Community-Based Screening for Chronic Kidney Disease, Hypertension and Diabetes in Dharan

Abstract

Introduction: Nepal cannot afford renal replacement therapy for End Stage Renal Disease due to lack
of resources. Early diagnosis of Chronic Kidney Disease and its risk factors may reduce the need of
renal replacement therapy.
Methods:A community-based screening on, 3218 people ≥20 years were assessed by door-to-door
survey in Dharan, Nepal. Health status, lifestyle habit, physical examination and blood pressure
were evaluated. Spot urine was examined for proteins and glucose by dipstick. Fasting blood glucose
and serum creatinine were measured in a subset of 1000 people and the prevalence of Chronic Kidney
Disease was evaluated.
Results: Overweight, obesity, hypertension, diabetes and proteinuria were found in 20%, 5.0%,
38.6%, 7.5%, and 5.1% respectively. In the subset group, Chronic Kidney Disease was detected
in 10.6%. Multivariate analysis indicated age (P <0.0001) and diabetes (P = 0.027) as statistically
significant predictors for Chronic Kidney Disease. Total of 848 patients entered the management
program of lifestyle modification and pharmacologic intervention. Glycemic and blood pressure
control was achieved in 60% and 72%, respectively. Regression or stabilization of proteinuria was
reported in 52% of patients.
Conclusions: Burden of Chronic Kidney Disease and cardiovascular risk factors are high in Dharan.
Reasonable control of blood sugar, hypertension and proteinuria was achieved in this program.
Findings indicate that activation a large prevention and intervention program to tackle Chronic
Kidney Disease and Cardiovascular Disease in Nepal is needed.

Keywords: chronic kidney disease; community-screening; diabetes; hypertension; intervention; Nepal.