Anna J Dare1, Sze Hang Fu1, Jayadeep Patra1, Peter S Rodriguez1, J S Thakur2, Prabhat Jha3. 1. Centre for Global Health Research, St Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 2. School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 3. Centre for Global Health Research, St Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Electronic address: prabhat.jha@utoronto.ca.
Abstract
BACKGROUND: Renal failure represents a growing but mostly undocumented cause of premature mortality in low-income and middle-income countries. We investigated changes in adult renal failure mortality and its key risk factors in India using the nationally representative Million Death Study. METHODS: In this cross-sectional analysis of population-based data, two trained physicians independently assigned underlying causes to 150 018 deaths at ages 15-69 years from a nationally-representative mortality survey in India for 2001-03 and 2010-13, using the International Classification of Diseases, 10th version (ICD-10). We applied the age-specific proportion of renal failure deaths for the 2010-13 period to the 2015 UN estimates of total deaths in India and calculated age-standardised death rates for renal failure by rural or urban residence, state, and age group. We used proportional mortality of renal deaths (cases) to injuries (controls) to calculate the odds of renal death in the presence of different comorbidities and stratified risks by decade of birth. FINDINGS: In 2001-03, 2·1% of total deaths among 15-69 year olds were from renal failure (1266 [2·2%] of 58 871; unweighted). By 2010-13, the proportion of deaths from renal failure had risen to 2·9% (2943 [3·2%] of 91 147; unweighted) of total deaths and corresponding to 136 000 renal failure deaths (range 108 000-150 000) of 4 688 000 total deaths nationally in 2015. Age-standardised renal death rates were highest in the southern and eastern states, particularly among adults aged 45-69 years in 2010-13. Diabetes, hypertension, and cardiovascular disease were all significantly associated with increased renal failure deaths, with diabetes the strongest predictor-odds ratio (OR) vs control 9·2 (95% CI 6·7-12·7) in 2001-03, rising to 15·1 (12·6-18·1) in 2010-13. In the 2010-13 study population, the diabetes to non-diabetes OR was twice as large in adults born in the 1970s (25·5, 95% CI 17·6-37·1) as in those individuals born during or before the 1950s (11·7, 9·1-14·9). INTERPRETATION: Renal failure is a growing cause of premature death in India. Poorly treated diabetes is the most probable reason for this increase. Strategies aimed at diabetes prevention, and early detection and treatment are urgently needed in India, as well as greater access to renal replacement therapy. FUNDING: US National Institutes of Health, International Development Research Centre, Centre for Global Health Research, University of Toronto.
BACKGROUND:Renal failure represents a growing but mostly undocumented cause of premature mortality in low-income and middle-income countries. We investigated changes in adult renal failure mortality and its key risk factors in India using the nationally representative Million Death Study. METHODS: In this cross-sectional analysis of population-based data, two trained physicians independently assigned underlying causes to 150 018 deaths at ages 15-69 years from a nationally-representative mortality survey in India for 2001-03 and 2010-13, using the International Classification of Diseases, 10th version (ICD-10). We applied the age-specific proportion of renal failure deaths for the 2010-13 period to the 2015 UN estimates of total deaths in India and calculated age-standardised death rates for renal failure by rural or urban residence, state, and age group. We used proportional mortality of renal deaths (cases) to injuries (controls) to calculate the odds of renal death in the presence of different comorbidities and stratified risks by decade of birth. FINDINGS: In 2001-03, 2·1% of total deaths among 15-69 year olds were from renal failure (1266 [2·2%] of 58 871; unweighted). By 2010-13, the proportion of deaths from renal failure had risen to 2·9% (2943 [3·2%] of 91 147; unweighted) of total deaths and corresponding to 136 000 renal failure deaths (range 108 000-150 000) of 4 688 000 total deaths nationally in 2015. Age-standardised renal death rates were highest in the southern and eastern states, particularly among adults aged 45-69 years in 2010-13. Diabetes, hypertension, and cardiovascular disease were all significantly associated with increased renal failure deaths, with diabetes the strongest predictor-odds ratio (OR) vs control 9·2 (95% CI 6·7-12·7) in 2001-03, rising to 15·1 (12·6-18·1) in 2010-13. In the 2010-13 study population, the diabetes to non-diabetes OR was twice as large in adults born in the 1970s (25·5, 95% CI 17·6-37·1) as in those individuals born during or before the 1950s (11·7, 9·1-14·9). INTERPRETATION:Renal failure is a growing cause of premature death in India. Poorly treated diabetes is the most probable reason for this increase. Strategies aimed at diabetes prevention, and early detection and treatment are urgently needed in India, as well as greater access to renal replacement therapy. FUNDING: US National Institutes of Health, International Development Research Centre, Centre for Global Health Research, University of Toronto.
Authors: Narayan Prasad; Mansi Bhatt; Sanjay K Agarwal; H S Kohli; N Gopalakrishnan; Edwin Fernando; Manisha Sahay; Mohan Rajapurkar; Arpita Roy Chowdhary; Manish Rathi; Tarun Jeloka; Valentine Lobo; Shivendra Singh; A K Bhalla; Umesh Khanna; S B Bansal; P K Rai; Amol Bhawane; Urmila Anandh; Ajit Kumar Singh; Bharat Shah; Amit Gupta; Vivekanand Jha Journal: Kidney Int Rep Date: 2020-07-06
Authors: Janet V Diaz; Elisabeth D Riviello; Alfred Papali; Neill K J Adhikari; Juliana C Ferreira Journal: Ann Glob Health Date: 2019-01-22 Impact factor: 2.462
Authors: Shuchi Anand; Yuanchao Zheng; Maria E Montez-Rath; Wang Jin Wei; Norberto Perico; Sergio Carminati; Km Venkat Narayan; Nikhil Tandon; Viswanathan Mohan; Vivekanand Jha; Luxia Zhang; Giuseppe Remuzzi; Dorairaj Prabahkaran; Glenn M Chertow Journal: BMJ Glob Health Date: 2017-10-09