engleski

HIGH PREVALENCE OF ADVANCED CKD STAGES, BUT NO DIFFERENCES IN EARLY PHASES OF CKD IN ENDEMIC NEPHROPATHY COMPARING TO NON-ENDEMIC VILLAGE

Introduction and Aims:Based on our recent results, endemic nephropathy (EN) is now considered to be an environmental form of aristolochic acid nephropathy (AAN). Interestingly, during the 50 years of investigation prevalence and classification of chronic kidney disease (CKD) in any EN area was never systematically analyzed. Our aim was to determine CKD prevalence and CKD stages in Croatian EN area using 4 different formulas and compare it to non-EN area. Methods:In this cross sectional survey we have enrolled 1573 subjects (consecutive sample, participation rate 91%, mean age 51.80±17.09) ; EN villages (N=1226), non-EN area (N=347). GFR was estimated using 4 formulas (C-G, MDRD, MCQE, CKD-EPI), albumin/creatinine ration (ACR) and alpha1microglobuline/creatinine ratio were determined from the spot morning urine sample. Blood pressure (BP) was measured following ESH/ESC guidelines, hypertension was defined as BP ≥ 140/90 mmHg and/or taking antihypertensive drugs, diabetes was diagnosed if fasting blood glucose ≥ 7 mmol/l and/or taking antidiabetic drugs. CKD was diagnosed and classified according to the KDIGO 2009 classification. Results:Prevalence of CKD was higher in EN than in non-EN villages in both men and women (p<0.00005 ; p<0.00005, respectively).There were no differences in prevalence of hypertension, diabetes or obesity between EN and non-EN villages (p>0.05). Using all 4 formulas we observed significantly higher prevalence (%) of stages CKD ≥3A in EN than in non-EN area (16.7, 15.5, 8.7, 16.3 vs. 8.3, 6.6, 1.1, 8.0 ; p<0.00005 ; p<0.00005 ; p<0.00005 ; p<0.00005, :respectively). However, lower prevalence (%) of stages CKD 1 and 2 was found in EN area (4.4, 4.7, 5, 5, 4, 4 vs. 6.3, 7.4, 8.3, 6.3 ; p=0.0001 ; p=0.004 ; p=0.0001 ; p=0.0001, respectively). We also failed to find differences in prevalence of ACR and aplha1/creatinine above the cut-off values between EN and non-EN (p<0.01). In both EN and non-EN areas MCQE formula significantly underestimates prevalence of CKD stages ≥ 3A (p<0.00005). Conclusions:High prevalence of CKD stages ≥3A in EN area very probably reflects present of subjects with milder clinical course of EN (either due to lower ingestion of AA or beneficial genotype). Due to higher risk of urothelial cancer those subjects should be closely monitored. Lower prevalence of early stages of CKD in EN area is in line with hypothesis that environmental factor i.e. AA is no longer active, and it could be speculated that in future prevalence of all CKD stages in EN area will be the same as in non EN villages.

Introduction and Aims:Based on our recent results; endemic nephropathy (EN) is now considered to be an environmental form of aristolochic acid nephropathy (AAN). Interestingly; during the 50 years of investigation prevalence and classification of chronic kidney disease (CKD) in any EN area was never systematically analyzed. Our aim was to determine CKD prevalence and CKD stages in Croatian EN area using 4 different formulas and compare it to non-EN area.

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