Clinical Nephrology – Epidemiology – Clinical Trials
Kidney International (2003) 64, 1437–1444; doi:10.1046/j.1523-1755.2003.00212.x
Ethnic differences and determinants of proteinuria among South Asian subgroups in Pakistan
Tazeen H Jafar, Nish Chaturvedi, Asma Gul, Abdul Q Khan, Christopher H Schmid and Andrew S Levey
Section of Nephrology, Department of Medicine, Aga Khan University, Karachi, Pakistan; Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan; Division of Nephrology, Department of Medicine, Tufts-New England Medical Center, Tufts University Medical School, Boston, Massachusetts; Department of Epidemiology and Public Health, Imperial College of Medicine at St. Mary's, London, United Kingdom; Pakistan Medical Research Council, Islamabad, Pakistan; and Division of Clinical Care Research, Department of Medicine, Tufts-New England Medical Center, Tufts University Medical School, Boston, Massachusetts
Correspondence: Tazeen H. Jafar, M.D., Head, Section of Nephrology, Medicine and Director, Clinical Epidemiology Unit, Community Health Sciences, Aga Khan University, PO Box 3500, Stadium Road, Karachi, Pakistan. E-mail: tazeen.jafar@aku.edu
Received 25 April 2003; Revised 15 May 2003; Accepted 23 May 2003.
Abstract
Ethnic differences and determinants of proteinuria among South Asian subgroups in Pakistan.
Background
Hypertension, diabetes, increasing age, and smoking are known risk factors for proteinuria. Prevalence of proteinuria is high in South Asians. However, ethnic subgroup differences and determinants of proteinuria within the South Asian population have not been explored.
Methods
The National Health Survey of Pakistan conducted between 1990 and 1994 was used to explore ethnic subgroup variation in proteinuria. Distinct ethnic subgroups, the Muhajir, the Punjabi, the Sindhi, the Pashtun, and the Baluchi, were defined by mother tongue. We report results in individuals aged 
15 years (N = 9442). Proteinuria was defined as dipstick positive for protein on random urine sample.
Results
Increasing age, high consumption of meat, and presence of hypertension and diabetes were each independently associated with proteinuria. The age-standardized prevalence of proteinuria was 4.6% (4.2% to 5.1%) and varied among ethnic subgroups (P < 0.001). The highest was among the Sindhi (men 9.5%, women 10.3%), then the Muhajir (men 8.2%, women 4.7%), the Punjabi (men 3.2% women 3.5%), and lowest among the Baluchi (men 2.4%, women 4.2%) and the Pashtun (men 2.7%, women 1.2%). The ethnic differences persisted after adjusting for the above-mentioned sociodemographic, dietary, and clinical risk factors [adjusted odds ratio (OR) (95% CI)] were 6.42 (3.97 to 10.38) for the Sindhis, 3.58 (2.22 to 5.79) for the Muhajirs, 2.03 (1.25 to 3.29) for the Punjabis, and 1.75 (0.79 to 3.88) for the Baluchis compared to the Pashtuns).
Conclusion
We conclude that unmeasured environmental or genetic factors account for ethnic variations in proteinuria, and deserve further study.
Keywords:
proteinuria, renal disease, epidemiology, South Asians, ethnicity
