Global Dialysis Perspective: Uganda

Kalyesubula, Robert; Brewster, Ursula C.; Kansiime, Grace

doi:10.34067/kid.0007002021

Cited by 7 publications

(4 citation statements)

References 13 publications

(19 reference statements)

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“…Proteinuria is a biomarker for kidney injury [28]; thus further research into context-speci c risk factors for kidney disease is needed to understand the cause of kidney injury in older PLWH. Kidney disease is progressive; thus these ndings of the excess prevalence of kidney function impairment and proteinuria may have implications for the health and survival of old PLWH in a country where there is limited access to life-saving therapies such as dialysis and renal transplants for kidney failure [15,16].…”

Section: Discussionmentioning

confidence: 99%

“…Kidney failure is associated with increased morbidity, poor quality of life, and increased risk of death among PLWH [11][12][13][14]. In low-income countries (LICs) such as Uganda, there is limited access to life-saving dialysis and kidney transplants to manage end-stage kidney disease(ESKD)/kidney failure and even when available, the costs exceed the average income for most patients [15,16]. Studies in the general population have documented the association of HIV with kidney disease in both low-and high-resource settings [17][18][19][20], but there is a paucity of data documenting the excess prevalence of kidney function impairment in older PLWH in Uganda and sub-Saharan Africa.…”

Section: Introductionmentioning

confidence: 99%

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Higher prevalence of kidney function impairment among older people living with HIV in Uganda

Ssemasaazi,

Kalyesubula,

Manabe

et al. 2024

Preprint

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Background People living with HIV (PLWH) are at risk of kidney function impairment due to HIV-related inflammation, antiretroviral therapy (ART), diabetes mellitus, and hypertension. Older persons may experience a higher burden of chronic kidney disease (CKD) as kidney function declines with increasing age. There is a paucity of data comparing the prevalence of kidney function impairment in older PLWH to that in HIV-uninfected people in sub-Saharan Africa. Methods We conducted a cross-sectional study among people aged ≥ 60 years living with and without HIV in Kampala, Uganda who were matched 1:1 by community location. We collected data on sociodemographics, comorbidities, and HIV-related clinical characteristics. We defined kidney function impairment as an estimated glomerular filtration rate(eGFR) < 60mls/min/1.73m2 with or without proteinuria. We constructed multivariable logistic regression models to study associations between participant characteristics and kidney function impairment. Results We enrolled 278 people (median age 66 years); 50% were PLWH, and 51.8% were female. Overall, the prevalence of kidney function impairment was 23.0% (95% CI:18.4%-28.4%); 33.1% (95% CI: 25.7%-41.4%) versus 12.9% (95% CI: 8.3%-19.7%) among people living with and without HIV (p-value < 0.01). The prevalence of proteinuria among PLWH versus people without HIV was 43.9% (95% CI:35.8%-52.3%) versus 19.4% (95% CI:13.6%-26.9%) p-value < 0.01. Living with HIV (OR = 3.89(95% CI: 2.04–7.41), p-value < 0.01), older age (OR = 1.13, (95% CI:1.07–1.20), p-value < 0.01), female sex (OR = 1.95, (95% CI:1.06–3.62), p-value = 0.03) and a prior diagnosis of hypertension (OR = 2.19(95% CI:1.02–4.67), p-value = 0.04) were significantly associated with kidney function impairment. Conclusions HIV infection is strongly associated with kidney function impairment among older PLWH. Prioritizing routine measurements of kidney function and proteinuria in older PLWH will enable early detection and institution of measures to reduce the progression of kidney disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Higher prevalence of kidney function impairment among older people living with HIV in Uganda

Ssemasaazi,

Kalyesubula,

Manabe

et al. 2024

Preprint

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“…In East Africa, most of the cases of hyperkalaemia are reported to be caused by: Acute kidney injury (AKI), Chronic kidney disease, Serum electrolytes and risk factors in Diabetic patients, Drug-drug interactions, Renal failure, Drug therapy problems, Tumour lysis syndrome and Post-Cardiac Arrest as shown in the table of results. In Uganda, majority of chronic kidney diseases are presented at late stages when they have already developed advanced complications like electrolyte imbalances such as hyperkalaemia [20] and it has been reported that people with normally functioning kidneys have equal chances of developing hyperkalaemia [21].…”

Section: Discussionmentioning

confidence: 99%

Occurrence and contributing factors associated with hyperkalaemia in East Africa: a systematic review

A.M,

I.V,

Odongo

et al. 2023

KJHS

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Hyperkalaemia is potentially a life-threatening medical condition characterized by higher-than-normal potassium in the blood. It can result in cardiac arrhythmias which is a serious heart problem and subsequently can lead to a sudden death. Impaired kidney function, such as chronic kidney disease or acute kidney injury, can hinder the proper excretion of potassium, leading to its accumulation in the blood. The prevalence of hyperkalemia in the United States is reported to be 1.55% for the normal population and 6.35% for kidney disease patients. Hyperkalaemia can be too problematic for people with kidney diseases. The prevalence of chronic kidney disease ranges between 2% and 7% in Uganda. The majority of the CKD patients in Uganda are presented late with advanced symptoms such as hyperkalemia. However, a study done by Dorsthorst has found out that it’s not only renal-impaired patients who are at the risk of becoming hyperkalemic after deviant consumption of potassium-rich foods, but the healthy humans with normally functioning kidneys are as well at risk. The study also alludes that the severity of hyperkalemia in patients with kidney disease or with normal kidney functionality does not differ. This review work was aimed at finding out the different reported cases of hyperkalemia in the Eastern region of Africa as well as their contributing factors. Articles used in this review were obtained from the internet using two search engines: Scopus and PubMed. Articles written in languages other than English and those which were review papers were excluded. The articles were screened and data were extracted. The results showed that hyperkalemia is caused by factors such as an overdose of potassium pills, chronic kidney disease, drug-to-drug interactions, and renal failure among other factors. Cases of hyperkalemia were reported in Uganda, Ethiopia, Tanzania, and Rwanda. Hyperkalaemia can be managed by responding to its specific cause. The overall prevalence of hyperkalemia has been reported to be approximately 1.1% in the general population (people with normal kidney function). From this review, it can be concluded that hyperkalemia occurs at high rates in people suffering from kidney disease. However, drug-drug interactions, increased intake of potassium, and tumor lysis are other causes.

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“…Sustainability is not a priority for patients when most cannot afford medications, transplantation, or dialysis, such as in Uganda, where 90% of patients in need of kidney replacement therapy cannot afford it. 26 In addition, access to care is inequitable as most dialysis and transplant programs are located in urban centers, 14 , 20 and many patients incur substantial out-of-pocket expenses ( Table 1 ).…”

Section: Barriers To Implementing Environmentally Sustainable Kidney ...mentioning

confidence: 99%

Challenges to Implementing Environmentally Sustainable Kidney Care in LMICs: An Opinion Piece

Bajpai,

Hailu,

Bagasha

et al. 2024

Can J Kidney Health Dis

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Global Dialysis Perspective: Uganda

Abstract: This is an Early Access article. Please select the PDF button, above, to view it.

Cited by 7 publications

References 13 publications

Higher prevalence of kidney function impairment among older people living with HIV in Uganda

Higher prevalence of kidney function impairment among older people living with HIV in Uganda

Occurrence and contributing factors associated with hyperkalaemia in East Africa: a systematic review

Challenges to Implementing Environmentally Sustainable Kidney Care in LMICs: An Opinion Piece

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