High prevalence of undiagnosed chronic kidney disease among at-risk population in Kinshasa, the Democratic Republic of Congo

Capacity for the management of kidney failure in the International Society of Nephrology Africa region: report from the 2023 ISN Global Kidney Atlas (ISN-GKHA)

The burden of chronic kidney disease and associated risk of kidney failure are increasing in Africa. The management of people with chronic kidney disease is fraught with numerous challenges because of limitations in health systems and infrastructures for care delivery. From the third iteration of the International Society of Nephrology Global Kidney Health Atlas, we describe the status of kidney care in the ISN Africa region using the World Health Organization building blocks for health systems. We identified limited government health spending, which in turn led to increased out-of-pocket costs for people with kidney disease at the point of service delivery. The health care workforce across Africa was suboptimal and further challenged by the exodus of trained health care workers out of the continent. Medical products, technologies, and services for the management of people with nondialysis chronic kidney disease and for kidney replacement therapy were scarce due to limitations in health infrastructure, which was inequitably distributed. There were few kidney registries and advocacy groups championing kidney disease management in Africa compared with the rest of the world. Strategies for ensuring improved kidney care in Africa include focusing on chronic kidney disease prevention and early detection, improving the effectiveness of the available health care workforce (e.g., multidisciplinary teams, task substitution, and telemedicine), augmenting kidney care financing, providing quality, up-to-date health information data, and improving the accessibility, affordability, and delivery of quality treatment (kidney replacement therapy or conservative kidney management) for all people living with kidney failure.

Inequities in kidney health and kidney care

Health inequity refers to the existence of unnecessary and unfair differences in the ability of an individual or community to achieve optimal health and access appropriate care. Kidney diseases, including acute kidney injury and chronic kidney disease, are the epitome of health inequity. Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of disease. Insufficient investment across the spectrum of kidney health and kidney care is a fundamental source of inequity. In addition, social and structural inequities, including inequities in access to primary health care, education and preventative strategies, are major risk factors for, and contribute to, poorer outcomes for individuals living with kidney diseases. Access to affordable kidney care is also highly inequitable, resulting in financial hardship and catastrophic health expenditure for the most vulnerable. Solutions to these injustices require leadership and political will. The nephrology community has an important role in advocacy and in identifying and implementing solutions to dismantle inequities that affect kidney health.

Prevalence and risk factors associated with chronic kidney disease in Moroccan rural communes: Fez-Meknes region

BACKGROUND AND AIMS

Chronic kidney disease is a worldwide public health issue. It can be a serious problem, especially in developing countries including Morocco. However, few studies have explored the factors influencing chronic kidney disease in this country. Hence, using the definitions proposed by Kidney Disease Improving Global Outcomes in 2012, we have conducted this study to establish the prevalence and risk factors of chronic kidney disease particularly in rural communities in the Fez-Meknes region.

METHODS

Weight, height, blood pressure, proteinuria, hematuria, plasma creatinine, estimated glomerular filtration rate (using the Modification of Diet in Renal Disease formula), and fasting glycemia were measured. Abnormal results were controlled within two weeks; estimated Glomerular filtration rate was retested at 3 months. Furthermore, to determine the factors associated with chronic kidney disease, multivariate logistic regression was used.

RESULTS

A total of 431 patients participated in the study; the prevalence of confirmed proteinuria, hematuria, and reduced estimated Glomerular filtration rate was 5.3%, 1.8%, and 3%, respectively. Overall, chronic kidney disease was found to be present in 6.5% of the population. Chronic kidney disease 1 and 2 accounted for 32.1% and 21.4% of the overall chronic kidney disease population, respectively, while chronic kidney disease 3 accounted for 46.4% (3A: 38.2%; 3B: 7.14%). Chronic kidney disease 4 and 5 were not present in the total chronic kidney disease population. Chronic kidney disease was strongly linked with advanced age (OR 2.65; 95%CI: 1.05-6.65), hypertension (OR 2.41; 95%CI: 1.03-5.63), agricultural occupation (OR 1.02; 95%CI: 1.00-1.04) and contact with Agrochemicals (OR 1.40; 95%CI: 0.81-2.71).

CONCLUSIONS

It is important to note that screening for kidney damage and being aware of the risks linked to it, is key for the early detection and management of chronic kidney disease; they are also crucial to provide in a database for the development of a national prevention policy.

High Prevalence of Chronic Kidney Disease Among People Living with Hypertension in Rural Sierra Leone: A Cross-Sectional Study

INTRODUCTION

Currently, there are no data on prevalence and associated risk factors of chronic kidney disease (CKD) among patients with hypertension in rural Sierra Leone.

PURPOSE

To estimate the prevalence and associated risk factors of CKD in rural Sierra Leone.

PATIENTS AND METHODS

A cross-sectional study of hypertension patients aged between 18 and 75 years attending a non-communicable disease clinic at Koidu Government Hospital, Kono District, Sierra Leone was conducted between February and December 2020. Using systematic random sampling, a structured questionnaire, which comprised of questions on social demographic characteristics and past and current clinical history, was administered followed by measurement of creatinine and urinary protein and glucose. Estimated glomerular filtration rate (eGFR) was estimated using CKD-epidemiology formula without race as a factor. Baseline eGFR between 60-89 min/mL/1.73m2 and <60 min/mL/1.73m2 defined reduced eGFR and renal impairment, respectively. Estimated GFR less than 60 min/mL/1.73m2 measured two times at least 3 months apart was used to define CKD.

RESULTS

Ninety-six percent (n = 304) patients out of 317 patients were included in the study. Among all included patients, only 3.9% (n = 12) had eGFR of 90 min/mL/1.73m2 and above. The prevalence of renal impairment and CKD was 52% (158/304, CI 46.2-57.7) and 29.9% (91/304, CI 24.8-34.5), respectively. In adjusted logistic regression analysis, currently taking herbal medications as treatment of hypertension (OR 4.11 (CI 1.14-14.80), p = 0.03) and being overweight and/or obese (OR 2.16 (CI 1.24-3.78), p < 0.001) was associated with CKD. Additionally, receiving some education was associated with a 48% (OR 0.52 (CI 0.29-0.91), p = 0.02) reduced likelihood of CKD.

CONCLUSION

The prevalence of renal impairment and CKD is high among hypertensive patients in rural Sierra Leone. CKD was associated with current history of taking herbal medications and being overweight and/or obese. Additionally, CKD was associated with reduced likelihood in patients who received some education.

Obesity and CKD in Sub-Saharan Africa: A Narrative Review

Obesity is a major public health problem in the developed world, where it has reached an epidemic status over the last few decades. In parallel with this, the prevalence of chronic kidney disease (CKD) has increased. Although obesity is a risk factor for hypertension and diabetes, it is also independently associated with the development and progression of CKD. Two-third of patients with CKD worldwide will be residents of developing countries by the year 2030. Risk factors for CKD are prevalent in the sub-Saharan Africa region; this review discusses the available data regarding the relationship between obesity and CKD. The prevalence of CKD appears to correlate with increasing adiposity in sub-Saharan Africa; however, limited data are currently available, and the analysis of this association is further complicated by a variety of parameters used to define obesity. (eg, body mass index vs waist circumference). Longer, large-scale studies are needed to inform the prevalence and kidney implications of obesity in sub-Saharan Africa.

Prevalence and determinants of chronic kidney disease in urban adults' populations of northern Cameroon

BACKGROUND

Chronic kidney disease (CKD) is a major health problem with growing prevalence in sub-Saharan Africa.

AIM

Assess the prevalence and determinants of CKD in Garoua and Figuil cities of the North region of Cameroon.

METHODS

A cross-sectional survey was conducted from January to June 2018 in the two cities, using a multi-level cluster sampling. All adults with low estimated glomerular filtration rate (eGFR) (< 60 ml/min/1.73 m²) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and/or albuminuria (≥ 30 mg/g) were reviewed three months later. Logistic regression models (accounting for the sampling strategy) were used to investigate the predictors of the outcomes.

RESULTS

A total of 433 participants were included, with a mean age (95%CI) of 45.0 (43.4-46.6) years, 212 (48.7%) men, 294 (67.9%) from Garoua and 218 (45.6%) with no formal education. Risk factors for chronic nephropathy were highly prevalent including longstanding use of street medications (52.8%), herbal medicines (50.2%) and non-steroidal anti-inflammatory drugs (50%), alcohol consumption (34.4%), hypertension (33.9%), overweight/obesity (33.6%), hyperuricemia (16.8%), smoking (11.3%) and hyperglycemia (6.5%). The prevalence of CKD was 11.7% overall, 10.7% in Garoua and 13% in Figuil participants. Equivalents figures for CKD G3-5 and albuminuria were 2.8%, 2.0% and 4.5%; and 9.1%, 9.3% and 8.5%, respectively. History of diabetes, increase systolic blood pressure, hyperglycemia and hyperuricemia were predictors of CKD.

CONCLUSION

The prevalence of CKD is as high in these northern cities as previously reported in southern cities of Cameroon, driven mostly by known modifiable risk factors of chronic nephropathy.

