Background Chronic kidney disease is an important cause of global mortality and morbidity. Data for epidemiological
features of chronic kidney disease and its risk factors are limited for low-income and middle-income countries. The
International Society of Nephrology’s Kidney Disease Data Center (ISN-KDDC) aimed to assess the prevalence and
awareness of chronic kidney disease and its risk factors, and to investigate the risk of cardiovascular disease, in countries
of low and middle income.
Methods We did a cross-sectional study in 12 countries from six world regions: Bangladesh, Bolivia, Bosnia and
Herzegovina, China, Egypt, Georgia, India, Iran, Moldova, Mongolia, Nepal, and Nigeria. We analysed data from
screening programmes in these countries, matching eight general and four high-risk population cohorts collected in
the ISN-KDDC database. High-risk cohorts were individuals at risk of or with a diagnosis of either chronic kidney
disease, hypertension, diabetes, or cardiovascular disease. Participants completed a self-report questionnaire, had
their blood pressure measured, and blood and urine samples taken. We defi ned chronic kidney disease according to
modifi ed KDIGO (Kidney Disease: Improving Global Outcomes) criteria; risk of cardiovascular disease development
was estimated with the Framingham risk score.
Findings 75 058 individuals were included in the study. The prevalence of chronic kidney disease was 14·3% (95% CI
14·0–14·5) in general populations and 36·1% (34·7–37·6) in high-risk populations. Overall awareness of chronic
kidney disease was low, with 409 (6%) of 6631 individuals in general populations and 150 (10%) of 1524 participants
from high-risk populations aware they had chronic kidney disease. Moreover, in the general population,
5600 (44%) of 12 751 individuals with hypertension did not know they had the disorder, and 973 (31%) of 3130 people
with diabetes were unaware they had that disease. The number of participants at high risk of cardiovascular disease,
according to the Framingham risk score, was underestimated compared with KDIGO guidelines. For example, all
individuals with chronic kidney disease should be considered at high risk of cardiovascular disease, but the
Framingham risk score detects only 23% in the general population, and only 38% in high-risk cohorts.
Interpretation Prevalence of chronic kidney disease was high in general and high-risk populations from countries of
low and middle income. Moreover, awareness of chronic kidney disease and other non-communicable diseases was
low, and a substantial number of individuals who knew they were ill did not receive treatment. Prospective programmes
with repeat testing are needed to confi rm the diagnosis of chronic kidney disease and its risk factors. Furthermore, in
general, health-care workforces in countries of low and middle income need strengthening