RESUMEN
BACKGROUND: In 2006, the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF) introduced World Kidney Day, to educate the public about the importance of chronic kidney disease (CKD) and its early detection. This prospective study examined the diagnostic yield of screening for CKD in poor neighborhoods in Guadalajara, Mexico, on World Kidney Day. METHODS: On World Kidney Day in 2006 and 2007, 2 screening stations were set up in Guadalajara, with a 2-week promotion period beforehand in the local media. Individuals who were aware that they had CKD and those <18 years of age were excluded. Data were prospectively collected by the staff of the screening programs using a standard form; all participants provided blood and urine specimens for serum creatinine assays and dipstick urinalysis. RESULTS: We studied 634 participants, of whom approximately 24% had proteinuria, 35% had hematuria and 6.4% had an estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2. Overall, the number needed to screen (NNS) to detect 1 new case of eGFR <60 ml/min per 1.73 m2 was 16 (95% confidence interval [95% CI], 12-22), varying from as low as 5 (95% CI, 4-8) in participants >60 years of age, to as high as 84 (95% CI, 35 to >200) in people aged 18 to 40 years. CONCLUSIONS: Proteinuria and eGFR <60 ml/min per 1.73 m2 were frequently detected among participants in community-based screening carried out on World Kidney Day in the state of Jalisco, Mexico, especially in people over 40 years old. Our data indicate that screening on World Kidney Day may be useful for identifying Jalisco residents with CKD, and suggest that trials of targeted screening and intervention are feasible and warranted.
Asunto(s)
Servicios de Salud Comunitaria , Enfermedades Renales/diagnóstico , Tamizaje Masivo , Programas Nacionales de Salud , Adulto , Anciano , Biomarcadores/sangre , Biomarcadores/orina , Creatinina/sangre , Diagnóstico Precoz , Femenino , Tasa de Filtración Glomerular , Hematuria/diagnóstico , Hematuria/etiología , Humanos , Cooperación Internacional , Enfermedades Renales/complicaciones , Enfermedades Renales/fisiopatología , Masculino , Tamizaje Masivo/métodos , México , Persona de Mediana Edad , Pobreza , Valor Predictivo de las Pruebas , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Proteinuria/diagnóstico , Proteinuria/etiología , Juego de Reactivos para Diagnóstico , Tiras Reactivas , Sociedades Médicas , Adulto JovenRESUMEN
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.
Asunto(s)
Enfermedades Cardiovasculares/diagnóstico , Enfermedades Renales/diagnóstico , Unidades Móviles de Salud , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Enfermedad Crónica , Estudios Transversales , Femenino , Humanos , Enfermedades Renales/epidemiología , Masculino , México , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Adulto JovenRESUMEN
World Kidney Day (WKD) is intended to raise awareness and increase detection of chronic kidney disease (CKD), but most emphasis is placed on adults rather than children. We examined yield of screening for CKD and hypertension among poor children in Mexico. On WKD (2006, 2007), children (age < 18 years) without known CKD were invited to participate at two screening stations. We measured body mass index (BMI), blood pressure, and serum creatinine, and performed dipstick urinalysis. The Schwartz equation was used to estimate glomerular filtration rate (GFR; reduced GFR defined as < 60 ml/min per 1.73 m(2)). Proteinuria and hematuria were defined by a reading of >or= 1+ protein or blood on dipstick. Hypertension was defined by gender, age, and height-specific norms. In total, 240 children were screened (mean age 8.9 +/- 4.1 years; 44.2% male). Proteinuria and hematuria were detected in 38 (16.1%) and 41 (17.5%), respectively; 15% had BMI > 95th percentile for age. Reduced GFR was detected in four (1.7%) individuals. Systolic hypertension was more prevalent in younger children (age 0-8 years, 19.6%; age 9-13 years, 7.1%; age 14-17 years, 5.3%) suggesting a possible white-coat effect. Hematuria, proteinuria, hypertension and obesity were frequently detected among children in a community based screening program in Mexico. This form of screening might be useful in identifying children with CKD and hypertension in developing nations.