Six-Fold Renal Risk: The Potent Synergy of T2D and Hypertension in India, Study

Chronic Kidney Disease (CKD) remains a primary driver of morbidity and mortality globally, yet while international research reports widely varying prevalence rates ranging from 1.7 percent in Chinese studies to 8.1 percent in the United States, there remains a critical lack of nationally representative epidemiological data for the Indian population. Consequently, Dr. Rajendra Pradeepa and colleagues from the Madras Diabetes Research Foundation (MDRF) conducted this investigation to evaluate the national prevalence of IKF and its specific associations with T2D and HTN across urban and rural settings.

Therefore, the comprehensive cross-sectional investigation, part of the larger Indian Council of Medical Research–India-DIABetes (ICMR-INDIAB) study, utilized a stratified multistage door-to-door survey to recruit a representative sample of 25,408 adults across 31 States and Union Territories between 2008 and 2020. Using the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) race-free equation to assess the primary endpoint of IKF—defined as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m²—researchers excluded individuals with missing metabolic data to analyze how kidney function correlates with diabetes and hypertension.

Key Clinical Findings of the Study Include:

• Demographic Prevalence Disparity: The study observed that the weighted prevalence of renal impairment was significantly higher in males at 3.8 per cent compared to 2.6 per cent in females, although no major differences existed between urban and rural residents.

• Metabolic Risk Synergism: The investigation highlighted that while T2D alone (Odds Ratio 3.2) poses a higher risk for developing impairment than HTN alone (Odds Ratio 2.4), the coexistence of both metabolic conditions results in a potent six-fold increase in the odds of renal dysfunction.

• Age-Associated Functional Decline: The research recorded an annual decrease in eGFR of approximately 1.0 mL/min/1.73 m², a loss that was more pronounced in urban dwellers and those managing both diabetes and hypertension.

• Significant Geographic Heterogeneity: The study documented substantial regional variation across the country, with weighted prevalence rates ranging from a low of 0.6 per cent in Chandigarh to high-burden peaks of 7.4 per cent in Goa and Telangana.

The results suggest that the prevalence of impaired kidney function is significantly high throughout India and is expected to climb as metabolic risk factors become more common, with an overall weighted prevalence confirmed at 3.2 percent. Furthermore, the findings indicate that diabetes may confer a higher risk for renal impairment than hypertension in this specific population.

Thus, the study concludes that the practitioners might find value in integrating routine serum creatinine testing and kidney function reporting into existing national non-communicable disease frameworks to facilitate the earlier detection and management of impairment in high-priority patient groups.

Although the study provides a powerful nationwide overview of renal health, its cross-sectional design and the necessary reliance on single creatinine measurements without supplementary albuminuria data suggest that future longitudinal research will be vital to fully grasp Indian kidney disease trajectories and validate these estimating equations within the local population.

Reference

Pradeepa R, Deepa M, Venkatesan U, Rao PV, Kumar A, Dash K, et al. Prevalence of impaired kidney function & its association with diabetes & hypertension in India: The ICMR–INDIAB study (ICMR-INDIAB-22). Indian J Med Res 2025; 162 : 143-54.