Clustering of chronic kidney disease and cardiovascular risk factors in South-West Nigeria

Abstract

Background: There exists a synergy between chronic kidney disease (CKD) and cardiovascular risk factors (CVRFs) with increased morbidity and poor outcomes. Objectives: Data relating to this clustering in black homogenous populations is scanty. We aim to investigate this relationship in Nigerian communities. Patients and Methods: It was a cross-sectional observation study from semi-urban communities in South-West Nigeria. We used modified World Health Organization (WHO) questionnaire on chronic diseases (WHO STEPS) to gather information on socio-demographic data, biophysical and clinical characteristics. Biochemical analysis of plasma samples was done. Results: We analyzed data of 1084 with mean age of 56.3 ± 19.9 years (33.4% female). Prevalence of stage 3 CKD was 14.2% (3a and 3b were 10.3% and 3% respectively). Prevalence of hypertension (systolic and diastolic blood pressure) and low high-density lipoprotein cholesterol (HDL-C) increased as clustering of cardiovascular (CV) risk factors (CVFRs) increased both in CKD and proteinuria (P < 0.05). CKD prevalence increases with number of risk factors. There was an inverse relationship between increasing risk factors and mean estimated glomerular filtration rate (eGFR) (P < 0.05). Clustering at least 2 CVRFs in the population with CKD compared to those without CKD was significantly higher (76.6% vs. 65.1%, OR: 1.8, 95% CI: 1.2-2.6, P = 0.005). Similarly, in a univariate analysis, albuminuria had an increased odds of clustering (69.7% vs. 59.6%, OR: 1.9, 95% CI 0.6-6.2, P = 0.409). Using multivariate logistic analysis, there is significantly increased odds of clustering when eGFR is <45 mL/min/1.73 m2 (OR: 2.66, 95% CI: 1.12-6.32) and microalbuminuria 1.74 (95% CI: 1.10-2.75). Conclusions: Reduced kidney function and proteinuria significantly clustered with CVRFs. This data suggests that individuals with CV clusters should be screened for CKD or vice versa and they should be considered for prompt management of their CVRFs.

Prevalence of chronic kidney disease in Nigeria: systematic review of population-based studies

“…18 The prevalence of CKD from two of the studies that used the CG formula was very high when compared to those obtained with the MDRD and the CKD-EPI creatinine equations. Three of the studies that used the MDRD equation 17,20,22 and the only study that used the CKD-EPI creatinine equation 18 had similar results. However, one of the studies that used the MDRD 21 has a very low prevalence of CKD when compared to the other three results.…”

“…Seven of the population-based studies met the inclusion criteria. [16][17][18][19][20][21][22] Each of the seven articles was closely scrutinized by at least two authors. Any controversy surrounding any particular article was discussed by all the authors, and a collective decision taken on the article (Figure 1).…”

“…Any controversy surrounding any particular article was discussed by all the authors, and a collective decision taken on the article (Figure 1). One of the seven articles was from South-south zone, 16 two from South-west, 17,20 two South-east, 18,22 one from Northwest, 19 one from the North-central, 21 and none was from the North-east geopolitical zone of Nigeria ( Figure 2). The subjects who took part in the studies were males and females of age ≥18 years.…”

“…All the seven relevant studies were cross-sectional. One of the studies used cluster sampling method, 16 three studies used multistage sampling technique, 17,19,22 two other studies used convenience sampling technique, 18,21 and one of the studies 20 did not state what sampling method was used.…”

“…Two of the studies used the CG formula in estimating GFR, 16,19 four studies used the MDRD, 17,[20][21][22] whereas one of the studies used the CKD-EPI creatinine equation. 18 The prevalence of CKD from two of the studies that used the CG formula was very high when compared to those obtained with the MDRD and the CKD-EPI creatinine equations.…”