Karachi: Up to one in five adults in Pakistan have chronic kidney disease, which has become one of the rapidly escalating causes of death. Patients with advanced CKD require dialysis or transplantation, unaffordable for the vast majority of people.
A research paper published in the Clinical Journal of the American Society of Nephrology reveals that simple and inexpensive public health interventions can help prevent many cases of CKD.
As part of a two-year study conducted at Aga Khan University (AKU) in Karachi, researchers Professor Tazeen Jafar, Health Services & Systems Research at Duke NUS Medical School in Singapore and Duke Global Health Institute in Durham, and Visiting Consultant Nephrologist, Singapore General Hospital, and Dr Imtiaz Jehan, Associate Professor of Community Health Sciences at AKU observed more than 1,200 individuals with high blood pressure.
The intervention included training community health workers on the many aspects of a healthy lifestyle – such as improving diet, stopping smoking, increasing physical activity, and taking prescribed blood pressure-lowering medications – and training community general practitioners on the latest standards for managing hypertension.
After seven years of follow up – five years after cessation of the intervention – kidney function remained unchanged among adults in the communities assigned to the intervention, whereas it significantly declined among those who received usual care.
Patients with the intervention were half as likely as other patients to experience over 20 per cent decline in kidney function.
“Unfortunately, there is a dearth of information on public health interventions to preserve kidney health and prevent CKD, even though certain unhealthy lifestyle factors and conditions such as obesity, hypertension and diabetes are common, and are known to increase the risk of developing CKD,” said Dr Jehan.
“This study shows that such a practical model based on training primary care physicians coupled with lifestyle advice from non-physician health workers is likely to have a long-term benefit on preserving kidney function at a population level,” said Professor Jafar. “These simple strategies can be implementable in other low- and middle-income countries with similar risk factor burden and health systems infrastructure.”
Other authors of the paper included Dr John Allen and Seyed Ehsan Saffari from Duke-NUS Graduate Medical School, Dr Aamir Hameed from AKU, Professor Shah Ebrahim from London School of Hygiene and Tropical Medicine, and Professors Neil Poulter and Nish Chaturvedi from Imperial College London.