Low awareness, high prevalence: CKD screening AP flags urgent gaps

Time of India

5 days ago

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Hyderabad: A pilot study in Andhra Pradesh has revealed a gap in kidney disease awareness, with chronic kidney disease (CKD) detected in nearly 60% of individuals screened, yet only a fraction of them knew they had it.
Conducted between March and June 2024, the screening covered two high-risk groups — 843 individuals with non-communicable diseases (NCDs) in urban public health centres (PHCs), and 1,217 residents of rural CKD hotspots. Despite high disease prevalence — 57.5% in urban and 61.8% in rural populations — awareness remained low, at 1.4% and 16.5%, respectively.
The study, titled 'Point-of-Care Testing and Integrated Digital Health Technology for CKD Screening in High-Risk Populations of India', was published in Kidney International Reports and led by Rama Krishna Chinta of the dept of nephrology, Vedanta hospitals, Guntur.
It evaluated the feasibility of using point-of-care testing and digital technology for early CKD detection in settings with limited laboratory access.
Researchers checked serum creatinine and urinary albumin-to-creatinine ratio among adults aged 18 and above who gave consent under the Digital Data Protection Act.
Urban participants were drawn from PHCs in Guntur and Mangalagiri, while the rural cohort came from Uddanam in Srikakulam and A Konduru in Krishna district — regions historically linked to CKD of unknown aetiology (CKDu).
The health infrastructure in both settings included physicians, midwives, and paramedics, but routine CKD diagnosis was not part of the national NCD control programme, which currently focuses on diabetes and hypertension.
The screening was carried out under the frontline optimisation and comprehensive upgradation of services in CKD project, a joint effort of HelloKidney.ai, Andhra Pradesh govt, and National Health Mission.
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The study found significant variation in disease severity. In rural areas, 12.5% of patients had grade 4 and 9.8% had grade 5 estimated glomerular filtration rate (eGFR) levels — markers of advanced kidney failure. Comparatively, only 4.4% and 1.4% of urban patients showed grade 4 and grade 5 eGFR, respectively. Albuminuria, another disease indicator, also differed: Grade A2 was present in 8.1% of urban and 20.6% of rural participants, while grade A3 was noted in 12.6% and 7.1%, respectively.
Notably, nearly half (48.4%) of CKD-positive rural patients had no comorbidities.
The researchers observed that CKD remains underdiagnosed despite India's progress in managing NCDs. "We found that in city PHCs, where almost all patients had at least one risk factor for kidney disease development, only 1.4% were aware of existing CKD," the authors noted. They also pointed to a key barrier: "Lack of health insurance in almost 85% of the population, resulting in high out-of-pocket expenditures" which made CKD tests unaffordable.
In the context of Uddanam, a region previously studied for CKDu, the results showed slightly better awareness (16.5%) but still confirmed that nearly 80% of those affected were unaware of their condition. The findings echo results from past studies, including one 15 years ago that found only 2% awareness in two Indian cities, and a recent Andhra Pradesh survey that recorded 3.9%.