Flood David, Garcia Pablo, Douglas Kate, Hawkins Jessica, Rohloff Peter
Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala.
Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
BMJ Open. 2018 Jan 21;8(1):e019778. doi: 10.1136/bmjopen-2017-019778.
Screening is a key strategy to address the rising burden of chronic kidney disease (CKD) in low-income and middle-income countries. However, there are few reports regarding the implementation of screening programmes in resource-limited settings. The objectives of this study are to (1) to share programmatic experiences implementing CKD screening in a rural, resource-limited setting and (2) to assess the burden of renal disease in a community-based diabetes programme in rural Guatemala.
Cross-sectional assessment of glomerular filtration rate (GFR) and urine albumin.
Central Highlands of Guatemala.
We enrolled 144 adults with type 2 diabetes in a community-based CKD screening activity carried out by the sponsoring institution.
Prevalence of renal disease and risk of CKD progression using Kidney Disease: Improving Global Outcomes definitions and classifications.
We found that 57% of the sample met GFR and/or albuminuria criteria suggestive of CKD. Over half of the sample had moderate or greater increased risk for CKD progression, including nearly 20% who were classified as high or very high risk. Hypertension was common in the sample (42%), and glycaemic control was suboptimal (mean haemoglobin A1c 9.4%±2.5% at programme enrolment and 8.6%±2.3% at time of CKD screening).
The high burden of renal disease in our patient sample suggests an imperative to better understand the burden and risk factors of CKD in Guatemala. The implementation details we share reveal the tension between evidence-based CKD screening versus screening that can feasibly be delivered in resource-limited global settings.
筛查是应对低收入和中等收入国家慢性肾脏病（CKD）负担不断上升的关键策略。然而，关于在资源有限环境中实施筛查项目的报告很少。本研究的目的是：（1）分享在农村资源有限环境中实施CKD筛查的项目经验；（2）评估危地马拉农村一项基于社区的糖尿病项目中的肾脏疾病负担。
对肾小球滤过率（GFR）和尿白蛋白进行横断面评估。
危地马拉中部高地。
我们在主办机构开展的一项基于社区的CKD筛查活动中，招募了144名2型糖尿病成年人。
使用改善全球肾脏病预后组织（KDIGO）的定义和分类，评估肾脏疾病的患病率和CKD进展风险。
我们发现，57%的样本符合提示CKD的GFR和/或蛋白尿标准。超过一半的样本有中度或更高的CKD进展风险增加，其中近20%被归类为高风险或非常高风险。样本中高血压很常见（42%），血糖控制不理想（项目入组时平均糖化血红蛋白为9.4%±2.5%，CKD筛查时为8.6%±2.3%）。
我们患者样本中肾脏疾病的高负担表明，必须更好地了解危地马拉CKD的负担和风险因素。我们分享的实施细节揭示了循证CKD筛查与在资源有限的全球环境中可行的筛查之间的矛盾。
