DEGREE: The Disadvantaged Populations Estimated Glomerular Filtration Rate (eGFR) Epidemiology Study

Dates: April 2017 – ongoing

DEGREE Executive: Neil Pearce, Ben Caplin, Kristina Jakobsson, Ajay Singh, Ricardo Correa Rotter, Jason Glaser.

DEGREE Steering Committee: Dorothea Nitsch, Liam Smeeth, Antonio Bernabe-Ortiz, Emmanuel Burdmann, Marvin Gonzalez-Quiroz, Vivekanand Jha, Rick Johnson, Prabdheep Kaur, Pronpimolk Kongtip, Hans Kromhout, Adeera Levin, Magdalena Madero Rovalo, Moffat Nyirenda, Cristina O’Callaghan-Gordo, Pablo Perel, Dorairaj Prabhakaran, Giuseppe Remuzzi, Rajiv Saran, Vidhya Venugopal

Other Collaborators: Laurie Tomlinson, Jaime Miranda, Neil Dalton, Devaki Nair

Funder for first phase of the DEGREE study: Medical Research Council

There is an epidemic of primarily tubular-interstitial chronic kidney disease (CKD) clustering in agricultural communities in low-and-middle income countries (LMICs). Although it is currently unclear whether there is a unified underlying aetiology, these conditions have been collectively termed CKD of undetermined cause (CKDu). CKDu is estimated to have led to the premature deaths of tens to hundreds of thousands of young men and women in LMICs over the last two decades. Thus, there is an urgent need to understand the aetiology and pathophysiology of these condition(s) and to develop preventive interventions.

Currently it is known that CKDu exists in Central America and mainly affects male rural agricultural workers. It may also be occurring in other tropical/subtropical parts of the world, but standardized data are not available for comparison, and also it is not known which population subgroups it affects. Obtaining this information is an essential step towards discovering the cause(s) of CKDu.

The disadvantaged populations estimated glomerular filtration rate (eGFR) epidemiology study (DEGREE) collaboration aims to:

  1. Inform local communities, healthcare systems and governments of the size of the problem
  2. Understand if there are factors in common between different areas affected, and
  3. Accurately measure whether the problem is worsening or improving over time.
  4. Act as a foundation for future aetiological and intervention studies
  5. Help build a network to address the problem of CKDu across the globe.

The first phase of the DEGREE project will be conducted in four countries (India, Malawi, Peru and Mexico) with funding from the UK Medical Research Council. It provides a simple set of tools that we hope researchers anywhere can use to quantify the distribution of eGFR (an estimate of kidney function) using cross-sectional surveys in a representative samples from populations thought to be at risk of disease.

This work will provide key information to inform hypotheses and to guide further research into the causes of CKDu.

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