Markers and risk factors for chronic kidney disease in sub-Saharan Africans: baseline levels and 12-month trajectories in newly referred patients in Cameroon

Abstract

Background: Little is known about the changes in disease makers and risk factors in patients with chronic kidney disease (CKD) under nephrological care in Africa. This study aimed to evaluate the baseline level of markers of CKD and their 12-month time-trend in newly referred patients in a tertiary hospital in Cameroon. Methods: This was a retrospective cohort study including 420 patients referred for CKD between 2006 and 2012 to the nephrology unit of the Douala General Hospital in the littoral region of Cameroon. Their disease and risk profile was assessed at baseline and every 3 months for 1 year. Estimated glomerular filtration rate (eGFR) was based on MDRD and Schwartz equations. CKD was diagnosed in the presence of eGFR< 60 ml/min/1.73 m 2 and/or proteinuria> 1+ and/or abnormal renal ultrasound persisting for ≥3 months. Data analysis used mixed linear regressions. Results: Of the 420 patients included, 66.9% were men and mean age was 53.8 (15.1) years. At referral, 37.5% of the participants were at CKD Stage 3, 30.8% at stage 4 and 26.8% at stage 5. There was 168 (40%) diabetic and 319 (75.9%) hypertensive patients. After some improvement during the first 3 months, eGFR steadily decreased during the first year of follow-up, and this pattern was robust to adjustment for many confounders. Systolic and diastolic blood pressure levels significantly fluctuated during the first twelve months of follow-up. Changes in the levels of other risk factors and markers of disease severity over time were either borderline or non-significant. Conclusion: Patients with CKD in African settings are referred to the nephrologist at advanced stages. This likely translates into a less beneficial effects of specialised care on the course of the disease.

High prevalence of uncontrolled hypertension among patients with early chronic kidney disease attending tertiary hospitals in Dodoma, Tanzania

“…The median age of participants with uncontrolled hypertension was 55 (50-60) years which is signi cantly higher than 48 (45-56) years for those with controlled hypertension. These nding has been observed in previous studies in LMICs whereby despite the fact that the age of onset of CKD in SSA is signi cantly higher in younger people compared to developed countries where CKD is the disease of old age (23,41). Age ≥ 50 years had 5 times increased risk for uncontrolled hypertension among patients with early-stage CKD; previous studies have reported that uncontrolled hypertension is associated with increasing age in CKD (8,16).…”

Supplementing Yogurt with Probiotic Bifidobacteria to Counter Chronic Kidney Disease

“…Fiti ® and Yoba-for-life yogurts are currently accessible to over >260,000 people in sub-Saharan Africa on a weekly basis. Since these populations face the greatest risk for CKD development [8][9][10][11], the addition of p-cresol-clearing strains to Fiti ® could have a dramatically positive impact on CKD incidence and severity in these regions at low cost and without needing to significantly modify the current production protocol. It would simply require one of the bifidobacteria tested here to be dried and made available in sachets to be added to the current strains.…”

“…In African populations, the disease incidence is higher due to an increased prevalence of risk factors, including hypertension, genetic polymorphisms, and the sickle cell trait [2][3][4][5][6][7]. Due to these risk factors, the likelihood of developing CKD is almost doubled in sub-Saharan Africa, where upwards of 20% of the population is burdened by the condition [8][9][10][11].…”

“…In 2002, local women in Tanzania were taught to produce probiotic yogurt (Fiti ® ) supplemented with Lacticaseibacillus rhamnosus GR-1 [46][47][48][49][50][51][52]; this social enterprise has resulted in over 260,000 consumers having weekly access to Fiti ® and Yoba-for-life, which utilizes a generic strain of L. rhamnosus GG. Considering ~20% of people in sub-Saharan Africa will develop CKD and probiotic yogurt has shown clinical efficacy against the disease [8][9][10][11]40], there is a unique opportunity to modify a fermented food for additional health benefits. Fiti ® was chosen as the product of choice because of its availability to populations in sub-Saharan Africa, where it has been clinically proven to have probiotic properties.…”

Prevalence, correlates and in-hospital outcomes of kidney dysfunction in hospitalized patients with heart failure in Buea-Cameroon

“…Heart failure and chronic kidney diseases (CKDs) are common conditions in sub-Saharan Africa (SSA), where they account for about 35% of all deaths [ 1 – 3 ]. Heart failure and CKD share common risk factors such as hypertension, obesity, and diabetes that have high prevalence rates in the region [ 1 , 4 – 7 ]. In Cameroon, about one in three adults is hypertensive [ 8 , 9 ] and one in nine has diabetes [ 10 ].…”