The Etiology of Advanced Chronic Kidney Disease in Southeast Asia: A Meta-analysis

Introduction: Chronic kidney disease (CKD) etiology varies greatly between developed and developing countries. In addition, differences in underlying pathogenesis and therapeutic options affect the progression towards advanced-CKD. This meta-analysis aims to identify the etiology of advanced-CKD in Southeast Asia. Methods: A systematic search in four electronic-databases and complementary search on national kidney registries and repository libraries was conducted until July 20, 2023. The risk of bias was assessed using Newcastle–Ottawa Scale for observational studies and Version-2 of Cochrane for intervention studies. A random-effects model was used to estimate pooled prevalence. The protocol is registered in the International Prospective Register of Systematic Reviews PROSPERO; Registration ID:CRD42022300786. Results: We analyzed 81 studies involving 32,834 subjects. The pooled prevalence of advanced-CKD etiologies are diabetic kidney disease (DKD) 29.2% (95%CI 23.88–34.78), glomerulonephritis 20.0% (95%CI 16.84–23.38), hypertension 16.8% (95%CI 14.05–19.70), other 8.6% (95%CI 6.97–10.47), unknown 7.5% (95%CI 4.32–11.50), and polycystic kidney disease 0.7% (95%CI 0.40–1.16). We found a significant increase in DKD prevalence from 21% (9.2%, 95%CI 0.00–33.01) to 30% (95%CI 24.59–35.97) before and after the year 2000. Among upper-middle-income and high-income countries, DKD is the most prevalent (26.8%, 95%CI 21.42–32.60 and 38.9%, 95%CI 29.33–48.79, respectively), while glomerulonephritis is common in lower-middle-income countries (33.8%, 95%CI 15.62–54.81). Conclusion: The leading cause of advanced-CKD in Southeast Asia is DKD, with a substantial proportion of glomerulonephritis. An efficient screening program targeting high-risk populations (diabetes mellitus and glomerulonephritis) is needed, with the aim to delay CKD progression.