Abraham Sb

Dr Anil J

Sathya Gr

Venkatachalam

Zile Singh

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IOSR Journal of Dental and Medical Sciences (JDMS) 
ISSN: 2279-0853, ISBN: 2279-0861. Volume 2, Issue 4 (Nov.- Dec. 2012), PP 29-33 
www.iosrjournals.org 
www.iosrjournals.org                                                             29 | Page 
 
Prevalence of Risk Factors for Chronic Kidney Disease in a 
Coastal Area of Tamil Nadu, South India. 
 
Venkatachalam.J
1
, Murugan N
2
, Abraham SB
3
, Zile Singh
4
, Dr. Anil J, Purty
5 
Sathya GR
6 
1,2Assistant Professor, Department of Community Medicine, Pondicherry Institute of Medical Sciences 
3Post Graduate student, Department of Community Medicine, Pondicherry Institute of Medical Sciences  
4Professor and HOD, Department of Community Medicine, Pondicherry Institute of Medical Sciences 
5Professor, Department of Community Medicine, Pondicherry Institute of Medical Sciences 
6Post Graduate student, Department of Physiology, Pondicherry Institute of Medical Sciences 
    
Abstract: Communicable Diseases which were the leading causs of mortality in the beginning of the twentieth 
century have now been replaced by Non-Communicable Diseases which account for almost two-thirds of all 
deaths presently in India. Considering the high prevalence of CKD risk factors it has long been presumed that 
CKD represents a major public health problem in our country. This study was conducted to determine the risk 
factors of CKD. 
Materials and Methods: A community based cross sectional study was conducted among the 1200 respondents, 
20 years and above, residing in a coastal area of  Villupuram district,  over a period of 6 months (Feb-July) 
using a pre-structured and validated questionnaire. The questionnaire included information on demographic 
characteristics, lifestyle habits, and awareness of CKD risk factors. Random blood sugar and spot urinary 
protein and sugar using urinalysis dipsticks were measured. Data was analyzed using SPSS 16.0 version, p 
value <0.05 was considered significant. 
Results: Majority of the respondents were females (67.8%) with maximum belonging to the age group of 20-
29yrs (23.8%), followed by 30-39yrs (22.8%).Most of them belonged to upper lower class (31.8%), followed by 
lower middle class (25.8%). 93.1% of the population were Muslims with 87.9% belonging to backward caste. 
The prevalence of CKD risk factors among the respondents were Proteinuria(12.5%), Glycosuria(8.4%), 
Hypertension (24.3%), Diabetes Mellitus(18%) and  Obesity( 44.4%). 
Conclusion: Prevalence of CKD risk factors in the study area was moderate to high. Hence, policies and 
programmes should focus on these areas and IEC should focus on creating awareness about CKD risk factors 
in the community. 
Key words: Prevalence, non-communicable diseases, CKD, risk factors. 
 
I. Introduction 
Communicable Diseases which were the leading causes of mortality in the beginning of the twentieth 
century have now been replaced by cardiovascular diseases, stroke, diabetes, cancer and accidents which 
account for almost two-thirds of all deaths presently in India [1]. One such situation being faced now by India 
and several others is the increasing prevalence of Chronic Kidney Disease. According to National Kidney 
Foundation (NKF) guidelines, CKD is defined as either kidney damage or Glomerular Filtration Rate (GFR) 
below 60 ml/min/1.73 m2 for three or more months with or without evidence of kidney damage, irrespective of 
the cause [2].  Evidence suggests that hypertension and diabetes are the two major causes of kidney disease   
worldwide [3, 4].According to the International Diabetes Federation, India stands second only to China with 
respect to world diabetes with 61.3 million in 2011 and the CURES cohort suggested that every fifth person in 
India is hypertensive [5] .In 2003, the American Heart Association (AHA) stated that persons with CKD should 
be regarded as the highest risk group for subsequent CVD [6].  
Patients with CKD are at high risk for progression to end stage renal disease (ESRD). Progress to 
kidney failure or other adverse outcomes could be prevented or delayed by early detection and treatment with 
population based screening [7,8]. 
Considering the high prevalence of CKD risk factors it has long been presumed that CKD represents a 
major public health problem in our country, at least in urban India. In our study, we aim to ascertain the risk 
factors for CKD prevalence in the community; screening study subjects based on standard clinical features of 
CKD in a resource limited setting.  
 