Assessment of serum electrolytes and kidney function test for screening of chronic kidney disease among Ethiopian Public Health Institute staff members, Addis Ababa, Ethiopia

BACKGROUND

Chronic kidney disease (CKD), which is characterized by its asymptomatic nature until an end stage, is one of the most common public health problems in the world. Thus, a regular checkup, especially for those individuals with high risk groups is inevitably important, and the screening has been done with laboratory findings. However, in developing countries, including Ethiopia screening for CKD are rarely done, and it is becoming common to hear sudden death from the kidney failure. Therefore, we aimed to screen serum electrolyte levels and estimated glomerular filtration rate (eGFR) among Ethiopian Public Health Institute (EPHI) staff members for an early detection of CKD and to identify the factors associated with it.

METHODS

A cross-sectional study was conducted from July 1 to October 28, 2018 among EPHI staff members. The level of serum creatinine and electrolytes were measured using COBAS 6000 analyzer. Then, eGFR was calculated using MDRD and CKD-EPI equations. Data analysis were done using SPSS version 20, and the factors associated with the outcome variable were assessed using logistic regression. P values < 0.05 were considered as statistically significant.

RESULTS

This study found that 3.6 and 1.9% of the study participants were at CKD stage II by MDRD and CKD-EPI equations, respectively. Out of the total study participants, 9.5% had hyperkalemia (serum potassium level > 5.0 mmol/L) and 8.5% had hypocalcemia (serum calcium level < 2.15 mmol/L). An older age (P = 0.006), high BMI (P = 0.045) and previous history of CVDs (P = 0.033) were found to be significantly associated factors with reduced glomerular filtration rate. Nine percent of the study participants were obese, 6.1% had family history of kidney failure, 18% self-reported history of hypertension, 3.4% diabetic and 5.3% had CVDs. About 51.2% of the study participants were males, and the majorities, (66%) of the study participants were found to be alcohol consumers.

CONCLUSIONS

The prevalence of a stage II kidney disease was relatively low and none of the participants was under serious kidney disease (GFR < 60 mmol/min/1.73m2). An older age, high BMI and previous history of CVDs were significantly associated with reduced GFR. Hyperkalemia and hypokalemia were the major electrolyte disorders in the study participants.

Dietary Habit and Other Risk Factors of Chronic Kidney Disease Among Patients Attending Dessie Referral Hospital, Northeast Ethiopia

Background

In low- and middle-income countries, the burden of chronic kidney disease (CKD) is rising due to poor access to early detection and management services. In Ethiopia, little is known about the context-specific risk factors and their magnitude, particularly the dietary habit of patients is not studied. Therefore, this study aimed to identify the dietary and other risk factors of CKD in Northeast Ethiopia.

Methods

We conducted a facility-based unmatched case–control study utilizing quantitative method of data collection. Data were collected on a total of 66 cases and 134 controls using structured questionnaire and anthropometric measurements. Dietary habit was assessed using the Diet History Questionnaire (DHQ). Medical history, patient chart review and physical examination were employed to collect other relevant information. To identify independent predictors of CKD, we conducted a multivariable logistic regression analysis.

Results

About 54.5% cases and 46.3% of controls were female, while 40.9% of cases and 38.8% of controls were within the age group of 36–55. All cases and 128 (95.5%) controls consumed meat in the last year. Forty-six (69.7%) cases and 74 (55.2%) controls use palm oil as the main cooking oil. History of hypertension (adjusted odds ratio (AOR)=2.39; 95%CI: 1.17–4.89), anemia (AOR=2.38; 95%CI: 1.04–5.42), palm oil use (AOR=2.10; 95%CI: 1.01–4.35) and family history of CKD (AOR=8.77; 95%CI: 3.73–20.63) were significantly associated with the risk of having CKD.

Conclusion

Meat consumption and use of palm oil are higher among patients with CKD than controls. History of hypertension, anemia, family history of CKD and palm oil consumption were found to be risk factors for CKD. Dietary counseling interventions and dietary modifications might help in CKD prevention. Furthermore, routine urinalysis and estimation of glomerular filtration rate (GFR) for all hospitalized patients with hypertension and anemia could help to detect CKD at an earlier stage for a better prognosis.

Kidney damage and associated risk factors in rural and urban sub-Saharan Africa (AWI-Gen): a cross-sectional population study

BACKGROUND

Rapid epidemiological health transitions occurring in vulnerable populations in Africa that have an existing burden of infectious and non-communicable diseases predict an increased risk and consequent prevalence of kidney disease. However, few studies have characterised the true burden of kidney damage and associated risk factors in Africans. We investigated the prevalence of markers for kidney damage and known risk factors in rural and urban settings in sub-Saharan Africa.

METHODS

In this cross-sectional population study (Africa Wits-International Network for the Demographic Evaluation of Populations and their Health Partnership for Genomic Studies [AWI-Gen]), we recruited unrelated adult participants aged 40-60 years from four rural community research sites (Nanoro, Burkina Faso; Navrongo, Ghana; Agincourt and Dikgale, South Africa), and two urban community research sites (Nairobi, Kenya; and Soweto, South Africa). Participants were identified and selected using random sampling frames already in use at each site. Participants completed a lifestyle and medical history questionnaire, had anthropometric and blood pressure measurements taken, and blood and urine samples were collected. Markers of kidney damage were defined as low estimated glomerular filtration rate (eGFR; <60 mL/min per 1·73 m²), presence of albuminuria (urine albumin creatinine ratio >3 mg/mmol); or chronic kidney disease (low eGFR or albuminuria, or both). We calculated age-adjusted prevalence of chronic kidney disease, low eGFR, and albuminuria by site and sex and used logistic regression models to assess risk factors of kidney damage.

FINDINGS

Between August, 2013, and August, 2016, we recruited 10 702 participants, of whom 8110 were analysable. 4120 (50·8%) of analysable participants were male, with a mean age of 49·9 years (SD 5·8). Age-standardised population prevalence was 2·4% (95% CI 2·1-2·8) for low eGFR, 9·2% (8·4-10·0) for albuminuria, and 10·7% (9·9-11·7) for chronic kidney disease, with higher prevalences in South African sites than in west African sites (14·0% [11·9-16·4] in Agincourt vs 6·6% [5·5-7·9] in Nanoro). Women had a higher prevalence of chronic kidney disease (12·0% [10·8-13·2] vs 9·5% [8·3-10·8]) and low eGFR (3·0% [2·6-3·6] vs 1·7% [1·3-2·3]) than did men, with no sex-specific differences for albuminuria (9·9% [8·8-11·0] vs 8·4% [7·3-9·7]). Risk factors for kidney damage were older age (relative risk 1·04, 95% CI 1·03-1·05; p<0·0001), hypertension (1·97, 1·68-2·30; p<0·0001), diabetes (2·22, 1·76-2·78; p<0·0001), and HIV (1·65, 1·36-1·99; p<0·0001); whereas male sex was protective (0·85, 0·73-0·98; p=0·02).

INTERPRETATION

Regional differences in prevalence and risks of chronic kidney disease in sub-Saharan Africa relate in part to varying stages of sociodemographic and epidemiological health transitions across the area. Public health policy should focus on integrated strategies for screening, prevention, and risk factor management in the broader non-communicable disease and infectious diseases framework.

FUNDING

National Human Genome Research Institute, Office of the Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Environmental Health Sciences, the Office of AIDS Research, and National Institute of Diabetes and Digestive and Kidney Diseases, all of the National Institutes of Health, and the South African Department of Science and Technology.

Prevalence and awareness of chronic kidney disease among adult diabetic outpatients in Northeast Ethiopia

Background

Chronic kidney disease (CKD) is a serious complication of diabetes associated with adverse outcomes of renal failure, cardiovascular disease and mortality. Despite this, data regarding the burden and awareness of CKD among adults with diabetes in Sub-Saharan Africa countries are lacking. The aim of this study was, therefore to determine the prevalence and awareness of CKD among diabetic outpatients attending a hospital in Northeast Ethiopia.

Methods

We conducted a cross-sectional study on 323 diabetic adults at the diabetes clinic of a hospital in Northeast Ethiopia, from February 1 to July 30, 2016. Each patient provided a blood sample for serum creatinine and urine for albuminuria. Glomerular filtration rate (eGFR) was estimated using the Modification of Diet in Renal Disease (MDRD) equation. CKD was defined as eGFR < 60 ml/min/1.73 m² and/or albuminuria. Awareness was defined as a positive response to “Has a doctor or other health care professional ever told you that you had kidney disease?”

Results

Of the 323 patients, 85 (26.3%) had Stage 1–5 CKD, 42 (13.0%) had eGFR < 60 ml/min/1.73m² and 58 (18.0%) had albuminuria. In patients with eGFR < 60 ml/min/1.73m² (stage 3–5 CKD), serum creatinine was abnormal (> 1.5 mg/dl) in 23.5% and albuminuria was absent in 31.8%. Of the patients with CKD, only 10.6% of them were aware of their CKD. The proportion of patients who were aware of their disease increased with worsening of CKD stages, from 3.4% of with stage 1 to 75.0% with stage 4. Awareness for all individuals with advanced stages of CKD was only 11.9%. Having albuminuria, high serum creatinine, a family history of kidney disease and being obese were significantly associated with CKD awareness.

Conclusion

A high prevalence but low awareness of CKD was found in diabetic outpatients attending our clinic in Northeast Ethiopia. Our results highlight the need for more diagnostic strategies for CKD screening among diabetic adults and primary care education on the impact of detecting CKD in the early stage to prevent adverse outcomes and improve diabetes care.

