Background Despite estimated glomerular filtration rate (eGFR) being the best marker for kidney function, there are no studies in sub-Saharan Africa comparing the performance of various equations used to determine eGFR. We compared prevalence of kidney disease determined by proteinuria of ≥ + 1 and or kidney disease improving global outcomes (KDIGO) eGFR criteria of < 60 ml/minute/1.73m2 determined using three creatinine-based equations among patients admitted on medical ward of Masaka Regional Referral Hospital. Methods This was a prospective study conducted among adult patients admitted on medical wards between September 2020 to March 2021. Spot urine samples were collected to assess for proteinuria and blood samples were collected to assess serum creatinine levels. Kidney disease was defined as proteinuria of ≥ 1 + on spot urine dipstick and or KDIGO eGFR criteria of < 60 ml/minute/1.73m2. Estimated glomerular filtration rate was calculated using three creatinine-based equations: a) Full Age Spectrum equation (FAS), b) chronic kidney disease-Epidemiology collaboration (CKD-EPI) 2021 equation, c) CKD EPI 2009 (without and with race factor) equation. CKD was determined after followed up at 90 days post enrollment to determine the chronicity of proteinuria of ≥ + 1 and or KDIGO eGFR criteria of < 60mls /minute/1.73m2. We also compared prevalence of CKD determined by KDIGO eGFR criteria of < 60mls /minute/1.73m2 vs age adapted eGFR threshold criteria for defining CKD. Results Among the 357 patients enrolled in the study, KDIGO eGFR criteria of < 60mls / minute determined using FAS and CKD-EPI 2009 without race factor equations and or proteinuria of ≥ + 1 showed the highest overall prevalence of kidney disease at 27.2%. Prevalence of confirmed CKD at 90 days was highest with proteinuria ≥ + 1 and or KDIGO eGFR criteria of < 60mls/min determined using CKD EPI 2009 without race factor Equation (15.1%). Conclusions Use of KDIGO eGFR criteria of < 60mls / minute /1.73m2 using FAS and CKD-EPI 2009 without race equations identifies the largest number of patients with CKD. Health care systems in sub-Saharan Africa should calculate eGFR using FAS equations or CKD-EPI 2009 without race equations during basic screening and management protocols.
Background: Kidney disease burden is raising worldwide, raising a need to closely monitor high risk populations for swift response. However, there is limited data on the prevalence of abnormal kidney function and outcomes among patients admitted at regional referral health facilities in Uganda which are the first points of care for most patients in the country. We determined the prevalence of abnormal kidney function and 90-days outcomes among patients admitted on medical ward of Masaka Regional Referral Hospital. Methods: This was a prospective study conducted among adult patients admitted on medical wards between September 2020 to March 2021. Patients were enrolled if they met the following inclusion criteria: a) ≥18 years of age, 2) provided written informed consent, 3) had phone contacts to help with patient follow up. Spot urine sample was collected to assess for proteinuria and a blood sample was collected to assess serum creatinine levels. Abnormal kidney function was defined as decreased estimated glomerular filtration rate < 90 ml/minute /1.73m² or proteinuria of ≥1+ on spot urine dipstick. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epi formula. Patients with abnormal kidney function were followed up at 90 days post enrollment to determine their outcomes.Results: Were enrolled 357 patients. The overall prevalence of abnormal kidney function was 32.8% (117/357), 08 (2.2%) patients having proteinuria alone, 68 (19.1%) having decreased eGFR alone, and 41 (11.5%) having both proteinuria and decreased eGFR. The median age of 117 patients with abnormal kidney function was 52 (IQR 39-70) years and majority were males (54.7%). Of the 117 patients with abnormal kidney function, 108 were followed up to 90-days. The 90 days mortality was 69.4% (75/108), and 13.0% (14/108) had progressed to chronic kidney disease. Conclusions: The prevalence of abnormal kidney function was high and the many had adverse outcomes including death and progression to chronic kidney disease. To reduce on these adverse outcomes, patients at risk or with abnormal kidney function may benefit from basic screening and use of management protocols for kidney disease.
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