NEPHROLOGY 2009; 14, 669–674 doi:10.1111/j.1440-1797.2009.01137.

x
nep_1137 669..674

Original Article

Detection and prevention of chronic kidney disease in

Indonesia: Initial community screening
WIGUNO PRODJOSUDJADI,1 SUHARDJONO,1 KETUT SUWITRA,2 PRANAWA,3
I GDE RAKA WIDIANA,2 JODI SIDHARTA LOEKMAN,2 GINOVA NAINGGOLAN,1
HERU PRASANTO,4 YANRI WIJAYANTI,4 DHARMEIZAR,1 MOCHAMMAD SJA’BANI,4
M YUSUF NASUTION,5 WIDODO BASUKI,3 ADITIAWARDANA,3 DAVID CH HARRIS6 and
DAVID J PUGSLEY7 FOR THE WORKING GROUP OF THE INDONESIAN
SOCIETY OF NEPHROLOGY

1
Faculty of Medicine, University of Indonesia, Jakarta, 2Faculty of Medicine, University of Udayana, Bali,
3
Faculty of Medicine, University of Airlangga, Surabaya, 4Faculty of Medicine, University of Gajah Mada,
Yogyakarta, and 5Faculty of Medicine, University of North Sumatera, Medan, Indonesia; and 6Faculty of
Medicine, University of Sydney, Westmead Hospital, and 7Hawthorn, South Australia, Australia

SUMMARY:
Aim: This survey evaluated the prevalence of chronic kidney disease (CKD if estimated glomerular filtration rate
(eGFR) <60 mL/min per 1.73 m2) and its risk factors amongst subjects from urban and semi-urban areas.
Methods: History of hypertension, diabetes mellitus, kidney disease, cardio- and cerebrovascular diseases of
subjects and their families was recorded. Blood pressure was determined as the mean of three readings in the
sitting position and hypertension classified according to the Joint National Committee VII. Urinalysis was
assessed using Combi 10R dipstick test. Random blood glucose and serum creatinine were measured in subjects
with either hypertension, proteinuria, glycosuria and/or a history of diabetes. eGFR was calculated according
Cockcroft–Gault (CG) adjusted by body surface area (BSA), Modification of Diet in Renal Disease (MDRD) and
Chinese MDRD equations.
Results: Of 9412 subjects recruited, 64.1% were female. Persistent proteinuria was found in almost 3%.
Systolic and diastolic hypertension was found in 10%, isolated systolic hypertension in 4.8% and isolated diastolic
hypertension in 4.6%. CKD was found in 12.5% (CG), 8.6% (MDRD) or 7.5% (Chinese MDRD) of subjects with
either hypertension, proteinuria and/or diabetes. Proteinuria, systolic blood pressure and a history of diabetes
mellitus were independent predictors of impaired eGFR. Obesity and smoking history were found in 32.5% and
19.8%, respectively.
Conclusion: The present study showed a high prevalence of CKD in representative urban and semi-urban
areas and argues for screening and treatment of all Indonesians, particularly those at an increased risk of CKD.

KEY WORDS: chronic kidney disease detection, estimated glomerular filtration rate, hypertension,
proteinuria.nep_1137 669..674