Prevalence and Sex-Specific Distribution of Cardiovascular Risk Factors in University Students in an Urban-Rural Environment of the Democratic Republic of the Congo

A recent qualitative study on health promotion in non-communicable diseases in Sub-Saharan University students suggested sex differences in knowledge and beliefs concerning a healthy lifestyle. However, the extent to which this is reflected in sex-specific distribution of cardiovascular risk factors among Sub-Saharan African students have not been fully evaluated. The objective of this study was to assess the prevalence and the sex-specific distribution of some modifiable cardiovascular risk factors among students at University of Kikwit in the Democratic Republic of the Congo. This cross-sectional descriptive study included 780 students (62.2% men) at the University of Kikwit between January and March of 2016. Data on physical measurements, lifestyle factors, and medical history were collected. The median age (interquartile range) of the students was 23 years (21-25 years). The modifiable cardiovascular risk factors identified were: alcohol consumption (53.1%), overweight (16.4%), general obesity (1.9%), abdominal obesity (10.4%), tobacco consumption (8.1%), hypertension (7.6%) and high pulse pressure (6.4%). Compared to women, men had a higher prevalence of hypertension (9.9 vs. 3.7%; p = 0.002), tobacco consumption (10.7 vs. 3.7%; p = 0.001), and alcohol consumption (58.4 vs. 44.4%; p < 0.001). In contrast, abdominal obesity was more predominant in women than in men (23.1 vs. 2.7%; p < 0.001). This study suggests a sex-specific distribution of several modifiable cardiovascular risk factors in students at the University of Kikwit. Design of sex-specific, student-targeted health promotion programs may be warranted to reduce the prevalence of risk factors and the subsequent burden of cardiovascular diseases.

Prevalence and associated factors of chronic kidney disease among adult hypertensive patients in Tigray teaching hospitals: a cross-sectional study

Objective

The aim of this study was to assess the prevalence of chronic kidney disease and to identify associated factors of chronic kidney disease among hypertensive patients. A cross-sectional study was conducted among selected 578 hypertensive patients. Data were collected using face to face interviewing questionnaires and from medical chart review. Binary logistic regression analyses were performed and analyzed using SPSS version 23.0.

Result

Of the total 578 hypertensive patients the prevalence of chronic kidney disease was found to be 128 (22.1%). Of these hypertensive patients, patients with uncontrolled blood pressure, overweight/obesity, dyslipidemia and diabetic mellitus, 43.3%, 33.7%, 27.3% and 28.2 respectively. After adjustment, the independent variables the significant associated factors of chronic kidney disease among hypertensive patients were age [AOR (95% CI 1.43 (1.07–1.81)], uncontrolled hypertension 4.434 [AOR (95% CI 9.45 (1.34, 14.73)], overweight/obese [AOR (95% CI 7.422 (2.72, 20.28)], dyslipidemia [AOR (95% CI) 13.749 (5.69, 33.215)], diabetic mellitus [AOR (95% CI) 2.137 (1.07, 4.26)]. In conclusion, the prevalence of chronic kidney disease was considerably high. The major associated factors of chronic kidney disease were age, uncontrolled hypertension, overweight/obese, diabetic mellitus and dyslipidemia.

Prevalence of impaired renal function among rural and urban populations: findings of a cross-sectional study in Malawi

Background: Sub-Saharan Africa faces region-specific risk factors for chronic kidney disease (CKD), such as nephrotoxic herbal medicines, antiretroviral therapy and infections, in addition to hypertension and diabetes. However, large epidemiological studies from this area are scarce. Methods: In a cross-sectional survey of non-communicable diseases, we conducted a prevalence sub-study of CKD in two Malawian populations. Study participants (N=5264) of 18 years of age and above were recruited and data on demographics and CKD risk factors were collected. Glomerular filtration rate was estimated (eGFR) using the CKD-EPI equation. Results: The prevalence of eGFR<60ml/min/1.73m 2 was 1.4% (95% CI 1.1 - 1.7%) and eGFR<90ml/min/1.73m 2 was 20.6% (95% CI 19.5 - 21.7%). The rural area had higher age-standardized prevalence of both eGFR<60ml/min/1.73m 2, at 1.8% (95% CI 1.4 - 2.3) and eGFR <90 ml/min/1.73m², at 21.1% (95% CI 19.9 - 22.3), than urban location, which had a prevalence of 1.5%, (95% CI 1.0 - 2.2) and 19.4% (95% CI 18.0 - 20.8), respectively, with overlapping confidence intervals. The prevalence of CKD was lower in females than in males in both rural and urban areas. Older age (p < 0.001), a higher level of education (p = 0.03) and hypertension (p < 0.001) were associated with a higher adjusted odds ratio (aOR) of low eGFR. Diabetes was associated with a reduced aOR of eGFR<90ml/min/1.73m 2 of 0.69 (95% CI 0.49-0.96; p=0.03). Of participants with eGFR<60ml/min/1.73m 2, 14 (19.4%) had no history of hypertension, diabetes or HIV, while 36 (50%) had a single risk factor of being hypertensive. Conclusion s: Impaired renal function is prevalent, but lower than expected, in rural and urban Malawi. Further research is needed to increase understanding of CKD incidence, survival and validation of eGFR calculations in this population.

Effects of chronic diseases on health-related quality of life and self-rated health among three adult age groups

Little is known about whether there is any difference in associations of chronic diseases with health-related quality of life and self-rated health across age groups. The purpose of the present study was to examine the associations of one specific and multiple chronic diseases with health-related quality of life and self-rated health (measured using the 5-level EQ-5D version) in three age groups: young (21-44 years), middle-aged (45-64 years), and older adults (≥65 years). Secondary data analysis of 1932 participants in the Population Health Index Survey was performed. Linear regression results showed that different chronic diseases had a characteristic effect on health-related quality of life and self-rated health among different age groups. The presence of a single chronic disease was associated with lower health-related quality of life and self-rated health in young adults. Multi-morbidity was consistently associated with decreased health-related quality of life and self-rated health in all age groups. Our findings suggest that although young adults have a lower prevalence of chronic diseases, their impacts on health-related quality of life and self-rated health can be as significant as that in middle-aged and older adults.

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

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.

G1 is the major APOL1 risk allele for hypertension-attributed nephropathy in Central Africa

Background

Sub-Saharan Africans exhibit a higher frequency of chronic kidney disease (CKD) than other populations. In this study, we sought to determine the frequency of apolipoprotein L1 (APOL1) genotypes in hypertension-attributed CKD in Kinshasa, Democratic Republic of the Congo.

Methods

We performed a case-control study identifying 162 subjects: 79 with hypertension-attributed CKD and 83 controls living in Kinshasa who were genotyped for APOL1 risk variants between July 2013 and November 2016. We selected control subjects from the general population and matched them with the cases according to age. Logistic regression analysis was used to examine the relationship between APOL1 high-risk genotypes and CKD.

Results

The frequencies of the APOL1 G1 and G2 alleles were 19.1 and 7.1%, respectively. The number of individuals with the G1 and G2 risk alleles was significantly higher in the CKD group (12.7%) than in the control group (2.4%), particularly in individuals with end-stage kidney disease (14.3%). Subjects carrying two risk alleles was strongly and independently associated with hypertension-attributed nephropathy, with an adjusted odds ratio of 7.7 (95% confidence interval 1.5-39.7; P = 0.014). The high-risk APOL1 genotypes were G1/G1 and G1/G2, whereas G2/G2 was not found in the study population.

Conclusions

The results of this study demonstrate the association of high-risk APOL1 genotypes with kidney disease in Kinshasa. The absence of G2/G2 may be consistent with powerful selective sweeps induced by Trypanosoma brucei gambiense infection. In contrast, the presence of APOL1 G2/G2 among individuals of African ancestry in the USA may indicate relaxation of natural selection in a trypanosome-free environment.

Awareness and attitude to deceased kidney donation among health-care workers in Sokoto, Nigeria

Background:

Access to renal replacement therapy by the increasing population of patients with end-stage kidney disease across Sub-Saharan Africa, including Nigeria, has become a major public health challenge. Although deceased kidney donation constitutes a viable source, its uptake by patients is contingent on its acceptance by health-care workers.

Objectives:

The aim of this study is to assess the awareness and attitude to deceased kidney donation among health-care workers in Sokoto, Nigeria.

Materials and Methods:

A cross-sectional study was conducted among 470 staff of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria (attending a 1-week seminar), selected by universal sampling. Data were collected with a set of pretested, self-administered, and semi-structured questionnaire.

Results:

The mean age of the respondents was 34.1 ± 7.8 years, and most of them (77.7%) were aged <40 years. Majority of respondents were males (60.6%), married (76.5%), and Moslems (73.5%). While almost all the respondents (98.1%) were aware of deceased kidney donation, only about half (51.9%) were willing to accept deceased kidney donation. Furthermore, 43.4% were willing to give consent to donate deceased relative's kidney, and 26.1% were willing to carry an organ donation card. Predictors of willingness to accept deceased kidney donation were male sex, being a medical doctor or laboratory scientist and being a Moslem (Odds ratio >2, P < 0.05). The major disincentives reported were fear that it may not work (42%) and fear of disease transmission (37.0%).

Conclusion:

Periodic education of health-care workers on effectiveness and safety of deceased kidney donation is crucial to promoting its acceptance among them.

