Comparison of the prevalence of kidney disease by proteinuria and decreased estimated glomerular filtration rate determined using three creatinine-based equations among patients admitted on medical wards of Masaka Regional Referral Hospital in Uganda: a prospective study

Abstract

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.

Un miembro del personal de la Building Foundation for Development ayuda a preparar suministros para su entrega a instalaciones sanitarias y campos de desplazados en Al Jazirah (Sudán), que actualmente acoge a desplazados internos que huyen del conflicto en Jartum (Sudán).

“…The pooled prevalence of diabetes in medical settings was 11.9% (95% CI: 9.9–14.3; 15 studies; Table 2 ). 39 , 49 , 50 , 52 , 53 , 62 , 64 , 66 , 69 – 71 , 79 , 84 , 85 , 92 In emergency departments, we found an overlapping prevalence estimate of 9.3% (95% CI: 5.1–16.2; three studies). 58 , 75 , 80 A high degree of heterogeneity of estimates in both settings is noted (medical wards 95% PI: 5.4–24.3; I 2 : 97.6% and emergency departments I 2 : 98.5%; < 5 studies).…”

“…HIV prevalence was reported in 32 studies ( Table 2 ). The pooled prevalence of HIV in medical wards was 36.4% (95% CI: 31.3–41.8; 25 studies) 39 , 40 , 43 , 45 , 47 – 49 , 51 , 52 , 55 , 56 , 60 , 61 , 64 , 69 – 71 , 79 , 81 , 84 – 87 , 89 higher than the prevalence in emergency departments (21.9%; 95% CI: 14.5–31.7; seven studies). 37 , 44 , 65 , 72 , 80 , 82 , 96 HIV infection was reported using laboratory or point-of-care diagnostics in 18 studies, 37 , 40 , 43 – 45 , 47 – 51 , 56 , 65 , 68 , 72 , 82 , 84 , 89 , 96 and by medical records or clinical history in the remaining studies ( Table 1 ).…”

“…We estimated the prevalence of hypertension from 16 studies. Pooled prevalence was 24.4% (95% CI: 16.7–34.2; 14 studies) 39 , 49 , 50 , 52 , 55 , 64 , 66 , 67 , 69 – 71 , 79 , 84 , 85 in medical wards, and 31.5% (95% CI: 26.4–37.1; two studies) 58 , 80 in emergency departments. A high degree of heterogeneity in prevalence estimates was observed in the medical setting (95% PI: 4.1–71.1; I 2 : 99.7%).…”