Chronic kidney disease (CKD) and associated risk in rural South Africa: a population-based cohort study

Fabian, June; Gondwe, Mwawi; Mayindi, Nokthula; Chipungu, Shingirai; Khoza, Bongekile; Gaylard, P; Wade, Alisha N.; Gómez‐Olivé, Francesc Xavier; Tomlinson, Laurie; Ramsay, Michèle; Tollman, Stephen; Winkler, Cheryl A.; George, Jaya; Naicker, Saraladevi

doi:10.12688/wellcomeopenres.18016.2

Cited by 9 publications

(15 citation statements)

References 30 publications

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“…[52][53][54] In a South African study, where CKDu made up 32% of the CKD burden, the APOL1 gene risk variants were associated with a 2-fold risk of CKD. 43 In this setting, lack of association of APOL1 risk variants with hypertension attributed CKD was also reported. 55 In a population-based study in Nigeria, the APOL1 risk variants were associated with an almost 5-fold risk of CKD of nondiabetic aetiology after adjustment for gender, age, body mass index and HIV, a proxy for CKDu.…”

Section: Ckd and Genetic Factorsmentioning

confidence: 90%

“…Due to the lack of attention and poor focus on the condition, many studies just reported CKD with no diabetes, hypertension or HIV. [42][43][44][45][46][47][48] Though the use of different criteria (Table 1) is a limitation on comparison of these findings and may lead to inadequate capture of CKDu cases, they are still informative about the burden of CKDu in African countries.…”

Section: Discussionmentioning

confidence: 99%

“…42 A population-based survey involving 2021 adults in rural South Africa reported that 32% of the CKD burden was attributed to CKDu. 43 A cross-sectional study of 5264 urban and rural populations in Malawi revealed 19.4% of the CKD burden attributable to CKDu. 44 In a large multisite survey involving 8110 rural and urban communities in four Southern, Western and Eastern African countries, CKDu accounted for 36.5% of the CKD burden.…”

Section: Epidemiology Of Ckdumentioning

confidence: 99%

“…50 It is also estimated that, in rural Africa, CKDu might account for a larger proportion of the total CKD burden. 28,40,[42][43][44] In rural East Africa, for example, CKDu comprise 66% of the total CKD burden. 42 Additional studies from a rural environment in Nigeria and Tanzania have reported a higher CKD prevalence of 12.4%-27.6% not associated with diabetes, hypertension, obesity or HIV, a proxy for CKDu.…”

Section: Ckd and Environmental Stressorsmentioning

confidence: 99%

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Chronic kidney disease of unknown aetiology in Africa: A review of the literature

Fiseha,

Ekong,

Osborne

2023

Nephrology

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During the last two decades, an epidemic of a severe form of chronic kidney disease (CKD) unrelated to traditional risk factors (diabetes and hypertension) has been recognized in low‐ to middle‐income countries. CKD of unknown aetiology (CKDu) mainly affects young working‐age adults, and has become as an important and devastating public health issue. CKDu is a multifactorial disease with associated genetic and environmental risk factors. This review summarizes the current epidemiological evidence on the burden of CKDu and its probable environmental risk factors contributing to CKD in Africa. PubMed/Medline and the African Journals Online databases were searched to identify relevant population‐based studies published in the last two decades. In the general population, the burden of CKD attributable to CKDu varied from 19.4% to 79%. Epidemiologic studies have established that environmental factors, including genetics, infectious agents, rural residence, low socioeconomic status, malnutrition, agricultural practise and exposure to agrochemicals, heavy metals, use of traditional herbs, and contaminated water sources or food contribute to the burden of CKD in the region. There is a great need for epidemiological studies exploring the true burden of CKDu and unique geographical distribution, and the role of environmental factors in the development of CKD/CKDu.image

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Section: Ckd and Genetic Factorsmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Epidemiology Of Ckdumentioning

confidence: 99%

Section: Ckd and Environmental Stressorsmentioning

confidence: 99%

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Chronic kidney disease of unknown aetiology in Africa: A review of the literature

Fiseha,

Ekong,

Osborne

2023

Nephrology

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“…

The burden of end-stage kidney disease (ESKD) continues to increase worldwide. The prevalence of chronic kidney disease (CKD) in South Africa (SA) is estimated to range from 6% to 17% [1][2][3] and is predicted to worsen in the future, for several reasons. [4][5][6][7] Despite being considered an upper middle-income country, [8] SA is ranked as the most unequal country in the world, with a Gini index of 63.