Performance of glomerular filtration rate estimation equations in Congolese healthy adults: The inopportunity of the ethnic correction

Context and objective

In the estimation of glomerular filtration rate (GFR), ethnicity is an important determinant. However, all existing equations have been built solely from Caucasian and Afro-American populations and they are potentially inaccurate for estimating GFR in African populations. We therefore evaluated the performance of different estimated GFR (eGFR) equations in predicting measured GFR (mGFR).

Methods

In a cross-sectional study, 93 healthy adults were randomly selected in the general population of Kinshasa, Democratic Republic of the Congo, between June 2015 and April 2016. We compared mGFR by plasma clearance of iohexol with eGFR obtained with the Modified Diet in Renal Disease (MDRD) equation with and without ethnic factor, the Chronic Kidney Disease Epidemiology (CKD-EPI) serum creatinine (SCr)-based equation, with and without ethnic factor, the cystatin C-based CKD-EPI equation (CKD-EPI SCys) and with the combined equation (CKD-EPI SCrCys) with and without ethnic factor. The performance of the equations was studied by calculating bias, precision and accuracy within 30% (P30) of mGFR.

Results

There were 48 women and 45 men. Their mean age was 45.0±15.7 years and the average body surface area was 1.68±0.16m². Mean mGFR was 92.0±17.2 mL/min/1.73m² (range of 57 to 141 mL/min/1.73m²). Mean eGFRs with the different equations were 105.5±30.1 and 87.2±24.8 mL/min/1.73m² for MDRD with and without ethnic factor, respectively; 108.8±24.1 and 94.3x20.9 mL/min/1.73m² for CKD-EPI SCr with and without ethnic factor, respectively, 93.5±18.6 mL/min/1.73m² for CKD-EPI SCys; 93.5±18.0 and 101±19.6 mL/min/ 1.73m² for CKD-EPI SCrCys with and without ethnic factor, respectively. All equations slightly overestimated mGFR except MDRD without ethnic factor which underestimated by -3.8±23.0 mL/min /1.73m². Both CKD-EPI SCr and MDRD with ethnic factors highly overestimated mGFR with a bias of 17.9±19.2 and 14.5±27.1 mL/min/1.73m², respectively. There was a trend for better P30 for MDRD and CKD-EPI SCr without than with the ethnic factor [86.0% versus 79.6% for MDRD (p = 0.21) and 81.7% versus 73.1% for the CKD-EPI SCr equations (p = 0.057)]. CKD-EPI SCrCys and CKD-EPI SCys were more effective than creatinine-based equations.

Conclusion

In the Congolese healthy population, MDRD and CKD-EPI equations without ethnic factors had better performance than the same equations with ethnic factor. The equations using Cys C (alone or combined with SCr) performed better than the creatinine-based equations.

Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review

OBJECTIVES

While increasing attention is paid to the rising prevalence of chronic diseases in Africa, there is little focus on chronic kidney disease (CKD). This systematic review assesses CKD burden among the general population and high-risk groups on the entire African continent.

DESIGN, SETTING AND PARTICIPANTS

We searched Medline and PubMed databases for articles published between 1 January 1995 and 7 April 2017 by sensitive search strategies focusing on CKD surveys at the community level and high-risk groups. In total, 7918 references were evaluated, of which 7766 articles were excluded because they did not meet the inclusion criteria. Thus, 152 studies were included in the final analysis.

OUTCOME MEASUREMENT

The prevalence of CKD in each study group was expressed as a range and pooled prevalence rate of CKD was calculated as a point estimate and 95% CI. No meta-analysis was done. Data were presented for different populations.

RESULTS

In the community-level studies, based on available medium-quality and high-quality studies, the prevalence of CKD ranged from 2% to 41% (pooled prevalence: 10.1%; 95% CI 9.8% to 10.5%). The prevalence of CKD in the high-risk groups ranged from 1% to 46% (pooled prevalence: 5.6%; 95% CI 5.4% to 5.8%) in patients with HIV (based on available medium-quality and high-quality studies), 11%-90% (pooled prevalence: 24.7%; 95% CI 23.6% to 25.7%) in patients with diabetes (based on all available studies which are of low quality except four of medium quality) and 13%-51% (pooled prevalence: 34.5%; 95 % CI 34.04% to 36%) in patients with hypertension (based on all available studies which are of low quality except two of medium quality).

CONCLUSION

In Africa, CKD is a public health problem, mainly attributed to high-risk conditions as hypertension and diabetes. The poor data quality restricts the validity of the findings and draws the attention to the importance of designing future robust studies.

Albuminuria and Reduced Estimated Glomerular Filtration Rate among First-degree Relatives of Patients with Chronic Kidney Disease in Lagos, Southwest Nigeria

Screening of individuals at increased risk of developing chronic kidney disease (CKD) has been advocated by several guidelines. Among individuals at increased risk are first-degree relatives (FDRs) of patients with CKD. There is a paucity of data on the prevalence and risk of CKD in FDRs of patients with CKD in sub-Saharan African population. This study aimed to screen FDRs of patients with CKD for albuminuria and reduced estimated glomerular filtration rate (eGFR). A cross-sectional survey of 230 FDRs of patients with CKD and 230 individuals without family history of CKD was conducted. Urinary albumin: creatinine ratio (ACR) was determined from an early morning spot urine. Glomerular filtration rate was estimated from serum creatinine. Reduced eGFR was defined as eGFR <60 ml/min/1.73 m² and albuminuria defined as ACR ≥30 mg/g. A higher prevalence of albuminuria was found in the FDRs compared to the controls (37.0% vs. 22.2%; P < 0.01). Reduced eGFR was more prevalent among the FDRs compared with the controls (5.7% vs. 1.7%, P < 0.03). Hypertension (odds ratio [OR], 2.9) and reduced eGFR (OR, 9.1) were independent predictors of albuminuria while increasing age (OR, 6.7) and proteinuria (OR, 10.7) predicted reduced eGFR in FDRs. The odds of developing renal dysfunction were increased 2-fold in the FDRs of patients with CKD, OR 2.3, 95% confidence interval, 1.29–3.17. We concluded that albuminuria and reduced eGFR are more prevalent among the FDRs of patient with CKD and they are twice as likely to develop kidney dysfunction as healthy controls.

Prevalence and correlates of chronic kidney disease in a group of patients with hypertension in the Savanah zone of Cameroon: a cross-sectional study in Sub-Saharan Africa

BACKGROUND

The prevalence of chronic kidney disease (CKD) is increasing worldwide due to an increase in the risk factors such as hypertension. The greatest burden is in low-income settings, coupled with late diagnosis and limited management resources. This work aimed at studying the prevalence and risk factors of CKD in a group of patients with hypertension in the Savanah zone in Sub-Saharan Africa (SSA).

METHODS

We carried out a cross-sectional study between January and May 2016 in the regional Hospital of Garoua-Cameroon. Participants were adults ≥18 years of both sexes, who had a diagnosis of hypertension. Patients underwent a comprehensive clinical, biological, and electrocardiographic evaluation.

RESULTS

A total of 400 patients with hypertension were included, of whom 132 (33%; 95% CI: 28.6-37.8%) were males. Their mean age was 54.16±11.17 years. Hypertension was controlled in 122 (30.5%; 95% CI: 26.2-35.2%) participants. Twelve percent had a positive urine dipstick for proteins. The mean glomerular filtration rate (GFR) was 75.27±24.87 mL/min/1.73m2. The prevalence of CKD was seen in 129 (32.3%; 95% CI: 27.9-36.98) participants. Stage 3A was the most frequent (62.01%). The main comorbidities were anemia (44.5%), obesity (39.75%), diabetes (32%), consumption of traditional medicines (15.75%), and hyperuricemia (10.75%). After multivariate analysis, age >50 years (aOR: 1.75; 95% CI: 1.06-2.89; P=0.027), female sex (aOR: 2.21; 95% CI: 1.29-3.78; P=0.0035), obesity (aOR: 1.58, 95% CI: 1.01-2.44; P=0.026) and the hyperuricemia (aOR: 3.67; 95% CI: 1.78-7.58; P<0.001) were independently associated with CKD.

CONCLUSIONS

The prevalence of CKD in adults with hypertension was high. This was associated with age greater than 50 years, female sex, obesity and the hyperuricemia.

[Chronic kidney disease: associated factors, etiologies, clinical and biological parameters at Lubumbashi city in Democratic Republic of Congo]

INTRODUCTION

Chronic kidney disease is fast becoming a worldwide public health problem due to the increase of hypertension and diabetes mellitus, its main risk factors. In countries like DRC where majority of population are in the low income bracket, very few studies about this disease, usually diagnosed at a very advanced stage have been conducted. As a result of such, cases are not always properly taken care of and managed.

METHODS

We opted for a descriptive cross-sectional study and it was conducted during the period from July 2014 to July 2015 at CMDC dialysis service. Were included all patients with glomerular filtration rate lower than 60ml / min / 1,73 m2 or high level of creatinine longer than three months during the study period Goal. This study aims at describing the sociodemographic characteristics, risk factors and biological parameters of patients admitted for kidney failure.

RESULTS

We selected 60 patients. The average age was 51, 38 + / _ 13, 47 with the most affected included age group between 50-59 years. 51, 67% had completed secondary education and 40% higher. Risk factors of renal damage were the HTA 66, 64%, 25% diabetes mellitus, use of nephrotoxic products 35%, HIV infection 11, 67%, 10% obesity, sickle cell disease 3, 3%. The birth weight birth of our patients as well as existing renal disease in family were unknown factors. 85% of our patients had hemoglobin levels below 12 g%.

