One in three with high blood pressure more likely to develop kidney disease

In some rural regions of Bangladesh, one in every three people with high blood pressure, known as hypertension, have a greater chance of developing chronic kidney disease (CKD), suggests the COBRA-BPS (Control of Blood Pressure and Risk Attenuation – Bangladesh, Pakistan and Sri Lanka) multi-country study with icddr,b.

The global burden of CKD is mostly centred in low- and middle-income countries (LMICs). Photo: GMB Akash / icddr,b

CKD is the inability of the kidneys to filter waste from the blood. This leads to the presence of a higher amount of proteins and waste that are unable to clear out.

In rural Bangladesh, around 37 percent of people aged over 40 who have hypertension have CKD, indicates new findings published in Nephrology Dialysis Transplantation from the COBRA-BPS (Control of Blood Pressure and Risk Attenuation – Bangladesh, Pakistan and Sri Lanka) trial that examined 850 people.

“This is an alarmingly high prevalence of CKD in a rural setting reported among apparently healthy individuals, and indicates that there are more people with CKD in the community who remain undiagnosed due to lack of screening” says Dr Aliya Naheed, the country lead of COBRA-BPS trial in Bangladesh, and head of non-communicable diseases (NCDs) initiative at icddr,b.

The COBRA-BPS trial has been conducted since 2016, and more than 2500 individuals with hypertension have participated in the trial in Bangladesh, Pakistan and Sri Lanka. The new study found that in comparison to Bangladesh, CKD prevalence rate is higher in Sri Lanka (58.3%) and lower in Pakistan (16.9%).

Recent evidence suggests that the global burden of CKD is mostly centred in low- and middle-income countries (LMICs). The World Health Organization (WHO) has recently campaigned to raise awareness about obesity – a potential risk factor for CKD.

“The rising burden of CKD will pose a greater economic threat to individual families due to the prohibitively high treatment cost; hence it is imperative that we invest more on prevention of CKD, which would be far less costly than treating the disease for life time. Routine screening for CKD and proper management among individuals with hypertension and diabetes is a simple strategy for averting the risk of CKD in the population.

However, it will be a greater responsibility for the government to plan a large investment on primary prevention of the risk factors of NCDs by promoting healthy eating, active living, cessation of consumption of tobacco of any form, and strengthening the primary care facilities for effective control of hypertension, diabetes and obesity, which will not only avert  the risk of CKD but also other common life threatening diseases in Bangladeshi adults, including stroke and myocardial infarction (MI),” she added.

The COBRA-BPS intervention strategy is a simple pathway for integrating management of hypertension in primary care facilities in rural Bangladesh, and strengthening capacity of the government health work force, by providing health information materials which enable workers to   promote healthy eating, physical activity, weight management and control of blood pressure among hypertensive individuals.

The trial will end in 2019 and is expected to provide evidence of a pragmatic low-cost solution for preventing the premature deaths from NCDs including CKD in Bangladesh, as well as other countries in South Asia.

The study trial is supported by Joint Global Heath Trials Scheme of the UK Department for International Development, the Medical Research Council, and the Wellcome Trust.

* Md. Tauhidul Islam contributed to this report