…”

mentioning

confidence: 99%

The state of kidney replacement therapy in Eastern Cape Province, South Africa: A call to action

Mtingi-Nkonzombi

Manning²,

Toit³

et al. 2023

S Afr Med J

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Background. South Africa (SA) is one of the most financially unequal countries in the world. This situation is highlighted by disparateaccess to healthcare, particularly provision of kidney replacement therapy (KRT). Unlike the private sector, public sector access to KRT is highly rationed, and patient selection is based on suitability for transplantation and capacity.Objectives. To investigate the state of the KRT service in Eastern Cape Province, SA, by analysing access to and provision of KRT in theprovince for individuals with end-stage kidney disease, as well as disparities between the private and public healthcare systems.Methods. This was a retrospective descriptive study to examine KRT provision and temporal trends in the Eastern Cape. Data were obtained from the South African Renal Registry and the National Transplant Waiting List. KRT provision was compared between the three main referral centres, in Gqeberha (formerly Port Elizabeth), East London and Mthatha, and between the private and public healthcare systems.Results. There were 978 patients receiving KRT in the Eastern Cape, with an overall treatment rate of 146 per million population (pmp).The treatment rate for the private sector was 1 435 pmp, compared with 49 pmp in the public sector. Patients treated in the private sector were older at initiation of KRT (52 v. 34 years), and more likely to be male, to be HIV positive, and to receive haemodialysis as their KRT modality. Peritoneal dialysis was more commonly used in Gqeberha and East London as the first and subsequent KRT modality, compared with Mthatha. There were no patients from Mthatha on the transplant waiting list. There were no waitlisted HIV-positive patients in the public sector in East London, compared with 16% of the public sector patients in Gqeberha. The kidney transplant prevalence rate was 58 pmp in the private sector and 19 pmp in the public sector, with a combined prevalence of 22 pmp, constituting 14.9% of all patients on KRT. We estimated the shortfall of KRT provision in the public sector to be ~8 606 patients.Conclusion. Patients in the private sector were 29 times more likely to access KRT than their public sector counterparts, who were onaverage 18 years younger at initiation of KRT, probably reflecting selection bias in an overburdened public health system. Transplantation rates were low in both sectors, and lowest in Mthatha. A large public sector KRT provision gap exists in the Eastern Cape and needs to be addressed urgently.

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Prevalence and Reclassification of Genetic Variants in South African Populations with Breast Cancer

Osler,

Brandenburg,

Schoeman

et al. 2024

Genes Chromosomes & Cancer

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Concurrent testing of numerous genes for hereditary breast cancer (BC) is available but can result in management difficulties. We evaluated use of an expanded BC gene panel in women of diverse South African ancestries and assessed use of African genomic data to reclassify variants of uncertain significance (VUS). A total of 331 women of White, Black African, or Mixed Ancestry with BC had a 9‐gene panel test, with an additional 75 genes tested in those without a pathogenic/likely pathogenic (P/LP) variant. The proportion of VUS reclassified using ClinGen gene‐specific allele frequency (AF) thresholds or an AF > 0.001 in nonguidelines genes in African genomic data was determined. The 9‐gene panel identified 58 P/LP variants, but only two of the P/LP variants detected using the 75‐gene panel were in confirmed BC genes, resulting in a total of 60 (18.1%) in all participants. P/LP variant prevalence was similar across ancestry groups, but VUS prevalence was higher in Black African and Mixed Ancestry than in White participants. In total, 611 VUS were detected, representing 324 distinct variants. 10.8% (9/83) of VUS met ClinGen AF thresholds in genomic data while 10.8% (26/240) in nonguideline genes had an AF > 0.001. Overall, 27.0% of VUS occurrences could potentially be reclassified using African genomic data. Thus, expanding the gene panel yielded few clinically actionable variants but many VUS, particularly in participants of Black African and Mixed Ancestry. However, use of African genomic data has the potential to reclassify a significant proportion of VUS.

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Chronic kidney disease (CKD) and associated risk in rural South Africa: a population-based cohort study

Cited by 9 publications

References 30 publications

Chronic kidney disease of unknown aetiology in Africa: A review of the literature

Chronic kidney disease of unknown aetiology in Africa: A review of the literature

The state of kidney replacement therapy in Eastern Cape Province, South Africa: A call to action

Prevalence and Reclassification of Genetic Variants in South African Populations with Breast Cancer

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