International patterns of prevalence of low estimated glomerular filtration rate (eGFR) in population-based surveys of working age adults: The Disadvantaged Populations eGFR Epidemiology Study (DEGREE)

Abstract

AbstractThe Disadvantaged populations estimated glomerular filtration rate (eGFR) epidemiology study (DEGREE) was designed to gain insight into the burden of chronic kidney disease (CKD) of undetermined cause (CKDu) using standard protocols to estimate the general-population prevalence of low eGFR internationally.Using population-representative surveys of working-age adults, we estimated the prevalence of eGFR<60mL/min/1.73m2not due to the common, known causes of CKD by excluding participants with ACR>300mg/g or equivalent, or self-reported or measured hypertension or diabetes (eGFR<60[absent HT, DM, high ACR]). Included studies were either designed to estimate CKDu burden or were re-analyses of large surveys (in areas with reported high CKDu prevalence or proposed risk factors), alongside two high-income reference datasets.There were 61 108 participants from 43 areas across 14 countries. High prevalence of eGFR<60[absent HT, DM, high ACR] (>5%) was generally only observed in rural men, but there were exceptions. Of the areas considered, prevalence in rural men was highest in Andhra Pradesh, India, (14%) and Northwest Nicaragua (14%); it was low (<2%) outside of Central America and South Asia, including areas in Kenya, Italy, Malawi, Peru, Chile, Ecuador, Thailand, England, and the USA.These observations represent the first attempts to quantify the prevalence of eGFR<60[absent HT, DM, high ACR], as an estimate of CKDu burden, around the world. These findings have limitations in terms of comparability of study populations and study timing, lack of individual-level exposure assessment, and absent data in many regions. Although clusters of disease may exist elsewhere, to date the available evidence supports a high general-population burden of CKDu in multiple areas within Central America and South Asia.