Screening for CKD and Cardiovascular Disease Risk Factors Using Mobile Clinics in Jalisco, Mexico

Background

Chronic kidney disease (CKD) is a major cause of morbidity and mortality in Mexico. However, many residents of underserved areas may be unaware that they potentially are affected.

Study Design

In an observational cross-sectional study, we examined the diagnostic yield of screening for CKD and cardiovascular disease risk factors using mobile units that traveled to poor communities in Jalisco, Mexico.

Setting & Participants

We excluded individuals who were aware that they had CKD and those < 18 years of age.

Outcomes

Glomerular filtration rate, cardiovascular risk.

Measurements

Demographic data, socioeconomic status, blood pressure, fasting glucose, and dipstick urinalysis.

Results

3,734 participants; 29.3% men and mean age of 57.4 ± 13.0 years. Most (99.7%) had no history of cardiovascular disease; however, 43.5% had a history of diabetes, 11.4% had dipstick-positive proteinuria, 62.0% had blood pressure in the hypertensive range, and 15.8% had an estimated glomerular filtration rate compatible with stages 3-5 CKD. In patients with no history of cardiovascular disease, proportions with predicted 5-year risks of new cardiovascular events <5%, 5%-10%, 10.1%-20%, 20.1%-30%, and >30% were 10.0%, 11.7%, 26.6%, 20.7%, and 30.9%, respectively. Screening 18 participants aged < 40 years would be expected to detect 6 new cases of hypertension or 2 new cases of diabetes.

Limitations

Data may not be generalizable to all low-income settings or other regions of Mexico.

Conclusions

Impaired kidney function, proteinuria, and cardiovascular risk factors were detected frequently when mobile units were used to perform screening in poor areas of Jalisco, Mexico. This suggests that trials of targeted screening and intervention are feasible and warranted.

Index Words: chronic kidney disease, proteinuria, hypertension