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      What do we know about chronic kidney disease in India: first report of the Indian CKD registry

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          Abstract

          Background

          There are no national data on the magnitude and pattern of chronic kidney disease (CKD) in India. The Indian CKD Registry documents the demographics, etiological spectrum, practice patterns, variations and special characteristics.

          Methods

          Data was collected for this cross-sectional study in a standardized format according to predetermined criteria. Of the 52,273 adult patients, 35.5%, 27.9%, 25.6% and 11% patients came from South, North, West and East zones respectively.

          Results

          The mean age was 50.1 ± 14.6 years, with M:F ratio of 70:30. Patients from North Zone were younger and those from the East Zone older. Diabetic nephropathy was the commonest cause (31%), followed by CKD of undetermined etiology (16%), chronic glomerulonephritis (14%) and hypertensive nephrosclerosis (13%). About 48% cases presented in Stage V; they were younger than those in Stages III-IV. Diabetic nephropathy patients were older, more likely to present in earlier stages of CKD and had a higher frequency of males; whereas those with CKD of unexplained etiology were younger, had more females and more frequently presented in Stage V. Patients in lower income groups had more advanced CKD at presentation. Patients presenting to public sector hospitals were poorer, younger, and more frequently had CKD of unknown etiology.

          Conclusions

          This report confirms the emergence of diabetic nephropathy as the pre-eminent cause in India. Patients with CKD of unknown etiology are younger, poorer and more likely to present with advanced CKD. There were some geographic variations.

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          Most cited references25

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          Epidemiologic and economic consequences of the global epidemics of obesity and diabetes.

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            Chronic renal failure among farm families in cascade irrigation systems in Sri Lanka associated with elevated dietary cadmium levels in rice and freshwater fish (Tilapia).

            Chronic renal failure (CRF), in the main agricultural region under reservoir based cascade irrigation in Sri Lanka has reached crisis proportion. Over 5,000 patients in the region are under treatment for CRF. The objective of this study is to establish the etiology of the CRF. Concentrations of nine heavy metals were determined in sediments, soils of reservoir peripheries, water and Nelumbo nucifera (lotus) grown in five major reservoirs that supply irrigation water. All five reservoirs carried higher levels of dissolved cadmium (Cd), iron (Fe) and lead (Pb). Dissolved Cd in reservoir water ranged from 0.03 to 0.06 mg/l. Sediment Cd concentration was 1.78-2.45 mg/kg. No arsenic (As) was detected. Cd content in lotus rhizomes was 253.82 mg/kg. The Provisional Tolerable Weekly Intake (PTWI) of Cd based on extreme exposure of rice is 8.702-15.927 microg/kg body weight (BW) for different age groups, 5-50 years. The PTWI of Cd due to extreme exposure of fish is 6.773-12.469 microg/kg BW. The PTWI on a rice staple with fish is 15.475-28.396 microg/kg BW. The mean urinary cadmium (UCd) concentration in CRF patients of age group 40-60 years was 7.58 microg Cd/g creatinine and in asymptomatic persons UCd was 11.62 microg Cd/g creatinine, indicating a chronic exposure to Cd. The possible source of Cd in reservoir sediments and water is Cd-contaminated agrochemicals. The CRF prevalent in north central Sri Lanka is a result of chronic dietary intake of Cd, supported by high natural levels of fluoride in drinking water, coupled with neglecting of routine de-silting of reservoirs for the past 20 years.
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              Chronic Kidney Disease: A Public Health Problem That Needs a Public Health Action Plan

              For a health problem or condition to be considered a public health issue, four criteria must be met: 1) the health condition must place a large burden on society, a burden that is getting larger despite existing control efforts; 2) the burden must be distributed unfairly (i.e., certain segments of the population are unequally affected); 3) there must be evidence that upstream preventive strategies could substantially reduce the burden of the condition; and 4) such preventive strategies are not yet in place. Chronic kidney disease meets these criteria for a public health issue. Therefore, as a complement to clinical approaches to controlling it, a broad and coordinated public health approach will be necessary to meet the burgeoning health, economic, and societal challenges of chronic kidney disease.
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                Author and article information

                Journal
                BMC Nephrol
                BMC Nephrol
                BMC Nephrology
                BioMed Central
                1471-2369
                2012
                6 March 2012
                : 13
                : 10
                Affiliations
                [1 ]Department of Nephrology, Muljibhai Patel Society for Research in Nephro-Urology, Dr Virendra Desai Road, Nadiad, 387001 India
                [2 ]Department of Nephrology, Christian Medical College, Ida Scudder Road, 632004 Vellore, India
                [3 ]Department of Nephrology, Bombay Hospital, 12, Marine Lines, Mumbai - 400020, India
                [4 ]Department of Nephrology, Madras Medical Mission, 4-A, Dr. J. Jayalalitha Nagar, Mogappair, Chennai 600037, India
                [5 ]Department of Nephrology, All India Institute of Medical Sciences, Ansari nagar, New Delhi 110029, India
                [6 ]Department of Nephrology, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai 400 016, India
                [7 ]Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibarely Road, Lucknow 226014, India
                [8 ]Samarpan Kidney Center, B 288 C Sector, Shahpura, Bhopal 462019, India
                [9 ]Department of Nephrology, Medica Superspecialty Hospital, 127 Mukundapur, E.M Bypass, Kolkata 700099, India
                [10 ]Department of Nephrology, Government Medical College, Ulloor Road, Trivandrum 695011 India
                [11 ]Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
                [12 ]Department of Nephrology, Mediciti Hospital, 5-9-22, Secretariat Road, Hyderabad 500063, India
                [13 ]Department of Nephrology, Sir Gangaram Hospital, Rajinder Nagar, New Delhi 110060 India
                [14 ]Department of Nephrology, SCB Medical College, Buxibazar, Cuttack 753007, India
                [15 ]Department of Nephrology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012 India
                [16 ]Department of Nephrology, Andhra Medical College, M.R.Peta, Vishakhapattanam 530002, India
                Article
                1471-2369-13-10
                10.1186/1471-2369-13-10
                3350459
                22390203
                ce0b5559-7cb7-4d89-a660-db09a402317b
                Copyright ©2012 Rajapurkar et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 July 2011
                : 6 March 2012
                Categories
                Research Article

                Nephrology
                Nephrology

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