Albuminuria Testing in Low-Income Setting

The interesting commentary by Christofides and Desai highlights albuminuria as a strong predictor for increased cardiovascular risk in diabetic individuals. ¹ Diabetic nephropathy, one of the micro-vascular complications of diabetes develops due to interplay of various hemodynamic and metabolic factors. The kidney function deterioration leads to the fast progression into chronic kidney disease, renal failure, and end-stage renal disease. These conditions increase the burden of disease, and result in inadequate access to health care facilities across the low income based countries. Furthermore, inadequate funds, absence of efficient infrastructure and limited resource availability for diabetes management and its complications add to the barriers of kidney health care.^2-4 However, some facilitators have been identified in low income settings like India which include improving knowledge & health literacy and access to health services at primary care hospitals.^5,6

A recent study on Indian metropolitan cities predicts an alarmingly high probability and lifetime risk of diabetes development in Indian urban settings. It is noteworthy that an equivalent risk also prevails among the rural residing Indian population. ⁷ Thus extensive utilization and promotion of m-health technologies may serve as useful tools to connect primary care hospitals to highly advanced tertiary level hospitals.

The Chunampet Rural Diabetes Prevention Project Model is 1 such unique tele-diabetes model conducted in Southern India. ⁸ Similarly another community based study in Southern India addressed the diabetic foot complications among diabetic individuals. ⁹ Despite geographical and etiological variations in growing prevalence of diabetic/chronic kidney disease in India, there in insufficient evidence on standardized renal function test routinely used for estimation and reporting. ¹⁰ Three phenotypes of chronic kidney disease have been recognized which include: estimated glomerular filtration rate decline only, albuminuria decline only or both. ¹¹

In routine clinical practice, assessments of serum creatinine levels are common over albuminuria although most diabetics present with no/normo-albuminuria. The question as to when the transition from normo-albuminuria to micro/macro albuminuria occurs among diabetic individuals remains largely unclear. To address this growing concern of non-communicable disease like diabetic nephropathy, should the low income countries march towards “Prevention is better than cure” using cost-effective approaches like targeting health literacy, behavioral change and lifestyle modification in the near future?