Chronic kidney disease (CKD) is rapidly becoming recog-
nized as a major health, social and economic problem for
developing countries such as Indonesia. A national register
of end-stage kidney disease (ESKD) and its treatment has
Correspondence: Professor Wiguno Prodjosudjadi, Secretariat Indo-
nesian Society of Nephrology (InaSN), Gedung YARNATI, 1st Floor,
Room 103, Jl. Proklamasi No. 44, Jakarta Pusat 10320, Indonesia.
Email: pernefri@cbn.net.id
Accepted for publication 16 February 2009.
© 2009 The Authors
Journal compilation © 2009 Asian Pacific Society of Nephrology
been introduced recently. However, the prevalence of CKD
is unknown, although limited data give the impression that
it is increasing rapidly.1
Hemodialysis (HD) and continuous ambulatory perito-
neal dialysis (CAPD) as modalities of treatment for ESKD
are available in almost every part of Indonesia, but are
precluded on financial grounds for most patients. Kidney
transplantation has been performed only occasionally in a
few nephrology centres. Both government and private
insurance programs cover less than 10% of ESKD patients
requiring dialysis therapy and do not cover expensive
immunosuppressive therapy required following kidney
670
transplantation. The government has increased the scope of
programs for the uninsured majority of the population, but
to an extent too limited to solve the problem.
Thus, there is a pressing need to implement strategies to
prevent or slow the progression of CKD to ESKD. Screening
for evidence of CKD and risk factors such as diabetes and
hypertension is an important and essential step for deter-
mining the prevalence, and ultimately the incidence of the
condition. In addition, it will be necessary to determine the
most common causes of CKD, especially if the prevalence is
thereafter shown to be high.
The Indonesian Society of Nephrology (InaSN) has just
completed an epidemiological survey entitled ‘Detection
and prevention of CKD in Indonesia: Initial Community
Screening’. This was designed as a pilot screening program
in four geographically distinct districts of Indonesia, with
the intention of determining the feasibility of a national
survey.
METHODS
We planned to screen 12 000 adult (18–70 years) subjects in four diver-
gent areas of the country. The study involved subjects in urban and
semi-urban (city and surrounding villages) areas of Yogyakarta, Jakarta,
Surabaya and Bali as depicted in Figure 1. It was anticipated that each
area of this survey would include 3000 subjects. The coordinator in
each area was responsible for determining the target area which would
be surveyed as a cluster.
A specific form was designed to explore any history of hypertension,
diabetes mellitus, kidney disease, and cardio- and cerebrovascular
disease in the respondents and in their families. A unique identification
code and demographic data were also recorded. A group of field workers
was trained by an experienced medical officer using a manual specifi-
cally prepared for the study.
Weight and height were measured using standardized equipment,
and body mass index (BMI) calculated based on The Asia–Pacific
INDONESIA
Bali
Jakarta
Yogyakarta Surabaya
Fig. 1 The four study areas in Indonesia.
W Prodjosudjadi et al.
Perspective (World Health Organization, 2000).2 Waist circumference
was determined by measurement made at the umbilicus in the recum-
bent position, and hip circumference at the point of maximum width of
the hip. Blood pressure was measured on three occasions after a few
minutes rest, using a mercury sphygmomanometer. The first Korotkoff
sound was used to determine systolic pressure and the fifth sound to
determine diastolic pressure. Recorded blood pressure was the mean of
the three readings. Hypertension was classified according to the Joint
National Committee VII guidelines.3 Systolic blood pressure of
140 mmHg or more and/or diastolic blood pressure of 90 mmHg or
more was classified as hypertension. Those who had blood pressure
between 140/90 mmHg and 159/99 mmHg were classified as having
stage I hypertension and those with a blood pressure of 160/100 mmHg
or more were classified as stage II hypertension.
All subjects were asked to collect a midstream sample of urine
between 10.00 and 13.00 hours on the day of the survey. Urinalysis was
performed using Combi 10R dipstick test for proteinuria, haematuria,
glycosuria, nitrites and leucocyturia. Dipstick tests were analyzed in the
field by trained laboratory personnel. If the first dipstick test was nega-
tive for protein, it was recorded as NEGATIVE. If the dipstick test
showed ++ or greater it was recorded as POSITIVE. If the test showed
trace or +, second and third tests were performed to demonstrate the
persistence or otherwise of the proteinuria. This was defined as persis-
tent if two of three urine dipstick tests performed within an interval of
2 weeks were positive for protein of at least 1+ or greater. Random
blood glucose and serum creatinine (SCr) were only measured in sub-
jects with hypertension, proteinuria, glycosuria or a history of diabetes.
Estimated glomerular filtration rate (eGFR) was calculated according
to Cockcroft–Gault (CG) adjusted by body surface area (BSA),
Modification of Diet in Renal Disease (MDRD) and Chinese MDRD
equations.4–7 Subjects whose blood sugar level exceeded 200 mg/dL
(11.1 mmol/L) were recorded as having diabetes mellitus.
Data analysis
Data are presented as mean and standard deviation. The prevalence of
proteinuria, hypertension and obesity among subjects in the survey was
determined. Multivariate analysis and logistic regression were used to
© 2009 The Authors
Journal compilation © 2009 Asian Pacific Society of Nephrology
Chronic kidney disease in Indonesia 671