 
 
Prevalence of Risk Factors for Chronic Kidney Disease in a Coastal Area of Tamil Nadu, South 
www.iosrjournals.org                                                             30 | Page 
II. Materials and Methods 
A cross sectional study was carried out in a coastal area of Villupuram district of Tamilnadu. Study 
Period: Six months (February-July 2012). Study Tool: Pre-designed structured questionnaire - interviewed by 
final year part 1 MBBS students, Interns and Post graduates, Department of Community Medicine. Study 
Variables Socio-demographic factors, CKD risk factors, Life style factors, Anthropometry, Clinical 
examination, Random blood sugar, Indian urine dipstick analysis for urinary sugar and protein. Association 
between variables was studied. Data was analyzed using SPSS 16.0 version. Sample size: Estimated sample size 
calculated for survey was 1111. (Considering prevalence of Hypertension -20% and precision-12%).  We 
studied 1200 individuals keeping in view attrition of study subjects. Inclusion and exclusion criteria: All 
adults in the age group of 18 years or more, both male and female, who were willing, were included in the study. 
The individuals below the age of 18 and those who were not willing for the study or those not available for 
interview on account of their absence on more than three visits were excluded. Sampling method:  The study 
was carried out during February-March in 2012. Initially a pilot study was carried out, preliminary analysis was 
done to reformate the questionnaire, and the proforma was finalized. House to house visit was carried out in the 
defined area using predefined and pre-tested proforma. Proper history and examination of all the participants 
were carried out. All persons of more than 18 years of age in the visited house were covered in the survey. After 
the completion of interview, people were educated about the importance of adopting a healthy life style and 
other health education was also given in relation to Chronic Kidney Disease. Body mass index (BMI) was 
calculated by dividing weight in kg by square of height in meters. Overweight/ obesity were estimated based on 
BMI > 23.0 kg/m2. Hypertension was defined based on a systolic blood pressure > 140 mm of Hg or diastolic 
blood pressure > 90 mm of Hg. Diabetes was defined as fasting blood glucose >7.0 mmol/L (126 mg/dl) and 
random blood glucose more than 200mg/dl or a previous diagnosis of diabetes mellitus as per the American 
Diabetes Association (ADA) criteria 2003–4. [9] Standard definitions were used to measure physical activity, 
hypertension [6] obesity and central obesity [7]. Statistical analysis: The statistical software SPSS version 16 was 
used for data analysis. Using chi square and odds ratio, association between variables were studied 
 
III. Results 
Table 1 shows: Majority of the respondents were females (67.8%), maximum number belonging to the age 
group of 20-29yrs (24%), followed by 30-39yrs (22.7%).Most of them belonged to upper lower class (31.8%), 
followed by lower middle class (25.8%). 93.1% of the population were Muslims and only 5.9% Hindus, with 
87.9% belonging to BC. Most of the population resided in pucca houses (88%) and only 3.1% of the population 
resided in kutcha houses. The prevalence of protenuria were high among males and elderly people which found 
to be statistically significant.  
 
Table1: Sociodemographic Characteristics of the Study Population 
Characteristic Frequency 
N=1200 
Percentage (%) Proteinuria  
N(%) 
N=148 
p value 
Gender    
Male 387 32.2 66(17.1) 0.01 
Female 813 67.8 82(10.1)  
Age   
20-29 288 24.0 18(6.2) 0.001 
30-39 273 22.7 22(8.1)  
40-49 223 18.6 27(12.1)  
50-59 229 19.1 44(19.2)  
>60 187 15.6 37(19.8)  
Mean Age: 50.28  SD:15  95% CI : (47.72-52.84)  
Socioeconomic status   
Upper 103 8.6 12(11.7) 0.06 
Upper middle 257 21.4 43(16.7)  
Lower middle 309 25.8 42(13.6)  
Upper lower 382 31.8 35(9.2)  
Lower lower 149 12.4 16(10.7)  
Religion   
Hindu 71 5.9 6(8.5) 0.243 
Muslim 1117 93.1 142(12.7)  
Christian 12 1.0 0(0)  
Caste   
SC/ST 24 2.0 3(12.5) 0.569 
BC 1056 88 128(12.1)  
General 120 10 17(14.7)  
Prevalence of Risk Factors for Chronic Kidney Disease in a Coastal Area of Tamil Nadu, South 
www.iosrjournals.org                                                             31 | Page 
Housing condition   
Kutcha 36 3.0 6(16.7) 0.544 
Pucca 1056 88 10(9.1)  
Semi pucca 108 9 132(12.5)  
 
