Kidney Week

Abstract: FR-PO1024

Redefining Strategies for Kidney Disease Screening in Low-Resource Settings

Session Information

• Social, Environmental, and Economic Determinants of Kidney Health
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diversity and Equity in Kidney Health

• 900 Diversity and Equity in Kidney Health

Authors

• Sharma, Sanjib Kumar, BP Koirala Institute of Health Sciences, Dharan, Koshi, Nepal

Sanjib Kumar Sharma, MD, MBBS

• Gautam, Ujwal, BP Koirala Institute of Health Sciences, Dharan, Koshi, Nepal

Ujwal Gautam

• Bhattarai, Urza, BP Koirala Institute of Health Sciences, Dharan, Koshi, Nepal

Urza Bhattarai, MD

• Katuwal, Pradip, BP Koirala Institute of Health Sciences, Dharan, Koshi, Nepal

Pradip Katuwal, MD

• Shah, Nensi, BP Koirala Institute of Health Sciences, Dharan, Koshi, Nepal

Nensi Shah, MD

• Manandhar, Srista, BP Koirala Institute of Health Sciences, Dharan, Koshi, Nepal

Srista Manandhar, MBBS

• Aebischer Perone, Sigiriya, Hopitaux Universitaires Geneve, Geneve, Genève, Switzerland

Sigiriya Aebischer Perone, DrMed, MSc

• Zimmermann, Kathrine, Hopitaux Universitaires Geneve, Geneve, Genève, Switzerland

Kathrine Zimmermann, RN, MPH

• Heller, Olivia, Hopitaux Universitaires Geneve, Geneve, Genève, Switzerland

Olivia Heller, MPH

• Chappuis, François, Hopitaux Universitaires Geneve, Geneve, Genève, Switzerland

François Chappuis, MD, PhD

Background

Equitable access to kidney care remains a major challenge in low- and middle- income countries (LMICs) like Nepal. Kidney, Hypertension, Diabetes, and Cardiovascular diseases (KHDC) program was formed in 2003 as part of an initiative from ISN for detection and management of major Non-Communicable Diseases (NCDs) in LMICs. The program, has since, shifted priorities from population-based mass screening to a targeted hish-risk approach. An integrated modality to improve service delivery on NCDs, including CKD, at primary care facilities was implemented in a municipality of Eastern Nepal. We present here an analysis of secondary data of risk factors among individuals with kidney disease.

Methods

Capacity building on early detection and management of NCDs, including CKD, was provided to 42 non-physician healthcare providers (HCPs). This was followed, between 2019 and 2023, by population-based screening among 14,517 individuals. Individuals were assessed for risk factors and NCDs through self-report forms, BMI, waist hip ratio, blood pressure, dipstick urine test, serum creatinine, fasting blood glucose and HbA1c measurements. Positively screened individuals were managed at primary care facilities. Kidney disease was defined as either or both of proteinuria and raised serum creatinine.

Results

Kidney disease was detected among 3.1% (n=454) with 88.3% of them having no prior history. 2.6% (n=375) and 1.2% (n=168) had proteinuria and elevated serum creatinine, respectively. Males were more likely [OR: 1.69 (95% CI: 1.38 – 2.06)] to exhibit kidney disease. Hypertension [OR: 2.51 (95% CI: 2.05 – 3.07)] and raised fasting glucose [OR: 2.81 (95% CI: 2.26 – 3.49)] were associated with occurrence of kidney disease. 132 cases required referral for further evaluation and kidney biopsy.

Conclusion

Population based screening strategies employed for early detection of kidney disease highlighted a significant disease burden. While integrating CKD screening as a part of regular NCD care is plausible, further exploration of the risk factors’ distribution within the population can be crucial in directing the screening efforts to the high-risk groups. Competency based trainings can be an effective means to mobilize available resources through task sharing as outlined by the KHDC experience.

Funding

• Government Support – Non-U.S.