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      Prevalence and determinants of chronic kidney disease in northeast of Iran: Results of the Golestan cohort study

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          Abstract

          Background

          The burden of chronic kidney disease (CKD) is increasing globally in particular in fast emerging economies such as Iran. Population-based studies on prevalence of CKD in Iran are scarce. The objective of the current study was to explore the prevalence and determinants of CKD in the setting of Golestan Cohort Study (GCS), the largest prospective cohort in the Middle East.

          Methods

          In this observational study, 11,409 participants enrolled in the second phase of GCS were included. Sex, age, literacy, residence, anthropometric measurements, smoking, opium use, self-reported history of cardiovascular diseases (heart disease and/or stroke), hypertension, diabetes, and lipid profile were the predictors of interest. The outcomes of interest were eGFR and CKD defined as eGFR< 60 ml/min/1.73m 2.

          Results

          Mean (SD) of GFR was 70.0 ± 14.7 ml/min/1.73m 2 among all participants, 68.2 ± 14.2 among women, and 72.0 ± 15.0 among men. Prevalence of CKD was 23.7% (26.6% in women, 20.6% in men). The prevalence of CKD stages 3a, 3b, 4, and 5 were 20.0%, 3.3%, 0.4% and 0.1%, respectively. Female sex, older age, urban residence, history of CVD, hypertension or diabetes, larger body mass and surrogates of body fat and opium use were all associated with CKD. Opium had a significant positive association with CKD in adjusted model. All anthropometric measurements had positive linear association with CKD. Being literate had inverse association. Sex had significant interaction with anthropometric indices, with higher odds ratios among men compared with women. A significantly high association was observed between the rate of change in waist circumference and systolic blood pressure with risk of CKD.

          Conclusion

          One in four people in this cohort had low eGFR. Obesity and overweight, diabetes, hypertension, and dyslipidemia are major risk factors for CKD. Halting the increase in waist circumference and blood pressure may be as important as reducing the current levels.

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          Most cited references18

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          Cohort Profile: The Golestan Cohort Study--a prospective study of oesophageal cancer in northern Iran.

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            The dual roles of obesity in chronic kidney disease: a review of the current literature.

            Obesity is a major risk factor for the development of de novo chronic kidney disease (CKD). However, once kidney disease is acquired, obesity is paradoxically linked with greater survival, especially in those with advanced CKD. This review examines current evidence for obesity as a risk factor for incident CKD, studies of obesity and mortality across various CKD populations, and potential mechanisms underlying the 'obesity paradox' in kidney disease.
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              Verbal Autopsy: Reliability and Validity Estimates for Causes of Death in the Golestan Cohort Study in Iran

              Background Verbal autopsy (VA) is one method to obtain valid estimates of causes of death in the absence of valid medical records. We tested the reliability and validity of a VA questionnaire developed for a cohort study in Golestan Province in northeastern Iran. Method A modified version of the WHO adult verbal autopsy was used to assess the cause of death in the first 219 Golestan Cohort Study (GCS) subjects who died. The GCS cause of death was determined by two internists who independently reviewed all available medical records. Two other internists (“reviewers”) independently reviewed only the VA answers and classified the cause of death into one of nine general categories; they repeated this evaluation one month later. The reliability of the VA was measured by calculating intra-reviewer and inter-reviewer kappa statistics. The validity of the VA was measured using the GCS cause of death as the gold standard. Results VA showed both good validity (sensitivity, specificity, PPV, and NPV all above 0.81) and reliability (kappa>0.75) in determining the general cause of death independent of sex and place of residence. The overall multi-rater agreement across four reviews was 0.84 (95%CI: 0.78–0.89). The results for identifying specific cancer deaths were also promising, especially for upper GI cancers (kappa = 0.95). The multi-rater agreement in cancer subgroup was 0.93 (95%CI: 0.85–0.99). Conclusions VA seems to have good reliability and validity for determining the cause of death in a large-scale adult follow up study in a predominantly rural area of a middle-income country.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                3 May 2017
                2017
                : 12
                : 5
                : e0176540
                Affiliations
                [1 ]Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
                [2 ]Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
                [3 ]Department of Nephrology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
                [4 ]Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland, United States of America
                [5 ]Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
                [6 ]Academy of Medical Sciences, Tehran, Iran
                [7 ]Division of Nephrology & Hypertension, School of Medicine, University of California Irvine, Irvine, California, United States of America
                [8 ]Veterans Affairs (VA) Long Beach Healthcare System‎, Long Beach, California, United States of America
                [9 ]Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, United States of America
                Universita degli Studi di Perugia, ITALY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: SGS HB IN FK KKZ.

                • Formal analysis: SGS FK KKZ.

                • Funding acquisition: RM.

                • Investigation: HP RS MSH AP MK AG.

                • Methodology: SGS FK KKZ.

                • Project administration: RM HP.

                • Supervision: BB AN KKZ RM.

                • Validation: KKZ FK.

                • Writing – original draft: SGS HB FK.

                • Writing – review & editing: SGS HB FK KKZ RM.

                Author information
                http://orcid.org/0000-0002-3669-5129
                Article
                PONE-D-16-47949
                10.1371/journal.pone.0176540
                5414986
                28467510
                d3d3b317-0b48-48a9-a8ea-68e262f46fd5
                © 2017 Sepanlou et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 4 December 2016
                : 12 April 2017
                Page count
                Figures: 4, Tables: 4, Pages: 14
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100004484, Tehran University of Medical Sciences and Health Services;
                Award ID: 82-603
                Award Recipient :
                Tehran University of Medical Sciences was the funder of this study, grant number 82-603, at www.tums.ac.ir. RM received the fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Nephrology
                Chronic Kidney Disease
                Biology and Life Sciences
                Anatomy
                Anthropometry
                Medicine and Health Sciences
                Anatomy
                Anthropometry
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Hypertension
                People and Places
                Geographical Locations
                Asia
                Iran
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Medicine and Health Sciences
                Cardiovascular Medicine
                Cardiovascular Diseases
                Biology and Life Sciences
                Physiology
                Renal Physiology
                Glomerular Filtration Rate
                Medicine and Health Sciences
                Physiology
                Renal Physiology
                Glomerular Filtration Rate
                Custom metadata
                We state that “our data are available upon request”. Unfortunately we can’t make the minimal data set publicly available due to rules and regulations of Tehran University of Medical Sciences (TUMS), the funding organization of the current study. To share any kind of data that is collected and funded by TUMS, we are obliged to sign a very short one-page data transfer agreement (DTA) with the recipient of the data and he or she should be defined in the DTA with his or her name, affiliation, and address. In the DTA it is just mentioned that the recipient should keep the data confidential and should not disseminate it. The interested reader shall contact Professor Reza Malekzadeh, the head of the Digestive Diseases Research Institute in TUMS. The process is very simple and the DTA can be filled out easily and in practice, there is no other restriction and the time between the data request and access to data is quite short. Professor Reza Malekzadeh, the corresponding author of the current manuscript, is the contact person with whom interested readers should contact: Professor Reza Malekzadeh; Digestive Diseases Research Institute; Tehran University of Medical Sciences; Address: Kargar-e-shomali Ave. Shariati Hospital, Digestive Diseases Research Institute; Tehran, Tehran, Iran. Postal Code: 14117-13135; Tel: +98-21-82415104; Fax: +98-21-82415400; Email 1: malek@ 123456tums.ac.ir ; Email 2: dr.reza.malekzadeh@ 123456gmail.com .

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