CKD risk factors versus socioeconomic status 
Prevalence of diabetes mellitus based on socio economic status showed that the people belonging to upper class 
21(20.4%)had more prevalence of diabetes compared to lower socioeconomic respondent 71(13.4%). Similarly, 
hypertension prevalence was also high among upper class 25(24.3%) compared to lower class 88(16.6%). 
Overweight/obesity was higher 31(30%) in upper class than lower class 106(20%). High salt intake: was high 
among lower class 436(82.1%) compared to upper class 81(78.6%). The prevalence of alcohol consumption was 
high in upper class respondent 3(2.9%) compared to middle class 12(2.1%).  Smoking was high in middle class 
compared to upper class. Renal calculus was high in lower class 32(6%). The prevalence of UTI was high in 
middle 30 (5.3%) and lower class 24(4.5%) compared to upper class were none of them had UTI.(table-2) 
 
Table2: CKD’s Risk Factors Prevalence in Association with Socio-Economic Status 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Protenuria and glycosuria with respect to socioeconomic status 
  
Out of the 12.3% individuals positive for urine albumin, maximum number of respondents belong to middle 
class 85(15%) compared to upper 12(11.7%) and lower class 51(9.6%). But glycosuria was not found to have 
statistically significant difference among the study population.(tab-3) 
 
 
 
CKDs risk factors Upper Middle Lower  Total p value 
No(%) 
N=103 
No(%) 
N=566 
No(%) 
N=531 
No(%) 
N=1200 
Diabetes 
Yes 
No 
 
21(20.4) 
82(79.6) 
 
92(16.3) 
474(83.7) 
 
71(13.4) 
460(86.6) 
 
184(15.3) 
1016(84.7) 
 
 
0.13 
Hypertension 
Yes 
No 
 
25(24.3) 
78(75.7) 
 
131(23.1) 
435(7.9) 
 
88(16.6) 
443(83.4) 
 
244(20.3) 
956(79.7) 
 
0.01 
Obesity /Overweight 
Yes 
No 
 
31(30) 
72(70) 
 
147(26) 
419(74) 
 
106(20) 
425(80) 
 
284(23.7) 
916(76.3) 
 
 
0.14 
High salt intake 
Yes 
No  
 
 
81(78.6) 
22(21.4) 
 
 
483(85.3) 
83(14.7) 
 
 
436(82.1) 
95(17.9) 
 
 
1000(83.3) 
200(16.7) 
 
 
0.14 
 
 
High oil intake 
yes 
no 
 
19(18.4) 
84(81.6) 
 
131(23.1) 
435(76.9) 
 
112(21.1) 
419(78.9) 
 
262(21.8) 
938(78.2) 
 
0.4 
 
Smoking 
Yes 
No 
 
6(5.8) 
97(94.2) 
 
44(7.8) 
522(92.2) 
 
38(7.2) 
493(92.8) 
 
88(7.3) 
1112(92.7) 
 
0.76 
Alcohol 
Yes 
No 
 
3(2.9) 
100(97.1) 
 
12(2.1) 
554(97.9) 
 
14(2.6) 
517(97.4) 
 
29(2.4) 
1171(97.6) 
 
0.80 
Renal Calculus 
Yes 
No 
 
1(1) 
102(99) 
 
29(5.1) 
537(94.9) 
 
 
32(6) 
499(94) 
 
62(5.2) 
1138(94.8) 
 
 
0.10 
UTI 
Yes 
No 
 
0(0) 
103(100) 
 
 
30(5.3) 
536(94.7) 
 
24(4.5) 
507(95.5) 
 
54(4.5) 
1146(95.5) 
 
0.05 
Prevalence of Risk Factors for Chronic Kidney Disease in a Coastal Area of Tamil Nadu, South 
www.iosrjournals.org                                                             32 | Page 
Table3: Prevalence of  Proteinuria and Glycosuria with respect to Socio-Economic Status 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fig-1 prevalence of DM with respect to Gender 
 
The prevalence of diabetes was more among males (12.7%) than females (6.3%).  
 
