CKD in Indigenous Populations in Kerala, India

Chronic kidney disease (CKD) is a major public health concern in India, with a disproportionate impact on underserved populations. Shifting epidemiological patterns indicate increasing metabolic risk in tribal communities. This study sought to assess the prevalence of CKD and explore its associated determinants among tribal communities in Kerala, South India.

A community-based cross-sectional study was conducted among 2029 tribal adults aged ≥ 30 years across 3 districts in Kerala, selected through multistage random sampling. Data collection involved structured interviews, anthropometry, point-of-care blood tests, and spot urine analysis. Based on Kidney Disease: Improving Global Outcomes (KDIGO) 2024 criteria, CKD was defined using estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Multivariable logistic regression was employed to identify factors independently associated with CKD.

A total of 2029 individuals were included in this study (1209 females and 820 males) from 18 distinct tribal communities. The mean age was 50.1 (± 13.1) years. The prevalence of CKD was 22.6% (95% confidence interval [CI]: 20.7%-24.7%), higher in females (24.2%, 95% CI: 21.8%-26.8%) than in males (20.4%, 95% CI: 17.8%-23.2%). Most cases were in early risk stages, reflecting a significant subclinical burden. CKD was positively associated with older age, hypertension, diabetes, lower education, and low body mass index (BMI).

This is the first large-scale population-based study to report a high prevalence of CKD among indigenous tribal communities in India. Effective CKD control in the indigenous communities in India necessitates an equity-focused strategy addressing both clinical and social determinants. The findings underscore the need for culturally adapted screening and prevention interventions integrated within primary health care systems.