FIRST COMMUNITY-BASED SCREENING FOR CHRONIC KIDNEY DISEASE, HYPERTENSION AND DIABETES IN DHARAN, NEPAL.

Aims: Nepal cannot afford renal replacement therapy (RRT) for ESRD due to lack of resources. Early diagnosis of CKD and its risk factors may reduce the need of RRT. Materials and Methods: In this first community-based screening program in Nepal, 3218 people iÝ 20 years were assessed by door-to-door survey in Dharan. 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 CKD was evaluated. A cardiovascular risk factor score was also determined. Results: Overweight, obesity, hypertension, diabetes and proteinuria were found in 20%, 5.0%, 38.6%, 7.5%, and 5.1% respectively. 47% hypertensives were newly detected during the screening. In the subset of 1000 subjects, CKD was detected in 10.6%. Multivariate logistic regression analysis showed that age (P <0.0001) and presence of diabetes (P = 0.027) were statistically significant predictors for CKD. Two or more cardiovascular risk factors were present in 47.3%. 848 patients entered the management phase of the program with lifestyle modification and pharmacologic intervention. 15% drop out during follow-up. Five patients died (2 on RRT). Glycemic (fasting glucose < 120 mg/dL) and blood pressure control (< 140/90 mmHg) was achieved in 60% and 72%, respectively. Regression or stabilization of proteinuria was reported in 52% of patients. Conclusion: Burden of CKD and cardiovascular risk factors are high at community level in Dharan. Reasonable control of blood sugar, hypertension and proteinuria was achieved in this program. These findings indicate the need of activating a large prevention and intervention program to tackle CKD and CVD in Nepal. [ABSTRACT FROM AUTHOR]