determine independent predictive factors for impaired eGFR. The non-
parametric Spearman test was used to compare abdominal circumfer-
ence and BMI. Data analysis was also performed in male and female
groups separately and based on each area of the survey.
RESULTS
The survey included 9412 or 78% of the 12 000 subjects
expected from the four survey areas. The survey areas of
Surabaya had to be moved twice to a new area because of a
natural disaster (mud-slide), and so data collection was
incomplete. Similarly, the Yogyakarta area provided less
than 50% of the expected subjects because the survey was
interrupted by an earthquake.
Demographic data from the areas of the study are shown
in Table 1. Nearly 64.1% of subjects in the survey were
female and the mean age was 43.3 1 12.9 years. The propor-
tion of female subjects in all four areas was more than 60%
because the men were frequently absent, working elsewhere
during the time of screening. Subject habits such as
smoking, coffee consumption and alcohol consumption
were also recorded in this survey. Current smoking was
found in 1948 (19.8%) and past smoking in 322 (3.3%)
subjects. Coffee consumption was identified in 5236
(53.1%) subjects and most of the subjects (94.3%) had not
consumed alcohol. Only 0.5% reported alcohol consump-
tion once a day, 0.9% once a week and 2.3% once a month.
Less than one quarter of the subjects was past or current
smokers, and few drank alcohol. Details of a previous history
of hypertension, diabetes mellitus, kidney disease, and
cardio- and cerebrovascular diseases among respondents
and their families are shown in Table 2. Whereas 15% of
subjects or their families gave a history of hypertension,
few reported a history of the other diseases. A history of
hypertension predicted recorded hypertension with a false-
positive rate of 0.43 (606/1409) and a false negative rate of
0.13 (1021/7994).
The prevalence of persistent proteinuria in this survey
was 2.8%. The prevalence of leucocyturia and erythrocy-
turia as recognized by 1+ or more on the dipstick test was
29.4% and 23.6%, respectively. Most subjects with erythro-
cyturia were female (76.4%) and 41.3% were women of
reproductive age (<40 years). Hypertension was detected in
1826 out of 9412 subjects (19.4%); 10% were classified as
having systolic and diastolic hypertension, 4.8% isolated
systolic hypertension and 4.6% isolated diastolic hyperten-
sion. Among those with systolic and diastolic hypertension,
65.4% were aged less than 60 years, whereas of those
with either systolic hypertension or diastolic hypertension
(50.8% and 84.8%, respectively) were aged less than
60 years. Among those with systolic and diastolic hyperten-
sion, 73.1% were classified as having stage I hypertension
and 26.9% stage II hypertension.
Of the subjects in this survey, 38.6% were classified as
having normal BMI (18.5–22.9) and 11.3% were under-
weight (BMI, <18.5), 17.1% overweight (BMI, 23–24.9),
25.2% obese I (BMI, 25–29.9) and 7.3% classified as
obese II (BMI, 330). There was a positive correlation
between abdominal circumference and BMI (r = 0.804,