CONCLUSION

From this observation, it appears that the age of our patients did not differ from that observed in other low-income communities. The level of education of our patients is higher compared to other studies. It would be better to develop strategies for early detection of kidney disease to avoid ending hemodialysis remains a very expensive treatment.

Chronic illness needing palliative care in Kinshasa hospitals, Democratic Republic of the Congo (DRC)

BACKGROUND

Chronic illnesses are a major public health problem in low-income countries. In the Democratic Republic of the Congo (DRC), few data are available, especially in palliative care. In this context, the present study aimed at describing the patterns of diseases in Kinshasa hospitals as well as risk factors associated with patients' evolving status and length of hospital stay.

METHODS

A prospective study was conducted in ten hospitals of Kinshasa, over a 1-year period. A total of 2699 patients with a chronic condition (non-communicable diseases (NCD) and/or AIDS) were consecutively enrolled in the study between January and December, 2013.

RESULTS

Out of 2699 patients studied, 36.9% were suffering from cardiovascular diseases, 29.7% from comorbidity and 17.5% from AIDS. 27.5% of patients died while hospitalized, and 67.4% were lost to follow-up. The risk factors independently associated with death in hospitals were AIDS (adjusted OR = 2.2) and age over 65 years old (adjusted OR = 1.7). Peri-urban and rural areas were significantly associated with a mean adjusted hospital stay longer than 3 days. The length of stay (LOS) was shorter for women and patients living in urban areas. Patients survived for a median of 10 days (range 7-20 days).

CONCLUSIONS

This study reveals the high proportion of patients suffering from advanced chronic diseases, including cardiovascular diseases, AIDS and comorbidity. It demonstrates the need for palliative care (PC) in medical practices in Kinshasa, the capital of the Democratic Republic of the Congo.

Clinical Utility of Urinary β2-Microglobulin in Detection of Early Nephropathy in African Diabetes Mellitus Patients

Background. Studies have indicated that diabetic tubulopathy may occur earlier than glomerulopathy, therefore providing a potential avenue for earlier diagnosis of diabetic nephropathy. Urinary beta-2-microglobulin (β2m) was investigated in this study as a potential biomarker in the detection of early nephropathy in type 2 diabetics. Methods. One hundred and two diabetic subjects and 103 controls that met the inclusion criteria had data (sociodemographic, medical history, physical examination, and laboratory) collected. Urinary β2m levels and urinary albumin concentration (UAC) were determined. Results. Elevated urinary β2m was more frequent among the diabetics (52%, 95% CI: 42.1–61.8%) than among the controls (32%, 95% CI: 22.9–41.2%). The frequency of microalbuminuria was higher in the diabetics (35.3%, 95% CI: 25.9–44.7%) than in the controls (15.5%, 95% CI: 8.4–22.6%). There was a positive correlation between urinary β2m and UAC (rho = 0.38, p < 0.001). Multivariate analysis showed BMI (OR: 1.23, 95% CI: 1.05–1.45), eGFR (OR: 0.97, 95% CI: 0.94–0.99), and presence of microalbuminuria (OR: 3.94, 95% CI: 1.32–11.77) as independent predictors of elevated urinary beta-2-microglobulin among the diabetics. Conclusion. Urinary β2m may be useful, either as a single test or as a component of a panel of tests, in the early detection of diabetic nephropathy.

[Chronic kidney disease and kidney transplantation]

OBJECTIVES

To report epidemiology and characteristics of end-stage renal disease (ESRD) patients and renal transplant candidates, and to evaluate access to waiting list and results of renal transplantation.

MATERIAL AND METHODS

An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords: "chronic kidney disease, epidemiology, kidney transplantation, cost, survival, graft, brain death, cardiac arrest, access, allocation". French legal documents have been reviewed using the government portal (http://www.legifrance.gouv.fr). Articles were selected according to methods, language of publication and relevance. The reference lists were used to identify additional historical studies of interest. Both prospective and retrospective series, in French and English, as well as review articles and recommendations were selected. In addition, French national transplant and health agencies (http://www.agence-biomedecine.fr and http://www.has-sante.fr) databases were screened using identical keywords. A total of 3234 articles, 6 official reports and 3 newspaper articles were identified; after careful selection 99 publications were eligible for our review.

RESULTS

The increasing prevalence of chronic kidney disease (CKD) leads to worsen organ shortage. Renal transplantation remains the best treatment option for ESRD, providing recipients with an increased survival and quality of life, at lower costs than other renal replacement therapies. The never-ending lengthening of the waiting list raises issues regarding treatment strategies and candidates' selection, and underlines the limits of organ sharing without additional source of kidneys available for transplantation.

CONCLUSION

Allocation policies aim to reduce medical or geographical disparities regarding enrollment on a waiting list or access to an allotransplant.

Urinary congophilia in women with hypertensive disorders of pregnancy and preexisting proteinuria or hypertension

BACKGROUND

Congophilia indicates the presence of amyloid protein, which is an aggregate of misfolded proteins, that is implicated in the pathophysiologic condition of preeclampsia. Recently, urinary congophilia has been proposed as a test for the diagnosis and prediction of preeclampsia.

OBJECTIVES

The purpose of this study was to determine whether urine congophilia is present in a cohort of women with preeclampsia and in pregnant and nonpregnant women with renal disease.

STUDY DESIGN

With the use of a preeclampsia, chronic hypertension, renal disease, and systemic lupus erythematosus cohort, we analyzed urine samples from healthy pregnant control subjects (n = 31) and pregnant women with preeclampsia (n = 23), gestational hypertension (n = 10), chronic hypertension (n = 14), chronic kidney disease; n = 28), chronic kidney disease with superimposed preeclampsia (n = 5), and chronic hypertension and superimposed preeclampsia (n = 12). Samples from nonpregnant control subjects (n = 10) and nonpregnant women with either systemic lupus erythematosus with (n = 25) and without (n = 14) lupus nephritis were analyzed. For each sample, protein concentration was standardized before it was mixed with Congo Red, spotted to nitrocellulose membrane, and rinsed with methanol. The optical density of the residual Congo Red stain was determined; Congo red stain retention was calculated, and groups were compared with the use of the Mann-Whitney test or Kruskal-Wallis analysis of Variance test, as appropriate.

RESULTS

Congophilia was increased in urine from women with preeclampsia (median Congo red stain retention, 47%; interquartile range, 22-68%) compared with healthy pregnant control subjects (Congo red stain retention: 16%; interquartile range, 13-21%; P = .002), women with gestational hypertension (Congo red stain retention, 20%; interquartile range, 13-27%; P = .008), or women with chronic hypertension (Congo red stain retention, 17%; interquartile range, 12-28%; P = .01). There were no differences in Congo red retention between pregnant women with chronic hypertension and normal pregnant control subjects (Congo red stain retention, 17% [interquartile range, 12-28%] vs 16% [interquartile range, 13-21%], respectively; P = .72). Congophilia was present in pregnant women with chronic kidney disease (Congo red stain retention, 32%; interquartile range, 14-57%), being similar to values found in women with preeclampsia (P = .22) and for women with chronic kidney disease and superimposed preeclampsia (Congo red stain retention, 57%; [interquartile range, 29-71%; P = .18). Nonpregnant women with lupus nephritis had higher congophilia levels compared with nonpregnant female control subjects (Congo red stain retention, 38% [interquartile range, 17-73%] vs 9% [7-11%], respectively; P < .001) and nonpregnant women with systemic lupus erythematosus without nephritis (Congo red stain retention, 38% [interquartile range, 17-73%] vs 13% [interquartile range, 11-17%], respectively; P = .001). A significant positive correlation was observed between congophilia and protein:creatinine ratio (Spearman rank correlations, 0.702; 95% confidence interval, 0.618-0.770; P < .001).

CONCLUSION

This study confirms that women with preeclampsia and chronic kidney disease without preeclampsia have elevated urine congophilia levels compared with healthy pregnant women. Nonpregnant women with lupus nephritis also have elevated urine congophilia levels compared with healthy control subjects. An elevated Congo Red stain retention may not be able to differentiate between these conditions; further research is required to explore the use of congophilia in clinical practice.

Prevalence and Determinants of Chronic Kidney Disease Among Hypertensive Cameroonians According to Three Common Estimators of the Glomerular Filtration Rate

Hypertension is a risk factor for renal diseases, which, in turn, are precursors of hypertension. The authors assessed the prevalence and determinants of chronic kidney disease (CKD) among 336 hypertensive adult Cameroonians (mean age, 60.9±11.3 years; 63.4% women) at Yaoundé. Any participant with an estimated glomerular filtration rate <60 mL/min/1.73 m(2) regardless of the equation used (Cockcroft-Gault [CG], Modification of Diet in Renal Disease [MDRD], and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) and/or dipstick proteinuria was reviewed 3 months later. Participants presented a high prevalence of diabetes (18.5%), dyslipidemia (17.6%), gout/hyperuricemia (10.7%), overweight/obesity (68.8%), self-medication (37.5%), and alcohol consumption (33.3%). Hypertension was uncontrolled in 265 patients (78.9%). The prevalence of CKD was 49.7%, 50.0%, and 52.1% according to MDRD, CKD-EPI, and CG equations, respectively. Advanced age, adiposity, and severity of hypertension were determinants of CKD. Nearly half of the hypertensive patients had CKD regardless of the estimators used, predicted by well-known risk factors.

