CKD and Pregnancy Outcomes in Africa: A Narrative Review

Abstract

Chronic kidney disease (CKD) is associated with adverse maternal and fetal outcomes and is reported to affect up to 3% of women of reproductive age in high-income countries, but estimated prevalence may be as much as 50% higher in low and middle-income countries (LMICs). All pregnancy complications occur much more frequently in women in LMICs compared with those in high-income countries. Given the anticipated high prevalence of CKD in women of reproductive age and high rates of maternal and fetal adverse events in Africa, we sought to explore the association between CKD and pregnancy outcomes in this setting through a narrative review of the literature. This review demonstrates the paucity of data in this area and highlights the systemic barriers that exist in many African countries that prevent robust management of noncommunicable diseases such as CKD during a woman's reproductive life. This evidence gap highlights the need for further research, starting by sampling normal ranges of serum creatinine concentrations in pregnant and nonpregnant women of reproductive age in the diverse populations of Africa, estimating prevalence of CKD, and understanding associated pregnancy outcomes. Research should then focus on pragmatic interventions that may improve outcomes for women and their infants.

Sex and gender differences in chronic kidney disease and access to care around the globe

“…Overall, it is women's lives that tend to be more impacted by the many social and structural factors illustrated in Table 1, with each factor impacting her own health as a child, as a mother, her safety, her ability to care for her family, and her ability to seek and access health care when needed. 87 All of these factors impact the health of a woman's kidneys and those of her children throughout their lives, and mandate urgent calls for improvement in gender equity across all 17 Sustainable Development Goals. The more rapid progression of kidney disease in men, observed almost globally, likely has a more biologic basis, which must not be overlooked, and the intersections with occupational, structural, and climate risk factors must be understood and addressed.…”

Drivers and Barriers to the Adoption of Telemedicine among Persons with Chronic Health Conditions in Ghana

“…It is empirical that telemedicine holds the key to eliminating many barriers to access to health delivery in Africa. However, without reducing these barriers, it will be difficult for African countries to achieve the needed benefits of telemedicine (Maule et al, 2020).…”

Social, political and legal determinants of kidney health: Perspectives from lower- and middle-income countries with a focus on India

“…The gender-specific disparities are partly explained by the fact that women are less frequently employed, have other social responsibilities and often give low priority to their health ( 42 ). Population studies had shown that a substantial proportion (up to 27%) of women of reproductive age especially from areas like Africa may have the presence of pre-existing risk factors for renal disease such as hypertension that may be revealed during the physiological stress period of pregnancy ( 43 , 44 ).…”