Table 1 Demographic data based on survey area

Survey area
Summary results Jakarta (%) Bali (%) Surabaya (%) Yogyakarta (%) Total (%)
Sex
Male 819 (29.5%) 1436 (47.3%) 711 (28.3%) 413 (38.1%) 3379 (35.9%)
Female 1959 (70.5%) 1601 (52.7%) 1801 (71.7%) 672 (61.9%) 6033 (64.1%)
Age
18–39 years 1465 (52.7%) 1239 (40.8%) 708 (28.2%) 311 (28.7%) 3723 (39.5%)
40–59 years 943 (33.9%) 1574 (51.8%) 1352 (53.8%) 514 (47.4%) 4383 (46.6%)
60–70 years 370 (13.3%) 224 (7.4%) 452 (18%) 260 (24%) 1306 (13.9%)
Marital status
Married 2357 (84.8%) 2726 (89.8%) 2151 (85.6%) 883 (81.4%) 8117 (86.2%)
Single 155 (5.6%) 299 (9.8%) 64 (2.5%) 73 (6.7%) 591 (6.3%)
Widow/widower 266 (9.6%) 12 (0.4%) 290 (11.5%) 118 (10.9%) 686 (7.3%)
Educational level
University/academy 18 (0.6%) 174 (5.7%) 278 (11.1%) 81 (7.5%) 551 (5.9%)
High school 333 (12%) 1161 (38.2%) 966 (38.5%) 473 (43.6%) 2933 (31.2%)
Elementary 993 (35.7%) 1095 (36.1%) 1062 (42.3%) 315 (29%) 3465 (36.8%)
None 1434 (51.6%) 606 (20%) 195 (7.8%) 195 (9.7%) 2430 (25.8%)
Occupation
Retired 9 (0.3%) 23 (0.8%) 75 (3%) 21 (1.9%) 128 (1.4%)
Employee (other) 73 (2.6%) 354 (11.7%) 618 (24.6%) 214 (19.7%) 1259 (13.4%)
Fisherman/farmer 805 (29%) 684 (22.5%) 527 (21%) 240 (22.1%) 2256 (24%)
Labourer 79 (2.8%) 1354 (44.6%) 73 (2.9%) 352 (32.4%) 1858 (19.7%)
Unemployed 629 (22.6%) 313 (10.3%) 1138 (45.3%) 76 (7%) 2156 (22.9%)
Other 1183 (42.6%) 309 (10.2%) 80 (3.2%) 169 (15.6%) 1741 (18.5%)

© 2009 The Authors

Journal compilation © 2009 Asian Pacific Society of Nephrology
672 W Prodjosudjadi et al.

Table 2 Subject and family medical history

Subject Family
History of diseases Total Percentage Total Percentage
Hypertension
Yes 1411 15% 1335 14.2%
Diabetes mellitus
Yes 329 3.5% 459 4.9%
Kidney disease
Yes 184 2% 124 1.3%
Cerebrovascular disease
Yes 72 0.8% 235 2.5%
Cardiovascular disease
Yes 96 1% 126 1.3%

Table 3 eGFR analyses by Cockcroft–Gault, MDRD and Chinese MDRD formulae

eGFR eGFR analyses
(mL/min per
1.73 m2) Cockcroft–Gault SCr (ℜ 1 SD) MDRD SCr (ℜ 1 SD) Chinese MDRD SCr (ℜ 1 SD)
360 1310 (87.5%) 0.8 1 0.2 1370 (91.4%) 0.8 1 0.2 1386 (92.5%) 0.8 1 0.2
390 644 (49.2%) 0.7 1 0.1 725 (52.9%) 0.7 1 0.1 885 (63.9%) 0.7 1 0.1
60–89 666 (50.8%) 0.9 1 0.2 645 (47.1%) 0.9 1 0.2 501 (36.1%) 1.0 1 0.1
<60 187 (12.5%) 1.7 1 1.7 129 (8.6%) 2.0 1 1.9 113 (7.5%) 2.1 1 2.0
30–59 164 (87.7%) 1.3 1 0.3 107 (82.9%) 1.4 1 0.3 90 (79.6%) 1.4 1 0.2
15–29 12 (6.4%) 2.7 1 1.0 10 (7.8%) 2.7 1 0.8 10 (8.8%) 2.5 1 0.5
<15 11 (5.9%) 7.4 1 2.8 12 (9.3%) 7.2 1 2.8 13 (11.5%) 7.0 1 2.8

eGFR, estimated glomerular filtration rate; MDRD, Modification of Diet in Renal Disease; SCr, serum creatinine; SD, standard deviation; ℜ, means.

