232
Nephrol Dial Transplant (2006) 21: 232
Table 1. Baseline characteristics of the study participants Placebo n ¼ 28
Antioxidant P-value n ¼ 25
Age (years) 52 (10) 54 (11) Male sex, n (%) 16 (57) 12 (48) Time since transplantation (years) 8.0 (4.3) 9.6 (6.7) Vitamin C (mmol/l) 61 (32) 56 (25) Total vitamin E (mmol/l) 36 (8) 35 (10) CSA trough-level (mg/l) 108 (42) 105 (40) Serum creatinine (mmol/l) 132 (34) 130 (36)
0.53 0.59 0.19 0.53 0.75 0.85 0.87
Data are presented as mean (SD). Differences between groups were investigated using Student’s t-test for continuous variables and -square for proportions.
Acknowledgements. The present study was funded by a grant from the Dutch Kidney Foundation (Nierstichting Nederland C00-1877). A.d.V. is sponsored by a Clinical Research Fellowship from the Netherlands Organization of Scientific Research (NWO-AGIKO 920-03-181). Conflict of interest statement. None declared.
Department of Medicine University Medical Center Groningen University of Groningen Groningen The Netherlands Email:
[email protected]
Aiko P. J. de Vries Leendert H. Oterdoom Rijk O. B. Gans Stephan J. L. Bakker
doi:10.1093/ndt/gfi112
Advance Access publication 11 October 2005
Incidence of chronic kidney disease in India Sir, Chronic kidney disease (CKD) is a global threat to health in general and for developing countries in particular, because therapy is expensive and life-long. In India 90% patients cannot afford the cost. Over 1 million people worldwide are alive on dialysis or with a functioning graft [1]. Incidence of CKD has doubled in the last 15 years. In the USA, 30 million people suffer from CKD [2] and by 2010 >600 000 patients will require renal replacement therapy, costing US$28 billion [3]. Risk factors for developing CKD differ between races and countries. It would be interesting to know the incidence of CKD and its causes in India, which is a densely populated country with low income, different food, cultural traditions and lifestyle habits. In contrast to high-income countries, patients with ESRD have to pay for dialysis and transplantation themselves. The currently reported incidence of CRF in India is based on extrapolated data from the US. As yet, no large-scale population studies are available. We conducted two studies: (i) a population screening in New Delhi [4] and (ii) a second prospective study that involved 48 hospitals. In the population screening 4712 subjects participated in a blood biochemistry test. Mean age was 42.38±12.54 years, 56.16% were male. Thirty-seven were found to have chronic renal failure (prevalence rate of 0.78%). If these data are applied to India’s 1 billion population there are 7.85 million CRF patients in India. Aetiologically, diabetes (41%), hypertension (22%), chronic glomerular nephritis (16%), chronic interstitial disease (5.4%), ischaemic nephropathy (5.4%), obstructive uropathy (2.7%), miscellaneous (2.7%) and unknown cause (5.4%) constituted the spectrum. The second study was more representative, as 48 centres were distributed all over India. Data were based on prospective investigations conducted over a period of 1 (33 hospitals) to 3 months (15 hospitals) comprising 4145 CKD patients. It showed the following aetiological pattern: diabetes (29.7%), chronic glomerulonephritis (19.3%), hypertension (14%), chronic interstitial disease and vesico-ureteral reflux (12.6%), obstruction and calculus (9.3%), ADPKD and Alport Syndrome (8.4%), undiagnosed (6.2%). This study shows that the prevalence of CRF in India is 0.8%. If we combine the two, diabetes has emerged as the most frequent cause (30–40%) followed by hypertension (14–22%), CGN (16–20%), CIN (5.4–12.7%), heredofamilial disease (8.4%), obstruction including calculus (2.9%). The two studies, which are different in some ways, perhaps explain the wide range in incidence, suggesting regional influences.
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There were no significant differences in baseline characteristics between the two groups (Table 1). Antioxidant supplementation with vitamin C and vitamin E resulted in significant changes in plasma concentrations of vitamin C (40±48 vs 19±33 mmol/l for placebo, P