Knowledge of physicians on chronic kidney disease and their attitudes towards referral, in two cities of Cameroon: a cross-sectional study

Background

Chronic kidney disease (CKD) is frequently unrecognized by non-nephrology physicians. There is an ongoing governmental program to create hemodialysis centers in the ten regions of Cameroon, where a previous study reported high levels of late referral to nephrologists. We aimed to assess the knowledge of physicians on CKD and their attitudes regarding referral.

Methods

A questionnaire based on the Kidney Disease Outcome Quality Initiative Guidelines of 2002 was self-administered to general practitioners and non-nephrology specialists working in two Cameroon cities that have hemodialysis centers (Douala and Bamenda).

Results

Of the 174 general practitioners and non-nephrology specialists approached, 114 (65.5 %) returned answered questionnaires. Only 58.8 % of doctors identified the correct definition of CKD. Most physicians were aware of the major risk factors of CKD (hypertension, 97.4 % and diabetes mellitus, 95.6 %). Most physicians were also aware of complications such as anemia (93.0 %), hypertension (90.4 %), uremia (85.1 %) and hyperkalemia (85.1 %). Only 44 % knew that CKD had five stages, with general practitioners 3.4 times more likely to know than specialists (p = 0.004). Even though 61.4 % of the physicians knew that the estimated glomerular filtration rate was the appropriate clinical means to diagnose CKD, 12.7 % would use serum creatinine alone for diagnosis. Also, up to 21.9 % of physicians would refer at late stage.

Conclusion

General practitioners and non-nephrology specialists lack general knowledge on CKD, especially on the definition and staging; they also have inadequate attitudes with regards to diagnosis and referral to the nephrologists. Educational efforts are warranted to improve on physicians’ knowledge and skills on CKD in Cameroon.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-016-1845-5) contains supplementary material, which is available to authorized users.

Prevalence of chronic kidney disease among the high risk population in South-Western Ghana; a cross sectional study

BACKGROUND

Chronic Kidney Disease (CKD) is a major global health problem. CKD is one of the most common complications of diabetes mellitus and hypertension and carries a risk of cardiovascular morbidity and mortality and progression to end-stage kidney disease.

OBJECTIVES

This study sought to use the 2012 Kidney Disease Improving Global Outcomes (KDIGO) definitions to establish the prevalence and risk factors for CKD among a high risk population in the Sekondi-Takoradi metropolis.

DESIGN

Cross sectional study.

SETTING

Effia-Nkwanta regional and the Takoradi Government hospitals in South Western Ghana.

PATIENTS

Two hundred eight consecutive adults with diabetes, hypertension or both.

MEASUREMENTS

Serum creatinine and urine albumin-creatinine ratio respectively. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) was used to estimate glomerular filtration rate (GFR).

METHODS

CKD was classified according to KDIGO.

RESULTS

The prevalence of CKD was 30 %: 27 % in patients with diabetes, 22 % in patients with hypertension only and 74 % in patients with both diabetes and hypertension. GFR category G3a CKD was most prevalent stage (9 %). Albuminuria was highest among people with diabetes (39 %).

LIMITATIONS

A convenience sample of patients attending clinics.

CONCLUSION

CKD was prevalent in these high-risk patients.

Prevalence and determinants of chronic kidney disease in rural and urban Cameroonians: a cross-sectional study

Background

Chronic kidney disease (CKD) is a global public health problem that disproportionally affects people of African ethnicity. We assessed the prevalence and determinants of CKD and albuminuria in urban and rural adults Cameroonians.

Methods

This was a cross-sectional study of 6-month duration (February to July 2014), conducted in the health district of Dschang (Western Region of Cameroon), using a multistage cluster sampling. All adults diagnosed with albuminuria (≥30 mg/g) and/or decreased estimated glomerular filtration rate (eGFR) (<60 ml/min/1.73 m²) were re-examined three months later. Logistic regression models were used to relate baseline characteristics with prevalent CKD.

Results

We included 439 participants with a mean age of 47 ± 16.1 years; with 185 (42.1 %) being men and 119 (27.1 %) being urban dwellers. There was a high prevalence of hypertension (25.5 %), diabetes (9.8 %), smoking (9.3 %), alcohol consumption (59.7 %), longstanding use of herbal medicine (90.9 %) and street medications (87.5 %), and overweight/obesity (53.3 %) which were predominant in rural area. The prevalence of CKD was 13.2 % overall, 14.1 % in rural and 10.9 % in urban participants. Equivalents figures for CKD stages G3-G4 and albuminuria were 2.5 %, 1.6 % and 5.0 %; and 12.1 %, 14.1 % and 6.7 % respectively. Existing hypertension and diabetes were associated with all outcomes. Elevated systolic blood pressure and the presence of hypertension and diabetes were the predictors of albuminuria and CKD while urban residence was associated with CKD stages G3-G4.

Conclusion

The prevalence of CKD and albuminuria was high in this population, predominantly in rural area, and driven mostly by the commonest risk factors.

Electronic supplementary material

The online version of this article (doi:10.1186/s12882-015-0111-8) contains supplementary material, which is available to authorized users.

Prevalence and risk factors of chronic kidney disease in urban adult Cameroonians according to three common estimators of the glomerular filtration rate: a cross-sectional study

Background

Chronic kidney disease (CKD) is a major threat to the health of people of African ancestry. We assessed the prevalence and risk factors of CKD among adults in urban Cameroon.

Methods

This was a cross-sectional study of two months duration (March to April 2013) conducted at the Cité des Palmiers health district in the Littoral region of Cameroon. A multistage cluster sampling approach was applied. Estimated glomerular filtration rate (eGFR) was based on the Cockcroft-Gault (CG), the four-variable Modification of Diet in Renal Disease (MDRD) study and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Logistic regression models were used to investigate the predictors of CKD.

Results

In the 500 participants with a mean age of 45.3 ± 13.2 years included, we observed a high prevalence of overweight and obesity (60.4 %), hypertension (38.6 %) and diabetes (2.8 %). The mean eGFR was 93.7 ± 24.9, 97.8 ± 24.9 and 99.2 ± 31.4 ml/min respectively with the MDRD, CG and CKD-EPI equations. The prevalence of albuminuria was 7.2 % while the prevalence of decreased GFR (eGFR < 60 ml/min) and CKD (any albuminuria and/or eGFR < 60 ml/min) was 4.4 and 11 % with MDRD, 5.4 and 14.2 % with CG, and 8.8 and 10 % with CKD-EPI. In age and sex adjusted logistic regression models, advanced age, known hypertension and diabetes mellitus, increasing body mass index and overweight/obesity were the predictors of albuminuria, decreased GFR and CKD according to various estimators.

Conclusion

There is a high prevalence of CKD in urban adults Cameroonian, driven essentially by the commonest risk factors for CKD.

Cost of renal replacement: how to help as many as possible while keeping expenses reasonable?

The treatment of kidney diseases consumes a substantial amount of the health budget for a relatively small fraction of the overall population. If the nephrological community and society do not develop mechanisms to contain those costs, it will become impossible to continue assuring optimal outcomes and quality of life while treating all patients who need it. In this article, we describe several mechanisms to maintain sustainability of renal replacement therapy. These include (i) encouragement of transplantation after both living and deceased donation; (ii) stimulation of alternative dialysis strategies besides classical hospital haemodialysis, such as home haemodialysis, peritoneal dialysis or self-care and necessitating less reimbursement; (iii) promotion of educational activities guiding the patients towards therapies that are most suited for them; (iv) consideration of one or more of cost containment incentives such as bundling of reimbursement (if not affecting quality of the treatment), timely patient referral, green dialysis, start of dialysis based on clinical necessity rather than renal function parameters and/or prevention of CKD or its progression; (v) strategically planned adaptations to the expected growth of the ageing population in need of renal replacement; (vi) the necessity for support of research in the direction of helping as large as possible patient populations for acceptable costs; and (vii) the need for more patient-centred approaches. We also extend the discussion to the specific situation of kidney diseases in low- and middle-income countries. Finally, we point to the dramatic differences in accessibility and reimbursement of different modalities throughout Europe. We hope that this text will offer a framework for the nephrological community, including patients and nurses, and the concerned policy makers and caregivers on how to continue reaching all patients in need of renal replacement for affordable expenses.

Epidemiological profile of patients with end stage renal disease in a referral hospital in Cameroon

BACKGROUND

Data regarding the epidemiology of end-stage renal disease (ESRD) and dialysis in sub-Saharan Africa are scarce and knowledge about the spectrum renal disease is very limited. This study is on the profile of patients with ESRD in a referral hospital in Cameroon.

METHODS

Medical records of patients with ESRD covering a 10-year period of activities of the Douala General Hospital were reviewed. Data were retrieved on socio demographic, and clinical data such as major comorbidities, the presumed aetiology of ESRD, blood pressure, biological variables and renal replacement therapy.

RESULTS

In all 863 patients were included with 66% being men. Mean age was 47.4 years overall, 48.9 in men and 44.5 in women (p < 0.001). The main background aetiologies of ESRD were hypertension (30.9%), glomerulonephritis (15.8%), diabetes (15.9%), HIV (6.6%) and unknown (14.7%). Participants with HIV, glomerulonephritis or unknown background nephropathy were younger, more likely to be women, to be single and unemployed, while those with hypertension and/or diabetes were older, more likely to be men, to be either married or widow, and to be retired or working in the public sector. A total of 677 patients started haemodialysis with decreasing trend across age quartiles (p = 009), and variation across background nephropathies (p < 0.001). Emergency dialysis unplanned on a temporary catheter occurs in 88.3% of patients.