P = 0.000); neither independently predicted eGFR. Bivari- Table 4 Predictive factors of impaired eGFR among studied
ate analysis showed that abdominal circumference corre- subjects
lated significantly with eGFR using CG (P = 0.000). Blood OR
glucose was assessed in 1120 out of 9412 subjects in
Cockcroft– Chinese
this survey; of these, 203 (18.1%) were defined as being
Predictor Gault MDRD MDRD
diabetic.
Estimated GFR was calculated according to CG and two Proteinuria† 3.799 5.907 6.210
MDRD formulae. Table 3 shows the classification of CKD Systolic blood pressure‡ 2.068 1.685 1.570
stage based on eGFR and SCr levels. An eGFR of less than History of diabetes 1.851 1.884 2.065
60 mL/min per 1.73 m2 by CG was found in 12.5%, of those mellitus†
whose serum creatinine was measured, when calculated by History of hypertension† NS 1.653 1.746
the MDRD formula in 8.6% and by the Chinese MDRD
formula in 7.5%. Amongst those with an eGFR of less than †Yes vs no. ‡3140 vs <140. eGFR, estimated glomerular filtration
rate; OR, odds ratio; MDRD, Modification of Diet in Renal Disease;
60 mL/min per 1.73 m2, serum creatinine was comparable NS, not significant.
between CG and the other two formulae. Multivariate
analysis showed that proteinuria, systolic blood pressure and Data analysis was reported separately for the different
a history of diabetes mellitus were independent predictors survey areas, and for both sexes. The prevalence of pro-
of an impaired eGFR as calculated by CG, MDRD and teinuria in men was 2.3% for Jakarta, 3.6% for Bali, 1.7% for
Chinese MDRD, as shown in Table 4. A history of hyper- Surabaya and 2.7% for Yogyakarta, while in women it was
tension was also predictive of impaired eGFR calculated by 2.9%, 3.7%, 2.3% and 2.4%, respectively. Estimated GFR
MDRD and Chinese MDRD. calculated by CG, MDRD and Chinese MDRD in men and
Estimated GFR was analyzed based on the presence of women are shown in Table 5.
persistent proteinuria and hypertension. Amongst subjects
with persistent proteinuria and hypertension, the percent- DISCUSSION
age of those with eGFR of less than 60 mL/min per 1.73 m2
calculated by CG and the two MDRD formulae was com- In the present study, almost 3% of subjects had persistent
parable (34–37%). proteinuria. There is evidence that proteinuria is both a

