Almost one in five adults surveyed in Tamil Nadu had abnormal renal parameters, indicating the need for increasing awareness of chronic kidney disease, according to the preliminary findings of the Tamil Nadu Chronic Kidney Disease Prevalence Survey.
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The study was conducted among persons aged above 18 in 177 areas across the State during February 2022. Of the 4,741 adults, who consented for the survey and from whom samples were lifted, 455 (9.5%) had elevated creatinine level, 276 (5.8%) had albumin and 367 (7.7%) had red blood cells in the urine. Overall, 934 persons — 19.7% — had either blood or albumin in urine or an elevated serum creatinine level, according to the survey that was conducted by the Directorate of Public Health and Preventive Medicine.
The report says these individuals will be followed up after three months and a re-test will be done to check whether the abnormal values are persistent. Only if they have consistently abnormal values will they be confirmed as having chronic kidney disease. As an immediate step, they will be referred to nearby higher institutions for a complete evaluation.
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Screening for chronic kidney disease among adults, especially those with risk factors such as diabetes and hypertension, is vital as early diagnosis and timely management can prevent the progression of the disease. “The chronic kidney disease survey is only preliminary, the individuals need to be followed up. We have slightly higher levels of suspected chronic kidney disease, but it needs confirmation. Essentially, what is needed is risk factor control,” Director of Public Health T. S. Selvavinayagam said.
Noting that it was time to focus on the control of non-communicable diseases, he said control meant not just treatment but also bringing the biological values down to the normal.
Need for survey
The chronic kidney disease is a major contributor to the mortality and morbidity due to non-communicable diseases. Haemodialysis is the most utilised package under the Chief Minister’s Comprehensive Health Insurance Scheme, indicating the huge burden of the chronic kidney disease. However, the State has scarce and patchy data of chronic kidney disease epidemiology. At present, there were data sourced only from the cases reported at various hospitals through insurance claims and other non-communicable disease reports, the report said.
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“Tamil Nadu is the first State in the country to have a systematic pan-State survey for chronic kidney disease,” N. Gopalakrishnan, director, Institute of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital. “This is the first phase of the study. The purpose of the study is to detect kidney disease. Those who have been found to have a decline in kidney function and/or protein leakage in the urine or presence of red blood cells in urine will undergo a repeat test after three months to confirm the persistence of the abnormalities. Only those with persistent abnormalities for three months will be defined as having chronic kidney disease,” he explained.
The design and methodology was developed by the Institute of Community Medicine with technical inputs from the Institute of Nephrology, Madras Medical College. The study was funded by the National Health Mission, Tamil Nadu.
Survey method
A total of 177 clusters were identified through the cluster random sampling method based on population proportions to size. Thirty adult participants were included from each cluster to arrive at a sample size of 5,310. A questionnaire was given to each participant, while blood samples were collected and serum was separated by centrifuging at the primary health centres. Urine samples were collected and tested on the spot for albumin and red blood cells with dipstick. All the serum samples were transported to the State Public Health Laboratory and serum creatinine was measured through the isotope dilution mass spectrometry reference standards.