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International Collaboration for the Epidemiology of eGFR in Low and Middle Income Populations - Rationale and core protocol for the Disadvantaged Populations eGFR Epidemiology Study (DEGREE)

Caplin, Ben; Jakobsson, Kristina LU ; Glaser, Jason; Nitsch, Dorothea; Jha, Vivekanand; Singh, Ajay; Correa-Rotter, Ricardo and Pearce, Neil (2017) In BMC Nephrology 18(1). p.1-8
Abstract

Background: There is an increasing recognition of epidemics of primarily tubular-interstitial chronic kidney disease (CKD) clustering in agricultural communities in low- and middle-income countries (LMICs). Although it is currently unclear whether there is a unified underlying aetiology, these conditions have been collectively termed CKD of undetermined cause (CKDu). CKDu is estimated to have led to the premature deaths of tens to hundreds of thousands of young men and women over the last 2 decades. Thus, there is an urgent need to understand the aetiology and pathophysiology of these condition (s). International comparisons have provided the first steps in understanding many chronic diseases, but such comparisons rely on the... (More)

Background: There is an increasing recognition of epidemics of primarily tubular-interstitial chronic kidney disease (CKD) clustering in agricultural communities in low- and middle-income countries (LMICs). Although it is currently unclear whether there is a unified underlying aetiology, these conditions have been collectively termed CKD of undetermined cause (CKDu). CKDu is estimated to have led to the premature deaths of tens to hundreds of thousands of young men and women over the last 2 decades. Thus, there is an urgent need to understand the aetiology and pathophysiology of these condition (s). International comparisons have provided the first steps in understanding many chronic diseases, but such comparisons rely on the availability of standardised tools to estimate disease prevalence. This is a particular problem with CKD, since the disease is asymptomatic until the late stages, and the biases inherent in the methods used to estimate the glomerular filtration rate (GFR) in population studies are highly variable across populations. Method: We therefore propose a simple standardised protocol to estimate the distribution of GFR in LMIC populations - The Disadvantaged Populations eGFR Epidemiology (DEGREE) Study. This involves the quantification of renal function in a representative adult population-based sample and a requirement for standardisation of serum creatinine measurements, along with storage of samples for future measurements of cystatin C and ascertainment of estimates of body composition, in order to obtain valid comparisons of estimated GFR (eGFR) within and between populations. Discussion: The methodology we present is potentially applicable anywhere, but our particular focus is on disadvantaged populations in LMICs, since these appear to be most susceptible to CKDu. Although the protocol could also be used in specific groups (e.g. occupational groups, thought to be at excess risk of CKDu) the primary aim of the DEGREE project is characterise the population distribution of eGFR in multiple regions so that international comparisons can be performed. It is only with a standardised approach that it will be possible to estimate the scale of, and variation in, impaired kidney function between affected areas. These data should then provide insights into important social, demographic and environmental risk factors for this increasingly recognised disease.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Chronic kidney disease of undetermined cause, Chronic kidney disease prevalence, Estimated glomerular filtration rate, Low- and middle-income countries, Mesoamerican nephropathy
in
BMC Nephrology
volume
18
issue
1
pages
8 pages
publisher
BioMed Central
external identifiers
  • scopus:85007575349
  • wos:000391072000001
ISSN
1471-2369
DOI
10.1186/s12882-016-0417-1
language
English
LU publication?
yes
id
e3177b19-680e-4895-9a94-acfa59389c5a
date added to LUP
2017-01-13 13:24:18
date last changed
2018-01-07 11:45:01
@article{e3177b19-680e-4895-9a94-acfa59389c5a,
  abstract     = {<p>Background: There is an increasing recognition of epidemics of primarily tubular-interstitial chronic kidney disease (CKD) clustering in agricultural communities in low- and middle-income countries (LMICs). Although it is currently unclear whether there is a unified underlying aetiology, these conditions have been collectively termed CKD of undetermined cause (CKDu). CKDu is estimated to have led to the premature deaths of tens to hundreds of thousands of young men and women over the last 2 decades. Thus, there is an urgent need to understand the aetiology and pathophysiology of these condition (s). International comparisons have provided the first steps in understanding many chronic diseases, but such comparisons rely on the availability of standardised tools to estimate disease prevalence. This is a particular problem with CKD, since the disease is asymptomatic until the late stages, and the biases inherent in the methods used to estimate the glomerular filtration rate (GFR) in population studies are highly variable across populations. Method: We therefore propose a simple standardised protocol to estimate the distribution of GFR in LMIC populations - The Disadvantaged Populations eGFR Epidemiology (DEGREE) Study. This involves the quantification of renal function in a representative adult population-based sample and a requirement for standardisation of serum creatinine measurements, along with storage of samples for future measurements of cystatin C and ascertainment of estimates of body composition, in order to obtain valid comparisons of estimated GFR (eGFR) within and between populations. Discussion: The methodology we present is potentially applicable anywhere, but our particular focus is on disadvantaged populations in LMICs, since these appear to be most susceptible to CKDu. Although the protocol could also be used in specific groups (e.g. occupational groups, thought to be at excess risk of CKDu) the primary aim of the DEGREE project is characterise the population distribution of eGFR in multiple regions so that international comparisons can be performed. It is only with a standardised approach that it will be possible to estimate the scale of, and variation in, impaired kidney function between affected areas. These data should then provide insights into important social, demographic and environmental risk factors for this increasingly recognised disease.</p>},
  author       = {Caplin, Ben and Jakobsson, Kristina and Glaser, Jason and Nitsch, Dorothea and Jha, Vivekanand and Singh, Ajay and Correa-Rotter, Ricardo and Pearce, Neil},
  issn         = {1471-2369},
  keyword      = {Chronic kidney disease of undetermined cause,Chronic kidney disease prevalence,Estimated glomerular filtration rate,Low- and middle-income countries,Mesoamerican nephropathy},
  language     = {eng},
  month        = {01},
  number       = {1},
  pages        = {1--8},
  publisher    = {BioMed Central},
  series       = {BMC Nephrology},
  title        = {International Collaboration for the Epidemiology of eGFR in Low and Middle Income Populations - Rationale and core protocol for the Disadvantaged Populations eGFR Epidemiology Study (DEGREE)},
  url          = {http://dx.doi.org/10.1186/s12882-016-0417-1},
  volume       = {18},
  year         = {2017},
}