© 2009 The Authors

Journal compilation © 2009 Asian Pacific Society of Nephrology
Chronic kidney disease in Indonesia
Table 5 eGFR analyses by Cockcroft–Gault, MDRD and Chinese MDRD formulae, according to survey area and sex
Cockcroft–Gault
Survey area <60 360
Jakarta
Male 22 (2.7%) 103 (12.6%)
Female 29 (1.5%) 308 (15.7%)
Bali
Male 47 (3.3%) 211 (14.7%)
Female 28 (1.7%) 253 (15.8%)
Surabaya
Male 27 (3.8%) 137 (19.3%)
Female 33 (1.8%) 298 (16.5%)
eGFR, estimated glomerular filtration rate; MDRD, Modification of Diet in Renal Disease.
predictor and perhaps a pathogenic factor in progressive
renal disease.8 For example, in a general population survey
of more than 100 000 subjects who were followed for
16 years, the incidence of ESKD was greater in subjects with
positive urinary protein by dipstick test.9 The National
Kidney Foundation of Singapore evaluated 450 000 subjects
and reported a high prevalence of proteinuria of 5.8% and
8.1%, respectively, in high-risk individuals such as taxi
drivers and subjects with a family history of ESKD.10 Other
data have shown that proteinuria is a risk factor for cardio-
vascular and renal disease in the general population.11
Iseki et al. showed that significant predictors of ESKD
were proteinuria, haematuria and hypertension, especially
diastolic, whereas age, obesity and hypercholesterolaemia
were not predictive.8 In our survey, proteinuria, systolic
blood pressure and a history of diabetes mellitus were inde-
pendent predictors of impaired eGFR. A history of hyper-
tension was also a significant predictor of impaired eGFR as
calculated by the MDRD equations. Although history of
hypertension was predictive of impaired eGFR on bivariate
analysis by CG, after adjustment for other variables, it was
not a predictor of impaired eGFR by multivariate analysis.
Systolic and diastolic hypertension was found in 10%
and nearly one-third of these subjects were classified as
having stage II hypertension. Hypertension is an important
feature of CKD and together with proteinuria is a major
contributing factor leading to its progression. In India, the
Chennai Community Screening Program which screened
25 000 subjects reported that the prevalence of hyperten-
sion was 6% and of diabetes mellitus 4%.12 In our survey,
the prevalence of diabetes mellitus could not be analyzed,
because blood glucose was only measured in selected
patients with proteinuria, hypertension, glycosuria or a
history of diabetes.
Estimated GFR of less than 60 mL/min per 1.73 m2, as
calculated by the CG formula, was found in 12.5% from a
total of 1497 subjects in this survey. This percentage was
substantially higher than when eGFR was calculated by
MDRD and Chinese MDRD. To date there is no agreement
about which standardized eGFR measurement should be
applied in determining the stage of CKD, including in Indo-
© 2009 The Authors
Journal compilation © 2009 Asian Pacific Society of Nephrology
673
eGFR (mL/min per 1.73 m2)
MDRD Chinese MDRD
<60 360 <60 360
5 (0.6%) 120 (14.7%) 5 (0.6%) 120 (14.7%)
18 (0.9%) 319 (16.3%) 15 (0.8%) 322 (16.4%)
34 (2.4%) 225 (15.7%) 29 (2%) 230 (16%)
26 (1.6%) 255 (15.9%) 23 (1.4%) 258 (16.1%)
17 (2.4%) 146 (20.5%) 15 (2.1%) 148 (20.8%)
29 (1.6%) 302 (16.8%) 26 (1.4%) 305 (16.9%)
nesia. This discrepancy in the current study emphasizes the
critical importance of the method of GFR estimation in
determining the stage of CKD. In the AusDiab study, the
prevalence of CKD (eGFR, <60 mL/min per 1.73 m2) was
11.2% when GFR was estimated by CG.13 The prevalence of
CKD in our study is lower than that reported in Thailand
(where the prevalence of CKD stage III was ~20% using the
CG formula and 13% using the MDRD formula).14 A recent
study from Japan estimated the prevalence of CKD (eGFR,
<60 mL/min per 1.73 m2 by modified MDRD formula) to be
20% in the adult population.15
A small scale epidemiological study of 300 subjects con-
ducted recently in the sub-district of Ubud, on the island of
Bali, found a prevalence of CKD (CG, <60 mL/min per
1.73 m2) of 17%, that of proteinuria (++ or more on single
occasion) 3%, hypertension 16.7% and diabetes mellitus
4.3%. Hypertension was an independent risk factor for
CKD (OR = 2.5) (unpubl. data, 2007, I Gede Raka Widiana
and Ketut Suwitra).
This study showed that proteinuria, systolic blood pres-
sure and a history of diabetes mellitus were independently
