Identifying undetected cases of chronic kidney disease in Mexico. Targeting high-risk populations.

BACKGROUND AND AIMS: Chronic kidney disease (CKD) is a major public health problem in Mexico. Current guidelines recommend routine CKD testing in patients at increased risk for CKD. We undertook this study to examine the diagnostic yield of targeted screening (case-finding) for CKD in high-risk populations in rural and urban communities in Jalisco, Mexico. METHODS: In a cross-sectional study, we did laboratory tests searching for CKD and its risk factors and compared the characteristics of participants with those reported by the National Health and Nutrition Survey 2006 (NHNS). Individuals who were aware that they had CKD and those <18 years of age were excluded. RESULTS: There were 9,169 participants assessed: 28.7% were men and mean age was 55.6 ± 13.7 years. They were predominantly female (71.3 vs. 55.6%, p = 0.0001) and older (55.59 ± 0.1 vs. 42.5 ± 0.3 years, p = 0.0001) than the NHNS population. Self-reported diabetes (41.9 vs. 7.3%, p = 0001) and fasting blood sugar >126 mg/dl (56.1 vs. 14.4%, p = 0.0001) were more prevalent among the participants; self-reported hypertension (41.9 vs. 7.3%, p = 0.0001), systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg (52.5 vs. 43.2%, p = 0.0001), and obesity (42.8. vs. 29.3%, p = 0.0001) were also more frequent among participants. There were 19.7% with proteinuria; CKD was more prevalent among the high risk participants in our study (31.3 vs. 8.0%, p = 0.0001) than in the general population. CONCLUSIONS: CKD was detected frequently in high-risk Mexican populations. Trials of case-finding and intervention are feasible and warranted in Mexico.

Chronic kidney disease in homeless persons in Mexico.

Little is known about the prevalence of chronic kidney disease (CKD) among the homeless in Mexico. The role of substance abuse, alcoholism, and homelessness in CKD has not been properly evaluated. We screened 260 homeless individuals in the state of Jalisco, Mexico, for the presence of CKD and its risk factors, and compared their characteristics with those from a separate cohort of poor Jalisco residents and with a survey of the general Mexican population. CKD was more prevalent among the homeless than among the poor Jalisco population (22% vs. 15.8%, P=0.0001); 16.5% had stage 3, 4.3% stage 4, and 1.2% stage 5. All were unaware of having CKD. Only 5.8% knew they had diabetes, but 19% had fasting blood sugar >126 mg/dl; 3.5% knew they were hypertensive but 31% had systolic blood pressure ⩾140 mm Hg or diastolic blood pressure ⩾90 mm Hg. Alcoholism was less common than in the poor Jalisco population (23.5% vs. 32.3%, P=0.002), but tobacco smoking (34.6% vs. 21.5%, P=0.0001) and substance abuse (18% vs. 1.1%, P=0.0001) were more prevalent among the homeless. Likewise, chronic viral infections such as HIV (4.5% vs. 0.3%, P=0.0001) and HCV (7.7% vs. 1.4%, P=0.0001) were also significantly higher among the homeless than in the general population. In conclusion, CKD and its risk factors are highly prevalent among the homeless individuals in Jalisco, Mexico. Lack of awareness of having diabetes and hypertension is highly common, as is substance abuse. Programs aiming to prevent CKD and its risk factors in Mexico should specifically target this high-risk population.

Prevalence of chronic kidney disease in the Kidney Early Evaluation Program (KEEP) México and comparison with KEEP US.

The National Kidney Foundation Kidney Early Evaluation Program (KEEP) is a free community screening program aimed at early detection of kidney disease among high-risk individuals. A pilot phase of KEEP México began in 2008 in México City and Jalisco State. Adults with diabetes, hypertension, or family history of diabetes, hypertension, or chronic kidney disease (CKD) were invited to participate through advertising campaigns. All participants completed a questionnaire. Blood pressure, weight, and height were measured; blood and urine tests included albuminuria and serum creatinine to estimate glomerular filtration rate using the Modification of Diet in Renal Disease Study equation. Mean age of KEEP México City and KEEP Jalisco participants was 46 and 53 years, respectively; >70% were women. CKD prevalence was 22% in KEEP México City and 33% in KEEP Jalisco, not significantly different from reported KEEP US prevalence of 26%. CKD stages 1 and 2 were more frequent in KEEP México and stage 3 in KEEP US. In KEEP México City, CKD prevalence was higher than the overall prevalence among participants with diabetes (38%) or diabetes and hypertension (42%). Most KEEP México participants were unaware of the CKD diagnosis, despite that 71% in KEEP México City had seen a doctor in the previous year. CKD is highly prevalent, underdiagnosed, and underrecognized among high-risk individuals in México. KEEP is an effective screening program that can successfully be adapted for use in México.

Screening for CKD and cardiovascular disease risk factors using mobile clinics in Jalisco, Mexico.

BACKGROUND: Chronic kidney disease (CKD) is a major cause of morbidity and mortality in Mexico. However, many residents of underserved areas may be unaware that they potentially are affected. STUDY DESIGN: In an observational cross-sectional study, we examined the diagnostic yield of screening for CKD and cardiovascular disease risk factors using mobile units that traveled to poor communities in Jalisco, Mexico. SETTING & PARTICIPANTS: We excluded individuals who were aware that they had CKD and those < 18 years of age. OUTCOMES: Glomerular filtration rate, cardiovascular risk. MEASUREMENTS: Demographic data, socioeconomic status, blood pressure, fasting glucose, and dipstick urinalysis. RESULTS: 3,734 participants; 29.3% men and mean age of 57.4 +/- 13.0 years. Most (99.7%) had no history of cardiovascular disease; however, 43.5% had a history of diabetes, 11.4% had dipstick-positive proteinuria, 62.0% had blood pressure in the hypertensive range, and 15.8% had an estimated glomerular filtration rate compatible with stages 3-5 CKD. In patients with no history of cardiovascular disease, proportions with predicted 5-year risks of new cardiovascular events <5%, 5%-10%, 10.1%-20%, 20.1%-30%, and >30% were 10.0%, 11.7%, 26.6%, 20.7%, and 30.9%, respectively. Screening 18 participants aged < 40 years would be expected to detect 6 new cases of hypertension or 2 new cases of diabetes. LIMITATIONS: Data may not be generalizable to all low-income settings or other regions of Mexico. CONCLUSIONS: Impaired kidney function, proteinuria, and cardiovascular risk factors were detected frequently when mobile units were used to perform screening in poor areas of Jalisco, Mexico. This suggests that trials of targeted screening and intervention are feasible and warranted.