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Detection and Prevention of Chronic Kidney Disease in Indonesia:
Community Screening Study (A Preliminary Report)
Dharmeizar1, Aida Lydia1, Ginova Nainggolan1, Suhardjono1, Wiguno Prodjosudjadi1, I Gde Raka Widiana2, Jodi Sidharta Loekman2, Ketut Suwitra2, Pranawa3, Yanri Wijayanti Subronto4, Heru Prasanto4, Mochammad Sjaﾕbani4
1Medical Faculty, University of Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, 2Medical Faculty, University of Udayana, Sanglah Hospital, Denpasar-Bali
3Medical Faculty, University of Airlangga, Dr. Soetomo Hospital, Surabaya
4Medical Faculty, University of Gajah Mada, Dr. Sardjito Hospital, Yogyakarta

Background
This study was designed to pilot a screening program in some districts in Indonesia as a preliminary for national kidney disease prevention conducted by the Indonesian Society of Nephrology. The primary objective of this screening was to determine the prevalence of proteinuria and hypertension. Renal function and random blood glucose were only measured in a selected group. Obesity and smoking habit were also recorded.

Methods
A prospective, cross-sectional and descriptive study was conducted in rural areas of Jakarta and Bali from October 2005 to April 2006. All subjects at the age of 18-70 years were enrolled until the target number of 6000 was reached. Persistent proteinuria was defined as ≥+2, or +1 in two of three repeated measurements by dipstick test. Creatinine serum and random blood glucose were performed if subjects had persistent proteinuria and/or hypertension and/or positive glucose in urine and/or history of diabetes. Diabetes mellitus (DM) was defined as random blood glucose of > 200 mg/dL, and obesity as BMI ≥ 23 Kg/m2. Creatinine clearance test (CCT) was determined by Cockcroft-Gault formula and CKD was classified according to the K/DOQI guidelines.

Results
Out of 6040 subjects included, 3700 (61.3%) were females. The mean age was 41.7±14.1 (18-70) years old. Hypertension was found in 842 subjects (13.9%), of which 84.1 % had stage 1 hypertension. Persistent proteinuria was identified in 215 subjects (3.6%). Random blood glucose was performed in 712 subjects of which 156 subjects (21.9%) had DM. Serum creatinine was measured in 1093 subjects either persistent proteinuria and/or hypertension and/or diabetes mellitus. CKD stages I, II, III, IV, and V were found in 31.8%, 39.1%, 26.1%, 2.2% and 0.8%, respectively. Obesity was found in 2479 subjects (41%) and active smoking in 716 subjects (11.9%).

Conclusion
These data revealed a significant number of hypertension (13.9%), while persistent proteinuria was only found in 3.6%. A high percentage of CKD was found in subjects with persistent proteinuria, and or hypertension, and or diabetes mellitus.
Keywords: CKD screening, rural area, risk factors

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