hypertension. Out of participants with proteinuria, 0.04% were receiving treatment whereas 0.18% of participants with e-GFR ≤ 60 were receiving treatment. 0.01% of participants with both proteinuria and e-GFR ≤ 60 were receiving treatment. All participants who were screened positive were managed as per context specific guidelines. 

Prevalence of CKD and its risk factors is high in this study, although in the Nepalese context, e-GFR MDRD equation has not been validated yet. Most of the patients with CKD and its risk factors are not receiving the treatment. Community awareness and engagement along with the implementation of the existing guideline can help in early detection and management of CKD and its risk factor in countries with limited resources.  

Kewords