Reasonably increased albuminuria (30C300?mg/g) was seen in 26

Reasonably increased albuminuria (30C300?mg/g) was seen in 26.4% and severely increased albuminuria ( 300?mg/g) in 8.4% of sufferers. We discovered that 57% of the sample met GFR and/or albuminuria criteria suggestive of CKD. Over half of the sample had moderate or greater increased risk for CKD progression, including nearly SRA1 20% who were classified as high or very high risk. Hypertension was common in the sample (42%), and glycaemic control was suboptimal (mean haemoglobin A1c 9.4%2.5% at programme enrolment and 8.6%2.3% at time of CKD screening). Conclusions The high burden of renal disease in our patient sample suggests an imperative to better understand the burden and risk factors of CKD in Guatemala. The implementation details we share reveal the tension between evidence-based CKD screening versus screening that can feasibly be delivered in resource-limited global settings. strong class=”kwd-title” Keywords: chronic renal failure, general diabetes, international health services Strengths and limitations of this study This study is one of the first to describe the implementation of a chronic kidney disease (CKD) screening programme in a rural area of a low-income or middle-income country. The primary strength of this study relates to the practical barriers that were overcome to implement a guideline-directed CKD screening programme in this setting. We investigated CKD in a small diabetes sample of 144 people, limiting the generalisability of our results. Our results could have overestimated the overall prevalence of CKD among people with diabetes in rural Guatemala, given that we sampled from a single institutions diabetes cohort rather than using a population-based sampling strategy. Our sample was predominantly composed of women, which reflects known challenges in enrolling men N6,N6-Dimethyladenosine in chronic disease programmes in Latin America. Introduction Chronic kidney disease (CKD) is a critical global health problem.1C3 The worldwide CKD prevalence rate is 11%C13%.4 From 2005 to 2015, deaths due to CKD rose from 0.9 to 1 1.2?million per year, N6,N6-Dimethyladenosine primarily owing to increases in CKD caused by diabetes and hypertension.5 Data on CKD are limited in low-income?and middle-income countries (LMICs), but age-adjusted prevalence and mortality rates may be greater than in high-income countries.6 7 The causes of CKD in LMICs are heterogeneous and incompletely understood, and most individuals are undiagnosed.2 8 9 A growing proportion of those with CKD in LMICs develop end-stage renal disease (ESRD), yet most do not have access to life-saving renal replacement therapy (RRT).10 11 The region of interest in this study is Latin America. Here, marked disparities exist with regard to the nephrology workforce and RRT rates. 12 Latin America has the highest CKD death rate in the world,5 and diabetes is the leading cause of ESRD.12 Recent high-quality evidence from Mexico suggests that diabetes is a potent risk factor for CKD and death from renal disease in this region.13 CKD screening and management in resource-limited settings Scaling up screening is an important strategy to address the burden of CKD in LMICs.14C16 International clinical guidelines recommend CKD screening for individuals with risk factors such as diabetes, using laboratory assessments of glomerular filtration rate (GFR) and urine albumin excretion.17C20 In the case of diabetes, interventions shown to slow disease progression for individuals who screen positive for CKD include glycaemic control, blood pressure management and renoprotection with ACE N6,N6-Dimethyladenosine inhibitors or angiotensin receptor blockers.21 However, there are many barriers to implementing CKD screening in resource-limited settings. Screening for CKD may be cost-effective in high-income countries in high-risk patients such as those with diabetes,22 but the cost-effectiveness in LMICs is uncertain. This is in large part because international CKD screening guidelines require access to specialised laboratory testing,21 which is frequently unavailable at the primary care level in LMICs.23 Furthermore, many national health systems in LMICs are not equipped or funded to deliver integrated care for individuals with CKD once they are detected by screening.23 24 Finally, there are few published reports documenting the practical details of implementing CKD screening programmes in LMICs. Scaling up CKD care requires that all implementers more readily share their experiences in designing and evaluating CKD screening programmes. Study objectives This study describes the.