CONCLUSION

This study has revealed substantial gender and age differentials in the socio-demographic features and background nephropathy in patients with ESRD in this setting. The likelihood of starting maintenance dialysis varied across background nephropathies, driven at least in part by age differences across background nephropathies.

Cystatin C- and creatinine-based equations in the assessment of renal function in HIV-positive patients prior to commencing Highly Active Antiretroviral Therapy

BACKGROUND

We evaluated the accuracy and precision of creatinine- and cystatin C-based prediction equations for estimating glomerular filtration rate compared to measured glomerular filtration rate in an antiretroviral-naive human immunodeficiency virus population.

METHODS

The study population consisted of 100 treatment-naive HIV patients. Glomerular filtration rate was estimated using the Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, as well as cystatin C-based equations (CKD-EPIcystatin C, cystatin Cvan Deventer and CKD-EPIcombined)) compared to (51)Cr-EDTA plasma clearance-measured glomerular filtration rate. We calculated percentage bias, standard deviation of the differences, accuracy within 15 and 30% of measured glomerular filtration rate and sensitivity and specificity for predicting measured glomerular filtration rate <60 mL/min/1.73 m(2).

RESULTS

Bias for all estimating glomerular filtration rate equations ranged from -9.4% to 38.4%. The CKD-EPIcombined without ethnicity correction factor equation had the least bias, 2.9% (-2.9 to 8.8). Bias was higher for the Modification of Diet in Renal Disease and CKD-EPI equation with the African-American ethnicity factor (38.4 and 33.7%) than without (14.2 and 15.3%). Standard deviation of the differences ranged from 29.2% (CKD-EPIcombined without ethnicity factor) to 54.0% (Modification of Diet in Renal Disease with ethnicity factor). Accuracy within 30% of measured glomerular filtration rate ranged from 78% for CKD-EPIcombined without ethnicity factor to 56.7% for the Cockcroft-Gault equation. Sensitivity for creatinine-based equations was less than 50% and for the CKD-EPIcystatin C equation was 75%.

CONCLUSION

Sensitivity of creatinine-based equations for predicting glomerular filtration rate was poor in this group of patients. The CKD-EPIcombined equation performed better than creatinine-based equations.

Self-reported sleep duration is associated with reduced glomerular filtration rate among adults with hypertension: a population-based study from rural northeast China

Short sleep duration has been found recently to be a predictor of proteinuria. However, population-based investigations addressing the association between self-reported sleep duration and glomerular filtration rate (GFR) among hypertensive patients are lacking. We therefore sought to investigate the extent to which self-reported sleep duration might be associated with reduced GFR in a large hypertensive population in rural northeast China. A total of 5555 hypertensive participants, aged ≥35 years, in rural areas of Liaoning Province, China, were screened between January 2012 and August 2013, using a stratified, cluster multi-stage sampling scheme. Anthropometric measurements, self-reported sleep duration, blood biochemical indexes and other health-related variables were collected by medically trained personnel. Reduced GFR was defined as the estimated GFR (eGFR) < 60 mL min(-1) 1.73 m(2). On average, participants slept for 6.9 ± 1.6 h per night. Mean self-reported sleep duration decreased with eGFR (P < 0.001). For both genders, a lower prevalence of reduced GFR was observed among participants who slept ≤6 h per night in total. In the multivariable regression model, after adjustments for age, gender, ethnicity, lifestyle factors, clinical correlates, depressive symptoms and general quality of life, participants who slept for 6 h or less per night were associated with a higher risk of reduced GFR [odds ratio (OR: 1.70, 95% confidence interval (CI): 1.05-2.73] compared with the reference group (self-reported sleep duration >7 and ≤8 h day(-1) ). We concluded that short self-reported sleep duration (≤6 h per night) was related significantly to an increased risk of reduced GFR in a hypertensive population. This novel risk factor should be taken into consideration during daily management of hypertension to prevent chronic kidney disease.

Assessment of health service delivery capacities, health providers' knowledge and practices related to type 2 diabetes care in Kinshasa primary healthcare network facilities, Democratic Republic of the Congo

Background

Democratic Republic of the Congo (DRC) is experiencing an increase in the morbi-mortality related to Non Communicable Diseases (NCD). The reform of DRC health system, based on Health District model, is needed in order to tackle this public issue. This article used 2006 International Diabetes Federation (IDF)’s guidelines to assess the capacities of health facilities belonging to Kinshasa Primary Health Care Network (KPHCN) in terms of equipments, as well as the knowledge, and the practice of their health providers related to type 2 diabetes care.

Methods

A multicentric cross-sectional study was carried in 18 Health Facilities (HF) of KPHCN in charge of the follow-up of diabetic patients. The presence of IDF recommended materials and equipment was checked and 28 health providers were interviewed about their theoretical knowledge about patients’ management and therapeutic objectives during recommended visits. Chi square test or Fisher exact test was used to compare proportions and the Student t-test to compare means.

Results

The integration of NCD healthcare in the KPHC network is feasible. The majority of HF possessed IDF recommended materials except for the clinical practice guidelines, urinary test strips, and monofilament, available in only one, two and four HF, respectively. KPHCN referral facilities had required materials for biochemical analyses, the ECG and for the fundus oculi test. Patients’ management is characterized by a lack of attention on the impairment of renal function during the first visits and a poor respect of recommended practices during quarterly and annual visits. A poor knowledge of the reduction of cardiovascular risk factors-related therapeutic objectives has been also reported.

Conclusion

The capacities, knowledge, and practice of T2D care were poor among HF of KPHCN. The lack of equipment and training of healthcare professionals should be supplied even to those who are not medical doctors. Special attention must to be put on the clinical practice guidelines formulation and sensitization and on supervision.

Evening -versus morning- dosing drug therapy for chronic kidney disease patients with hypertension: a systematic review

BACKGROUND/AIMS

There is a strong correlation between non-dipping status and cardiovascular events in chronic kidney disease (CKD) patients. Our study is designed to identify the effect of evening administration of antihypertensive drugs to hypertensive CKD patients.

METHODS

A comprehensive search of Medline, Embase, the Chinese Biomedical Literature Database, Wanfang Data, Chinese National Knowledge Infrastructure, and the Cochrane Central Register of Controlled Trials was performed in July 2014. Concurrent controlled or crossover trials (including randomized and non-randomized experimental trials) designed to evaluate the effects of evening- versus morning-dosing hypertensive drug regimens on clinical outcomes in CKD patients with hypertension were included. All statistical analyses were performed using the RevMan software, which is available free from the Cochrane Collaboration.

RESULTS

Seven trials involving 1277 patients were identified, and the randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) were classified into two groups. Taking at least one blood pressure-lowering medication at bedtime was not shown to reduce total death (P=0.056) or cardiovascular death (P=0.059) but was shown to reduce total events (P<0.001) and major cardiovascular events (P<0.001) in both RCTs and non-RCTs. Compared with a morning dosing regimen, taking antihypertensive drug in the evening significantly lowered nighttime systolic blood pressure (SBP) (P<0.0001) and diastolic blood pressure (P<0.05) in patients in the RCTs but did not affect blood pressure in patients in the non-RCTs (P<0.05). There is limited evidence from one non-RCT that taking an antihypertensive drug (benazepril 10 mg) in the evening did not increase adverse events (P=0.72) or withdrawals due to adverse events (P=0.64).

CONCLUSIONS

A regimen of antihypertensive drugs in the evening should be considered for CKD patients with hypertension to lower nighttime blood pressure and help prevent total events and cardiovascular mortality. More studies are needed to verify the results of this study.

Overnight soaking or boiling of "Matooke" to reduce potassium content for patients with chronic kidney disease: does it really work?

BACKGROUND

There is an increase in number of patients with chronic kidney disease (CKD) in Uganda's health facilities looking for different options of preparing matooke (bananas), their staple food.

OBJECTIVE

To establish and evaluate an effective method of removing potassium from bananas (matooke).

METHODS

Bananas were sampled from 5 markets in Kampala, Uganda. Deionized water was used to soak the bananas and the potassium concentration was determined using an atomic absorption spectrophotometer in both the bananas and water after soaking for varying time intervals. We also determined the potassium concentrations in the bananas and the water after boiling the bananas at 200 degrees Celsius at intervals of 10 minutes (for 60 minutes).

RESULTS

The potassium concentration did not appear to change on soaking alone without boiling. However, on boiling, the concentration in the bananas decreased from about 1.4 ppm to approx. 1 ppm after 60 min; yet the concentration of potassium released into deionized water increased steadily from 0.0 ppm to about 1.2 ppm after 60 min of boiling.

CONCLUSION

This study demonstrates that boiling the bananas is a more effective way of removing the potassium from bananas than simply soaking them.

High population frequencies of APOL1 risk variants are associated with increased prevalence of non-diabetic chronic kidney disease in the Igbo people from south-eastern Nigeria

BACKGROUND

Continental Africa is facing an epidemic of chronic kidney disease (CKD). APOL1 risk variants have been shown to be strongly associated with an increased risk for non-diabetic kidney disease including HIV nephropathy, primary non-monogenic focal and segmental glomerulosclerosis, and hypertension-attributed nephropathy among African ancestry populations in the USA. The world's highest frequencies of APOL1 risk alleles have been reported in West African nations, overlapping regions with a high incidence of CKD and hypertension. One such region is south-eastern Nigeria, and therefore we sought to quantify the association of APOL1 risk alleles with CKD in this region.

