The epidemiology of chronic kidney disease and the association with non-communicable and communicable disorders in a population of sub-Saharan Africa

Abstract

In sub-Saharan Africa (SSA), epidemiological data for chronic kidney disease (CKD) are scarce. We conducted a prospective cross-sectional study including 952 patients in an outpatient clinic in Tanzania to explore CKD prevalence estimates and the association with cardiovascular and infectious disorders. According to KDIGO, we measured albumin-to-creatinine ratio and calculated eGFR using CKD-EPI formula. Factors associated with CKD were calculated by logistic regression. Venn diagrams were modelled to visualize interaction between associated factors and CKD. Overall, the estimated CKD prevalence was 13.6% (95% CI 11–16%). Ninety-eight patients (11.2%) (95% CI 9–14%) were categorized as moderate, 12 (1.4%) (95% CI 0–4%) as high, and 9 (1%) (95% CI 0–3%) as very high risk according to KDIGO. History of tuberculosis (OR 3.75, 95% CI 1.66–8.18; p = 0.001) and schistosomiasis (OR 2.49, 95% CI 1.13–5.18; p = 0.02) were associated with CKD. A trend was seen for increasing systolic blood pressure (OR 1.02 per 1 mmHg, 95% CI 1.00–1.03; p = 0.01). Increasing BMI (OR 0.92 per 1kg/m2, 95% CI 0.88–0.96; p = <0.001) and haemoglobin (OR 0.82 per 1g/dL, 95% CI 0.72–0.94; p = 0.004) were associated with risk reduction. Diabetes was associated with albuminuria (OR 2.81, 95% CI 1.26–6.00; p = 0.009). In 85% of all CKD cases at least one of the four most common factors (hypertension, diabetes, anaemia, and history of tuberculosis or schistosomiasis) was associated with CKD. A singular associated factor was found in 61%, two in 14%, and ≥3 in 10% of all CKD cases. We observed a high prevalence estimate for CKD and found that both classical cardiovascular and neglected infectious diseases might be associated with CKD in a semi-rural population of SSA. Our finding provides further evidence for the hypothesis that the “double burden” of non-communicable and endemic infectious diseases might affect kidney health in SSA.

Factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis in national referral hospitals in Kenya: a mixed-methods survey

“…This represents 11 to 13% of the total global population [2][3][4]. In Sub--Saharan Africa, currently, about 16% of the population is affected [5], a rise from 14% reported in 2014 [6]. The prevalence of CKD in Eastern Africa is also high, currently reported at 14% [7].…”

Potential drug-drug interactions among patients with chronic kidney disease admitted at National Hospital: a retrospective study in Tanzania

“…The global prevalence of CKD ranges between 11% and 13% while the prevalence of CKD in Tanzania was 13.6% (3,4). The mortality attributed to CKD has been increasing from time to time, for example, there was an increase of 32% of mortality in ten years from 2005 to 2015 (5).…”

“…The CKD is accompanied with other diseases such as cardiovascular (hypertension, heart failure and stroke) and diabetes mellitus (1, 3,4,6). Therefore, prescriptions with more than one medicine for treatment of these patients is a common practice.…”

“…Despite the inevitable polypharmacy practice among CKD patients there is still a critical need to minimize the number of prescribed medicines for these patients in order to reduce risk of associated outcomes (10). As there is an increasing prevalence of kidney diseases in developing countries (1,4) and the ongoing improvement of nephrology services in Tanzania, the need of studies on the pattern and potential of DDIs is important in order to closely monitor the prescribed medicines among CKD patients. However, to our understanding there are no sufficient published evidence on the pattern and pDDIs among CKD patients admitted at MNH.…”

Chronic kidney disease in low-middle income populations: a call to action for screening and prevention

“…The influence of specific risks for acute and chronic kidney disease may occur across the socio-economic spectrum, with a considerable overlap of non-communicable conditions and infectious diseases [13,14]. Infectious diseases such as tuberculosis or schisostomiasis are frequently neglected, and treatment for acquired immunodeficiency implies the development of risk factors (hypertension, diabetes, metabolic syndrome) favoring cardiovascular events.…”