The Epidemiology of Chronic Kidney Disease in Northern Tanzania: A Population-Based Survey

Abstract

BackgroundIn sub-Saharan Africa, kidney failure has a high morbidity and mortality. Despite this, population-based estimates of prevalence, potential etiologies, and awareness are not available.MethodsBetween January and June 2014, we conducted a household survey of randomly-selected adults in Northern Tanzania. To estimate prevalence we screened for CKD, which was defined as an estimated glomerular filtration rate ≤ 60 ml/min/1.73m2 and/or persistent albuminuria. We also screened for human immunodeficiency virus (HIV), diabetes, hypertension, obesity, and lifestyle practices including alcohol, tobacco, and traditional medicine use. Awareness was defined as a self-reported disease history and subsequently testing positive. We used population-based age- and gender-weights in estimating prevalence, and we used generalized linear models to explore potential risk factors associated with CKD, including living in an urban environment.ResultsWe enrolled 481 adults from 346 households with a median age of 45 years. The community-based prevalence of CKD was 7.0% (95% CI 3.8-12.3), and awareness was low at 10.5% (4.7-22.0). The urban prevalence of CKD was 15.2% (9.6-23.3) while the rural prevalence was 2.0% (0.5-6.9). Half of the cases of CKD (49.1%) were not associated with any of the measured risk factors of hypertension, diabetes, or HIV. Living in an urban environment had the strongest crude (5.40; 95% CI 2.05-14.2) and adjusted prevalence risk ratio (4.80; 1.70-13.6) for CKD, and the majority (79%) of this increased risk was not explained by demographics, traditional medicine use, socioeconomic status, or co-morbid non-communicable diseases (NCDs).ConclusionsWe observed a high burden of CKD in Northern Tanzania that was associated with low awareness. Although demographic, lifestyle practices including traditional medicine use, socioeconomic factors, and NCDs accounted for some of the excess CKD risk observed with urban residence, much of the increased urban prevalence remained unexplained and will further study as demographic shifts reshape sub-Saharan Africa.

Kidney disease in Uganda: a community based study

“…This has been found by other studies from Africa [2, 27]. In contrast, low socioeconomic status has been associated with both development and progression of CKD in Europe and United States of America [25, 32].…”

“…The high prevalence of kidney disease in rural and peri-urban areas highlights the current burden of NCDs. High prevalence of kidney disease has been identified in other areas of SSA; in Tanzania the prevalence of CKD was found to be 7.0% overall with 15.2% in the urban population while a systematic review estimates an overall prevalence of CKD in SSA at 13.9% [2, 10]. These findings have far reaching consequences to a developing country of 34.9 million people [20] with few trained specialist and few dialysis centres to support the increased burden of kidney disease [21].…”

“…Chronic kidney disease (CKD) plays a major role as a cause and a consequence of other NCDs. A recent systematic review estimates the current prevalence of CKD in sub-Saharan Africa (SSA) at 13.9% (95% Confidence Interval [CI] 12.2–15.7) [2]. It is also estimated that by 2030, 70% of worldwide end-stage renal disease (ESRD) will be in low income countries like those in SSA [3].…”

CKD of Uncertain Etiology

“…In low-income countries, for example, rapid urbanization has led to poor sanitation, unplanned infrastructure, overcrowding, and environmental pollution (35,36). For CKD, these exposures may interact with other urban risk factors, such as high rates of noncommunicable and communicable diseases, to increase CKD prevalence (37).…”

Epidemiology of Impaired Renal Function in the Bamenda Health District, North West Region of Cameroon

“…Even though statistics for most of the developing countries are unknown [4], following a research on CKD in Senegal, Tanzania and Congo [5], results indicated that the prevalence of CKD in these countries were respectively 6.1%, 7.0% and 13.2% [6,7] which is still very high considering the GDP of these countries. The situation in Sub-Saharan Africa (SSA) is even more dismal and worsened by the almost complete lack of data making it difficult for policy makers to see the gravity of the disease [3].…”