First-ever standardized CKDnT prevalence study receives U.K. Medical Research Council Foundation Award; study protocol accepted for publication

Press Contact: Jason Glaser
President and CEO, La Isla Network



The United Kingdom Medical Research Council (MRC) awarded researchers led by Neil Pearce of the London School of Hygiene and Tropical Medicine a Foundation Award[1] this week to support the first-ever standardized global prevalence study of Chronic Kidney Disease of undetermined causes (CKDnT).

The award will fund the launch of the Disadvantaged Populations eGFR Epidemiology Study (DEGREE), a protocol developed by researchers in partnership with La Isla Network (LIN) with the aim of establishing a common procedure for gathering and comparing information about CKDnT internationally. LIN will help identify future collaborating centers and manage communications, including a web-based platform to facilitate dissemination of findings from DEGREE studies.

This week’s announcement of the MRC Foundation Award coincides with the acceptance for publication of the DEGREE study protocol in open source medical journal BMC Nephrology.[2] LIN will publicize the link to the protocol as soon as it is published.

“DEGREE provides a simple set of tools that we hope researchers anywhere can use to measure the numbers of people with reduced kidney function in the population by testing asymptomatic individuals,” said Ben Caplin, a researcher and nephrologist at University College London and author of the protocol.

The DEGREE study’s goals are to better inform local communities, healthcare systems and governments of the size of the CKDnT issue, understand if there are factors in common between different areas affected, and accurately measure whether the problem is worsening or improving over time, according to Caplin.

Pearce, a professor of epidemiology and biostatistics, led the team of researchers that designed the DEGREE study. “We are delighted to be collaborating on this work with colleagues from India, Malawi, Peru and Mexico, and we are also delighted with the support for the project from the MRC,” he said.

Pearce and the broader global team of nephrologists, epidemiologists, and occupational and environmental health experts were inspired by similar methods used previously to study other diseases. “We see this study as the first step in a major international collaboration to find out how severe and widespread the problem of CKDnT is, what the causes are, and how it can be prevented,” Pearce said. “This approach has been used for other chronic diseases in the past, such as heart disease, cancer and asthma, where many of the well-known causes were first discovered by making international comparisons and assembling a ‘global map.’”

In order to build such a map for CKDnT, researchers cannot use more conventional methods to quantify the numbers of people affected. “Using routinely collected information such as death certificates or hospital records doesn’t really work for CKDnT,” Caplin said. “This is because many of those affected have limited access to healthcare, the disease does not have clear symptoms, and medical practitioners may have varying awareness of the condition.”

To date, CKDnT has been most studied in Central America, so generating data from other regions impacted by the disease is a priority for researchers internationally. “We know that this is a serious public health problem globally, but we don’t know how serious since we only have good data from a few parts of the world,” Pearce said.

While CKDnT in Central America and Sri Lanka has made headlines for years, the apparently related epidemics in other parts of the world have gone less reported. Researchers hope the DEGREE study will change that.

“This project would help clear the air of uncertainty about the existence and scope of the problem of kidney disease in South Asia using a standardized methodology – identify any pockets where there is high prevalence so that research could be directed to identifying the causes,” said Vivek Jha, professor of nephrology at the University of Oxford and co-investigator on the MRC Foundation Award.

DEGREE executive committee member Ajay Singh of Harvard Medical School believes the standardized studies could point to local solutions to local epidemics. “Kidney disease is a devastating problem in South Asia,” Singh said. “If environmental factors are the cause as many of us suspect, then preventive strategies like access to clean water and uncontaminated food could prevent CKDnT and therefore save many lives.”

The Foundation Awards are the MRC’s first phase of research funding anticipated from the £1.5bn Global Challenges Research Fund (GCRF). Out of over 1,000 applicants 41 Foundation Awards were given by the MRC, and supported by the Arts and Humanities Research Council (AHRC), Biotechnology and Biological Sciences Research Council (BBSRC), Economic and Social Research Council (ESRC) and Natural Environment Research Council (NERC). These awards have been allocated to support ambitious, novel and distinctive research in non-communicable diseases and infections, with the aim of improving the health and prosperity of low and middle-income countries through harnessing the UK’s research expertise.


1 Pearce N, Caplin B, Nyirenda M, Jha V, Nitsch D, Smeeth L, Bernabe-Ortiz A, Glaser J, O’Callaghan-Gordo C, Madero Rovalo M, Tomlinson L, Perel P, Singh A, Jakobssen K, Miranda J, Nair D. Chronic Kidney Disease of unknown cause (CKDnT) in disadvantaged communities in low-and-middle income countries (LMICs). Medical Research Council.


2 Caplin B, Jakobsson K, Glaser J, Nitsch D, Jha V, Singh A, Correa-Rotter R, Pearce N. International collaboration for the epidemiology of eGFR in low and middle income populations: Rationale and core protocol for the Disadvantaged populations eGFR epidemiology study (DEGREE). BMC Nephrology, in press.

DEGREE Protocol >>