predictive of the risk of an impaired eGFR. GFR was mea-
sured only in those with hypertension, proteinuria, glyco-
suria or a history of diabetes mellitus. Amongst those with
persistent proteinuria and hypertension, 33 out of 92 sub-
jects (35.9%), had an eGFR of less than 60 mL/min per
1.73 m2 by CG. Moreover, subjects with hypertension but
not proteinuria, 110 out of 1041 (10.6%), had an eGFR of
less than 60 mL/min per 1.73 m2 by CG. Thus, not surpris-
ingly, the combination of hypertension and persistent
proteinuria predicts more CKD (eGFR, <60 mL/min per
1.73 m2) than does persistent proteinuria or hypertension
alone. In this survey, the number subjects with both persis-
tent proteinuria and hypertension was relatively small,
making interpretation problematic.
Obesity was found in 32.5%, with obesity I in 25.2% and
obesity II in 7.3% of subjects in the survey. Most of the obese
subjects were women (71.6%) and more than half over
40 years of age. Another interesting finding in this survey is
the fact that current smoking was only found in approxi-
mately 20%, whereas previous studies showed prevalence of
674
smoking in Indonesia of more than 30%.16 In that survey,
63.2% of subjects who smoked were male, compared to
94.1% in our survey. Whereas obesity and smoking have
previously been linked to risk and progression of CKD, in
this study neither predicted impaired eGFR as calculated by
CG or MDRD formulae.
The prevalence of haematuria as assessed by dipstick test
in our survey was 23.3%, four times higher than reported in
the AusDiab study, a randomized sample of the Australian
population involving 11 247 subjects. In AusDiab, haema-
turia which was initially detected by dipstick was confirmed
by urine microscopy.13,17 The presence of erythrocyturia
in this survey was found mostly in women, in particular
actively reproductive women, and so this might represent
menstrual contamination. As erythrocyturia was not
analyzed further in this survey, these data are difficult to
interpret.
Because two-thirds of the subjects in our survey were
female, we performed data analysis by sex and also by
survey area. The prevalence of persistent proteinuria in Bali
was 3.7% and the apparently higher prevalence amongst
women, was not statistically significant. CKD as defined by
GFR estimation using CG, MDRD and Chinese MDRD
based on survey area in both men and women is depicted in
Table 5. There were no differences amongst survey areas and
between sexes in the presence of eGFR less than 60 mL/min
per 1.73 m2 calculated by CG. However, Jakarta showed a
lower percentage of subjects with eGFR of less than 60 mL/
min per 1.73 m2 calculated by MDRD and Chinese MDRD
than did the other subject areas.
In conclusion, this survey provides preliminary insights
into the prevalence of risk factors for CKD in Indonesia and
the basis for designing a national screening program of CKD
risk factors. Proteinuria, systolic blood pressure and a history
of diabetes mellitus were independent predictors of impaired
eGFR. Hypertension and proteinuria are modifiable factors
that influence the progression of CKD. Therefore, this
survey argues for an intervention program focusing on blood
pressure control using antihypertensive agents which also
lower urinary protein.
There are some weaknesses in this population survey,
including the unexpected sex imbalance in subject numbers,
the natural disasters (earthquake and mud-slide) which
made the survey difficult to conduct in two areas, the finan-
cial constraints which permitted measurement of serum
creatinine and blood glucose in only a subset of high-risk
subjects and the reliance on dipstick but not microscopy or
urine culture to assess haematuria. These deficiencies need
to be remembered when interpreting the data and planning
future surveys.
ACKNOWLEDGEMENTS
This survey was funded by the Indonesian Society of
Nephrology (InaSN). Support from the CREED Program
W Prodjosudjadi et al.
is gratefully acknowledged. The support of local government
personnel and all participants in this survey is highly appre-
ciated. The authors acknowledge the assistance of InaSN
secretaries Ms Tety for survey facility arrangement, and Ms
Linda and Ms Fresty for help with the manuscript.
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© 2009 The Authors
Journal compilation © 2009 Asian Pacific Society of Nephrology