Risk estimation of chronic kidney disease in a leptospirosis endemic area: A case-control study from south Andaman Islands of India

Abstract

Objective: To estimate the risk of chronic kidney disease in patients with leptospirosis. Methods: All reported (41 890) and later confirmed leptospirosis (1 990) cases from 2010-2020 were traced by universal sampling. 386 Laboratory-confirmed leptospirosis cases were enrolled and 413 age, gender, area, and occupation matched healthy persons were included as controls. Variables including socio-demographic characteristics, medical history, and health-related behaviours were compared between the two groups and association between these variables and reduced estimated glomerular filtration rate (eGFR) was analyzed with multiple linear regression. Results: The median of eGFR was 49.0 (27.0, 75.0) mL/min/1.73 m² in the cases and 96.0 (72.0, 121.0) mL/min/1.73 m² in the controls, showing significant differences (P<0.001). Bivariate analysis showed that leptospirosis seropositivitiy, repeat leptospirosis infection, diabetes, male gender, working in field (sun exposure), COVID-19 infection and smoking had statistically significant association with reduced eGFR. Leptospirosis seropositivity had negative effects on eGFR. Multiple linear regression confirmed that leptospirosis seropositivity had negative effects on eGFR (unstandardised β coefficients= −30.86, 95% CI −49.7 to −11.9, P<0.001). Conclusions: Chronic kidney disease is a complex disease with multiple risk factors involved. Exposure to leptospirosis is one of the essential factors in accelerating its progression.

Keywords

Chronic kidney disease / Endemic leptospirosis / Estimated glomerular filtration rate (eGFR)

References

[1] Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: A position statement from kidney disease: Improving Global Outcomes (KDIGO). Kidney Int 2005; 67(6):2089-2100.

[2] Jha V, Garcia GG, Iseki K, Zuo L, Saraladevi N, Plattner B, et al. Chronic kidney disease: Global dimension and perspectives. Lancet 2013; 382(9888):260-272.

[3] Bikbov B, Purcell CA, Levey AS, Smith M, Abdoli A, Abebe M, et al. Global, regional, and national burden of chronic kidney disease, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2020; 395(10225):709-733.

[4] Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859):2095-2128.

[5] Kasiske B. KDIGO guideline on CKD. Kidney Int Suppl 2014; 4(1):1-66.

[6] Varma PP. Prevalence of chronic kidney disease in India - Where are we heading. Ind J Nephrol 2015; 25(3):133-135.

[7] Tsai WC, Wu HY, Pheng YS, Yang JY, Chen HY, Chiu YL, et al. Association of intensive blood pressure control and kidney disease progression in nondiabetic patients with chronic kidney disease: A systematic review and meta-analysis. JAMA Intern Med 2017; 177(6):792-799.

[8] Thomas MC, Brownlee M, Susztak K, Sharma K, Dahm KJ, Zoungas S, et al. Diabetic kidney disease. Nat Rev Dis Prim 2015; 1(1):1-46.

[9] Johnson RJ, Wesseling C, Newman LS. Chronic kidney disease of unknown cause in agricultural communities. N Engl J Med 2019; 380(19):1843-1852.

[10] Chapman E, Haby MM, Illanes E, Viamonte JS, Elias V, Reveiz L. Risk factors for chronic kidney disease of non-traditional causes: A systematic review. Rev Panam Salud Publica/Pan Am J Public Heal 2020; 43:1-12.

[11] Vlahos P, Schensul SL, Anand S, Shipley E, Diyabalanage S, Chaoran H, et al. Water sources and kidney function: Investigating chronic kidney disease of unknown etiology in a prospective study. NPJ Clean Water 2021; 4(1):1-7.

[12] Faine S. Leptospira and leptospirosis. 1st ed. Madison: Crc Press Inc; 1994, p.13-49.

[13] Levett PN. Leptospirosis. Clin Microbiol Rev 2001; 14(2):296-326.

[14] Lai KN, Woodroffe AJ, Clarkson AR. Renal lesions in leptospirosis. Aust N Z J Med 1982; 12(4):276-279.

[15] Yang H, Hung C, Liu S, Guo Y, Chen Y. Overlooked risk for chronic kidney disease after leptospiral infection: A population-based survey and epidemiological cohort evidence. PLoS Negl Trop Dis 2015; 9(10):1-15.

[16] WHO. Human leptospirosis: Guidance for diagnosis, surveillance and control. Malta: Jointly published with the International Leptospirosis Society; 2003.

[17] LERG. Report of the Second Meeting of the Leptospirosis Burden Epidemiology Reference Group. Geneva: World Health Organ; 2011.

[18] Boca NPJ. Statistics for epidemiology. Int J Epidemiol 2004; 33(5):1158-1159.

[19] National Informatics Centre. Andaman unit. [Online]. Available from:https://andaman.nic.in/. [Accessed on 5 March 2023].