IV. Discussion 
  Prevalence of risk factors for chronic kidney disease is increasing day by day due to the high 
prevalence of hypertension and diabetes in this region. Individuals with hypertension and diabetes are more 
prone for chronic kidney diseases compared to general population. However, progression to end stage renal 
disease can be halted with timely and regular medication and life style modification. The early biochemical 
markers for kidney disease are protenuria and glycosuria. These will give clue to the clinician to diagnose and 
confirm the kidney disease.   
 In our study with respect to CKD risk factors, we found that 184(15.3%) individuals had DM, with 
majority (20.4%) of them belonging to upper socioeconomic class. In the study by Venkatachalam et al in an 
area of rural Tamilnadu, out of the 8.6% diabetics, 10.6% respondents belonged to lower class compared to 
6.4% and 3.9% in the upper and middle class respectively [10]. 
 In our study, the prevalence of DM was more common among males 49(12.7%) compared to 
females57 (6.3%). A similar study conducted in an urban area of Ahmedabad by Himanshu K et al also found 
higher prevalence among males (16.9%) [11].This could be due to higher prevalence of NCD risk factors among 
males. 
 The overall prevalence of hypertension was found to be 20.3%. Gaurav R B et al in a community based 
study in urban area in India, found that the prevalence of hypertension was 23.9% [12] . This study showed that 
the prevalence of hypertension is increasing in rural population as well. 
 The prevalence of proteinuria in our study population was 12.3%, using albumin specific dipstick as a 
screening test with mean age of 50.28 ± 15 years.It was more prevalent in the age group more than or equal to 
60 years (19.8%). A Study conducted at Vellore showed that 11.7% of the individuals screened were found 
positive using dipstick test with a mean age of 50.94 ± 11.2 yr [13]. The findings of this study correlates with our 
study findings. Another study from Gujarat showed the prevalence of microalbuminuria to be 30 %( 14). This 
high variation could be because this study was hospital based were the prevalence of diseased individuals is 
more whereas our study was community based. 
NCD risk 
factors 
Upper Middle Lower Total P 
value 
 
 
 
 
 
0.004 
 
 No(%) 
N=103 
 
No(%) 
N=566 
 
No(%) 
N=531 
 
No(%) 
N=1200 
Urine 
Albumin 
      Present  
 
12(11.7) 
 
 
85(15.0) 
 
51(9.6) 
 
148(12.3) 
      Absent  91(88.3) 481(85.0) 480(90.4) 1052(87.7) 
 
 
   Urine 
Sugar 
      Present  
 
8(7.8) 
 
46(8.1) 
 
46(8.7) 
 
100(8.3) 
 
 
  0.86 
       Absent  95(92.2) 520(91.9) 485(91.3) 1100(91.7) 
Prevalence of Risk Factors for Chronic Kidney Disease in a Coastal Area of Tamil Nadu, South 
www.iosrjournals.org                                                             33 | Page 
The prevalence of glycosuria in the study population was 8.3% using dipstick as a screening test 
whereas in a study published in British Medical Journal stated that out of 5,562 people covered by the house-to-
house survey 148 (2.7%)were found to have glycosuria[15]. This could be due to the fact that our study 
population had a higher prevalence of diabetes, hypertension and obesity.   
 
V. Contributions: 
Venkatachalam J: Conception and design of the study; planning and conducting the study; analysis and 
interpretation of data; and drafting the paper. Murugan N:  Design of the study; providing guidance; and 
revising the draft critically for substantial intellectual content. Abraham SB:  Design of the study; and revising 
the draft critically for substantial intellectual content. Zile Singh: Design of the study; planning and coordinating 
the study;   Anil Purty: - Analysis and interpretation of data; drafting the paper and revising the draft critically 
for substantial intellectual content. Sathya GR: - Revising the draft critically for substantial intellectual content. 
Conflict of Interest: - None.  
Role of Funding Source: - Pondicherry Institute of Medical Sciences 
 
Acknowledgements: 
The authors would like to thank, Chairman PIMS Management committee, Director –Principal PIMS, 
for providing financial and transport support for this study. The authors want to extend thanks to final year part-I 
MBBS students for helping in data collection and data entry. Also extend thanks to Dr. Elangovan Veerappan, 
Nephrologist, who provided timely suggestions during the design and conduct of the study.  
 
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[3] Haroun MK et al: Risk factors for chronic kidney disease: a prospective study of 23,534 men and women in Washington County, 
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[4] Perneger TV, Brancati FL, Whelton PK, Klag MJ: End-stage renal disease attributable to diabetes mellitus. Ann Intern Med 1994, 
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Prevalence of Risk Factors for Chronic Kidney Disease in a Coastal Area of Tamil Nadu, South India

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Prevalence of Risk Factors for Chronic Kidney Disease in a Coastal Area of Tamil Nadu, South India

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