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BMJ Open. 2012; 2(5): e001357.
Published online Sep 26, 2012. doi:  10.1136/bmjopen-2012-001357
PMCID: PMC3467605
Preventing renal and cardiovascular risk by renal function assessment: insights from a cross-sectional study in low-income countries and the USA
Paolo Cravedi,1 Sanjib Kumar Sharma,2 Rodolfo Flores Bravo,3 Nazmul Islam,4 Irma Tchokhonelidze,5 Madhav Ghimire,2 Bishnu Pahari,2 Sanjeev Thapa,2 Anil Basnet,2 Avtandil Tataradze,5 Davitaia Tinatin,6 Lela Beglarishvili,5 Chyng-Wen Fwu,7 Jeffrey B Kopp,8 Paul Eggers,9 Bogdan Ene-Iordache,1 Sergio Carminati,1 Annalisa Perna,1 Antonietta Chianca,1 William G Couser,10 Giuseppe Remuzzi,1 and Norberto Perico1
1Clinical Research Center for Rare Diseases “Aldo e Cele Daccò”, Villa Camozzi, Ranica, and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Mario Negri Institute for Pharmacological Research, Bergamo, Italy
2Department of Medicine, BP Koirala Institute of Health Science, Dharan, Nepal
3Department of Medicine, Hospital Juan XXIII, La Paz, Bolivia
4Department of Nephrology, North East Medical College Hospital Sylhet, Sylhet, Bangladesh
5Dialysis, Nephrology and Transplantation Union of Georgia, National Center of Urology, Tbilisi, Georgia
6Department of Pediatrics, M. Iashvili Children Central Hospital, Tbilisi, Georgia
7Social & Scientific Systems, Inc., Silver Spring, Maryland, USA
8Kidney Disease Section, NIDDK, NIH, Bethesda, Maryland, USA
9Division of Kidney, Urologic and Hematologic Diseases, NIDDK, NIH, Bethesda, Maryland, USA
10Division of Nephrology, University of Washington, Seattle, Washington, USA
Correspondence to Dr Giuseppe Remuzzi, Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Villa Camozzi, Ranica, and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Mario Negri Institute for Pharmacological Research, Via Stezzano, 87, Bergamo 24126, Italy; gremuzzi/at/marionegri.it
Received May 3, 2012; Accepted August 6, 2012.
Abstract
Objective
To assess the prevalence of microalbuminuria and kidney dysfunction in low-income countries and in the USA.
Design
Cross-sectional study of screening programmes in five countries.
Setting
Screening programmes in Nepal, Bolivia, the USA (National Health and Nutrition Examination Survey (NHANES) 2005–2008) Bangladesh and Georgia.
Participants
General population in Nepal (n=20 811), Bolivia (n=3436) and in the USA (n=4299) and high-risk subjects in Bangladesh (n=1518) and Georgia (n=1549).
Primary and secondary outcome measures
Estimated glomerular filtration rate (eGFR)<60ml/min/1.73 m2 and microalbuminuria (defined as urinary albumin creatinine ratio values of 30–300 mg/g) were the main outcome measures. The cardiovascular (CV) risk was also evaluated on the basis of demographic, clinical and blood data.
Results
The prevalence of eGFR<60ml/min/1.73 m2 was 19%, 3.2% and 7% in Nepal, Bolivia and the USA, respectively. In Nepal, 7% of subjects were microalbuminuric compared to 8.6% in the USA. The prevalence of participants with predicted 10-year CV disease (CVD) risk ≥10% was 16.9%, 9.4% and 17% in Nepal, Bolivia and in the USA, respectively. In Bangladesh and Georgia, subjects with eGFR<60 ml/min/1.73 m2 were 8.6% and 4.9%, whereas those with microalbuminuria were 45.4% and 56.5%, respectively. Predicted 10-year CVD risk ≥10% was 25.4% and 25% in Bangladesh and Georgia, respectively.
Conclusions
Renal abnormalities are common among low-income countries and in the USA. Prevention programmes, particularly focused on those with renal abnormalities, should be established worldwide to prevent CVD and progression to end-stage renal disease.
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