[20] Mallappallil M, Friedman EA, Delano BG, Mcfarlane SI, Salifu MO. Chronic kidney disease in the elderly: Evaluation and management. Clin Pract 2014; 11(5):525-535.

[21] García GG, Iyengar A, Kaze F, Kierans C, Altamira CP, Luyckx VA. Sex and gender differences in chronic kidney disease and access to care around the globe. Semin Nephrol 2022; 42(2):101-113.

[22] Kaze FF, Meto DT, Halle MP, Ngogang J, Kengne AP. Prevalence and determinants of chronic kidney disease in rural and urban Cameroonians: A cross-sectional study. BMC Nephrol 2015; 16(1):11-18.

[23] Borrelli S, Provenzano M, Gagliardi I, Ashour M, Liberti ME, Nicola LD, et al. Sodium intake and chronic kidney disease. Int J Mol Sci 2020; 21(13):4744.

[24] Yacoub R, Habib H, Lahdo A, Ali RA, Varjabedian L, Atalla G, et al. Association between smoking and chronic kidney disease: A case control study. BMC Public Health 2010; 10:731.

[25] Bruha R, Dvorak K, Petrtyl J. Alcoholic liver disease. World J Hepatol 2012; 4(3):81-90.

[26] McLaughlin JK, Lipworth L, Chow WH, Blot WJ. Analgesic use and chronic renal failure: A critical review of the epidemiologic literature. Kidney Int 1998; 54(3):679-686.

[27] Kovesdy CP, Furth SL, Zoccali C. Obesity and kidney disease: Hidden consequences of the epidemic. J Nephrol 2017; 30(1):1-10.

[28] Crowe J, Wesseling C, Solano BR, Solano BR, Umana MP, Ramirez AR, et al. Heat exposure in sugarcane harvesters in Costa Rica. Am J Ind Med 2013; 56(10):1157-1164.

[29] Oh TR, Choi HS, Kim CS, Bae EH, Ma SK, Sung SA, et al. Hyperuricemia has increased the risk of progression of chronic kidney disease: Propensity score matching analysis from the KNOW-CKD study. Sci Rep 2019; 9(1):1-9.

[30] Hsiao CY, Lin HL, Lin YK, Chen CW, Cheng YC, Lee WC, et al. Urinary tract infection in patients with chronic kidney disease. Turkish J Med Sci 2014; 44(1):145-149.

[31] World Health Organization. Hypertension. [Online]. Available from:https://www.who.int/news-room/fact-sheets/detail/hypertension. [Accessed on 2 October 2023].

[32] World Health Organization. Mean fasting blood glucose. [Online]. Available from:https://www.who.int/data/gho/indicator-metadata-registry/imr-details/2380. [Accessed on 2 October 2023].

[33] Levey AS, Stevens LA. Estimating GFR using the CKD epidemiology collaboration (CKD-EPI) creatinine equation: More accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis 2010; 55(4):622-627.

[34] Wolff JW. The laboratory diagnosis of leptospirosis. Oxford: Charles C. Thomas; Blackwell Scientific Publication, Ltd: 1954.

[35] Phannajit J, Lertussavavivat T, Limothai U, Tachaboon S, Avihingsanon Y, Praditpornsilpa K, et al. Long-term kidney outcomes after leptospirosis: A prospective multicenter cohort study in Thailand. Nephrol Dial Transplant 2023; 10(1093):32-35.

[36] Anacleto FE, Collado AB, Wyson AM. Profile of acute kidney injury in pediatric leptospirosis. Ren Fail 2014; 36(7):1090-1094.

[37] Kennedy ND, Path MRC, Higginson A. Review of the literature. J Dermato Surg Oncol 1989; 15(7):779-782.

[38] Daher EDF, De Abreu KLS, Da Silva Junior GB. Leptospirosis-associated acute kidney injury. J Bras Nefrol orgão of Soc Bras e Latino-Americana Nefrol 2010; 32(4):400-407.

[39] Sitprija V, Evans H. The kidney in human leptospirosis. Am J Med 1970; 49:780-788.

[40] Pry JM, Jackson W, Rupasinghe R, Lishanthe G, Badurdeen Z, Abeysekara T, et al. A pilot study of behavioral, environmental, and occupational risk factors for chronic kidney disease of unknown etiology in Sri Lanka. Carbohyd Polym 2019; 6(1):5-10.

[41] Riefkohl A, Rubio OR, Laws RL, McCleanc MD, Weinerd DE, Kaufmane JS, et al. Leptospira seropositivity as a risk factor for mesoamerican nephropathy. Int J Occup Environ Health 2017; 23(1):1-10.

[42] Herath C, Jayasumana C, De Silva PMCS, Siribaddana S, De Broe ME. Kidney diseases in agricultural communities: A case against heat-Stress nephropathy. Kidney Int Reports 2018; 3(2):271-280.