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Early Detection of Chronic Kidney Disease in a Diabetic Population. A Massive Screening Program in Primary Healthcare in a Middle-Income Country

Mejia-Arias Miguela, H. Santiago Lastiri-Quirosb, Gregorio T. Obradorc, Lina Sofia Palacio-Mejiad, Juan Eugenio Hernandez-Avilae, Mario Marquez Amezcuaf, Marcela Tamayo-Ortizg, Mariana Alvarez-Acevesh, Leslie Guzmán-Sandovali, Mauricio Hernandez-Avilaj, Juan Alfredo Tamayo-Orozcok

Title: Early detection of chronic kidney disease in a diabetic population. A massive screening program in primary healthcare in a middle-income country.

Background: Early detection of Chronic Kidney Disease (CKD) allows health professionals and patients to take actions to slow physical impairment and prevent or delay dialysis or transplantation and their catastrophic costs. In this study, we aimed to describe a CKD massive screening program in patients with diabetes to explore the feasibility of massive detection of CKD in high risk patients.

Methods and findings: We performed a descriptive, cross-sectional study with people living with diabetes, at the primary healthcare units of the ministry of health in Jalisco, Mexico. They underwent a screening including a health history questionnaire, somatometry, urinary albumin, serum creatinine, and estimated Glomerular Filtration Rate (eGFR) in accordance with the Kidney Early Evaluation Program (KEEP). We described demographic and clinical characteristics of the population by sex and calculated the prevalence of each CKD stage.

Of 7,693 recruited patients, 44% were identified with CKD; 35% were in early stages (1 or 2), and 9% in stages 3 to 5. Less than 1% of total patients had previous CKD diagnosis. Among other clinical characteristics, we found that 83% of all patients were overweight or obese and 79% had blood pressure values over 130/80 mmHg.

Conclusion: This study shows the technical feasibility and usefulness of massive CKD screening campaigns in high risk people at primary healthcare services. Patients with renal function impairment, who require treatment for preventing disease progression, were identified. It is essential to formulate public policies aimed at protocolization of timely medical interventions to address the incidence and prevalence of CKD.