METHODS

APOL1 risk variants were genotyped in a case-control sample set consisting of non-diabetic, CKD patients (n = 44) and control individuals (n = 43) from Enugu and Abakaliki, Nigeria.

RESULTS

We found a high frequency of two APOL1 risk alleles in the general population of Igbo people of south-eastern Nigeria (23.3%). The two APOL1 risk allele frequency in the CKD patient group was 66%. Logistic regression analysis under a recessive inheritance model showed a strong and significant association of APOL1 two-risk alleles with CKD, yielding an odds ratio of 6.4 (unadjusted p = 1.2E-4); following correction for age, gender, HIV and BMI, the odds ratio was 4.8 (adjusted p = 5.1E-03).

CONCLUSION

APOL1 risk variants are common in the Igbo population of south-eastern Nigeria, and are also highly associated with non-diabetic CKD in this area. APOL1 may explain the increased prevalence of CKD in this region.

Tubular and glomerular proteinuria in HIV-infected adults with estimated glomerular filtration rate ≥ 60 ml/min per 1.73 m2

OBJECTIVE

To assess the frequency of glomerular and tubular proteinuria in a cohort of HIV-infected patients, and to determine the factors associated with each type of injury.

DESIGN

Cross-sectional study of 1210 consecutive HIV-infected adults followed in HIV outpatient unit (Montpellier/France).

METHODS

Spot urine protein to creatinine (uPCR), albumin to creatinine (uACR) and albumin to protein (uAPR) ratios were assessed. Glomerular injury was defined as uACR at least 30 mg/g or uPCR at least 200 mg/g with uAPR at least 0.4. Tubular injury was defined as uPCR 200 mg/g or more with uAPR less than 0.4. Multivariate logistic regression identified independent factors of each type of proteinuria, in the 1158 patients with estimated glomerular filtration rate (eGFR) at least 60 ml/min per 1.73 m, using re-expressed modification of diet in renal disease equation.

RESULTS

Frequency of proteinuria was 18.2% among patients with eGFR at least 60 ml/min per 1.73 m consisting in tubular proteinuria for 50.7% of them. Factors associated with glomerular proteinuria were age [OR 1.34/10-year increment (95%CI: 1.08-1.66)], diabetes [OR 3.37 (95%CI: 1.53-7.44)], and arterial hypertension [OR 2.52 (95%CI: 1.36-4.66)]. Factors associated with tubular proteinuria were age [OR 1.43 (95%CI: 1.14-1.79)], current tenofovir use [OR 3.52 (95%CI: 1.86-6.65)], hepatitis C co-infection [OR 1.62 (95%CI: 1.00-2.65)], AIDS stage [OR 1.83 (95%CI: 1.18-2.82)], CD4 cell count less than 200 per μl [OR 2.48 (95%CI: 1.31-4.70)].

CONCLUSION

This study distinguished risk factors for tubular injury, mainly related to HIV disease and its treatment (tenofovir), and glomerular injury, linked to non HIV-related variables (age, diabetes, hypertension). Measuring uPCR, uACR and uAPR may help with the detection and specific management of early chronic kidney disease in HIV-infected patients having normal or sub-normal eGFR.

Association of anemia and renal function test among diabetes mellitus patients attending Fenote Selam Hospital, West Gojam, Northwest Ethiopia: a cross sectional study

BACKGROUND

Anemia is a common problem in diabetic patients. Diabetic patients have a greater severity of anemia as the level of Glomerular Filtration Rate (GFR) decreases compared to non-diabetic patients. Despite these facts, anemia is unrecognized and largely untreated in patients with diabetes in Ethiopia particularly in those patients attending Fenote Selam Hospital. Therefore, this study was aimed to assess the association of anemia and renal function test among diabetes mellitus patients attending Fenote Selam Hospital, North West of Ethiopia.

METHODS

An Institutional -based cross-sectional study was conducted from February 2012 to April 2012 on diabetes mellitus (DM) patients. Systematic random sampling technique was used to get the total sample size of 384 patients. A total of seven ml of venous blood was collected from diabetes mellitus patients; two ml was collected by EDTA anticoagualted vacutainer test tube for haemoglobin determination and 5 ml venous blood was collected by plain vacutainer tube for creatinine and Blood urea nitrogen determination. The data were double entered and analyzed using SPSS-16 statistical software. The degree of association between independent and dependent variables was assessed using bivariate and multivariate logistic regression analysis in terms of P-value and odds ratio with 95% confidence interval.

RESULTS

Out of the total 384 DM patients included in the study 73 (19%) were anemic. Fifty three (13.8%), forty eight (12.5%), and two hundred eighty three (73.7%) DM patients had an estimated GFR <60 ml/min/1.73 m, 60 - 90 ml/min/ 1.73 m, and > 90 ml/min/1.73 m respectively. One hundred eleven (28.9%) diabetic patients had increased urine albumin level. There was a statistically significant association between anaemia and Glomerular filtration rate (P<0.05) with Odds ratio of 8.58 and CI (10.21, 49.94). As the glomerular filtration rate increase, the risk to be anemic will decrease dramatically.

CONCLUSION

The study showed that there was a significant association between anaemia and Glomerular filtration rate in DM patients. Therefore, DM patients should be strictly monitored for renal failure and anemia for proper management of diabetes patients.

Chronic kidney diseases in mixed ancestry south African populations: prevalence, determinants and concordance between kidney function estimators

BACKGROUND

Population-based data on the burden of chronic kidney disease (CKD) in sub-Saharan Africa is still very limited. We assessed the prevalence and determinants of CKD, and evaluated the concordance of commonly advocated estimators of glomerular filtration rate (eGFR) in a mixed ancestry population from South Africa.

METHODS

Participants were a population-based sample of adults selected from the Bellville-South community in the metropolitan city of Cape Town. eGFR was based on the Cockroft-Gault (CG), Modification of Diet in Kidney Disease (MDRD) and CKD Epidemiology Collaboration (CKD-EPI) equations (with and without adjustment for ethnicity). Kidney function staging used the Kidney Disease Outcome Quality Initiative (KDOQI) classification. Logistic regressions and kappa statistic were used to investigate determinants of CKD and assess the agreement between different estimators.

RESULTS

The crude prevalence of CKD stage 3-5 was 14.8% for Cockcroft-Gault, 7.6% and 23.9% respectively for the MDRD with and without ethnicity correction, and 7.4% and 17.3% for the CKD-EPI equations with and without ethnicity correction. The highest agreement between GFR estimators was between MDRD and CKD-EPI equations, both with ethnicity correction, Kappa 0.91 (95% CI: 0.86-0.95), correlation coefficient 0.95 (95% CI: 0.94-0.96). In multivariable logistic regression models, sex, age and known hypertension were consistently associated with CKD stage 3-5 across the 5 estimators.

CONCLUSIONS

The prevalence of CKD stages greater than 3 is the highest reported in Africa. This study provides evidence for support of the CKD-EPI equation for eGFR reporting and CKD classification.

Nicaragua revisited: evidence of lower prevalence of chronic kidney disease in a high-altitude, coffee-growing village

BACKGROUND

Chronic kidney disease (CKD) is found at epidemic levels in certain populations of the Pacific Coast in northwestern Nicaragua especially in younger men. There are knowledge gaps concerning CKD's prevalence in regions at higher altitudes.

METHODS

A cross-sectional study of adults between the ages of 20 and 60 years in 1 coffee-growing village in Nicaragua located at 1,000 m above sea level (MASL) altitude was performed. Predictors included participant sex, age, occupation, conventional CKD risk factors and other factors associated with CKD suggested by previous surveys in Central America. Outcomes included serum creatinine (SCr) values >1.2 mg/dL for men and >0.9 mg/dL for women, estimated glomerular filtration rate (GFR) <60 ml/min per 1.73 m2, dipstick proteinuria stratified as microalbuminuria (30-300 mg/dL) and macroalbuminuria (>300 mg/dL), hypertension and body mass index.

RESULTS

Of 324 eligible participants, 293 were interviewed (90.4%), and 267 of those received the physical exam (82.4% overall). Of the sample, 45% were men. Prevalence rate of estimated GFR <60 ml/min per 1.73 m2 was 0 for men (0%) and 2 for women (1.4%). The prevalence of at least microalbuminuria was significantly higher among men compared with women (27.5% vs. 21.4%, respectively; p=0.02).

CONCLUSIONS

The CKD prevalence in this village is comparable to a previously studied Nicaraguan coffee-farming region and much lower than previously screened portions of northwestern Nicaragua. There is heterogeneity in CKD prevalence across Nicaragua. At this time, screenings should target individuals living in previously identified, higher risk regions. More work is needed to understand determinants of CKD in this resource-poor nation.

Analysis of urinary microRNAs in chronic kidney disease

Kidney biopsy is the gold-standard diagnostic test for intrinsic renal disease, but requires hospital admission and carries a 3% risk of major complications. Current non-invasive prognostic indicators such as urine protein quantification have limited predictive value. Better diagnostic and prognostic tests for chronic kidney disease patients are a major focus for industry and academia, with efforts to date directed largely at urinary proteomic approaches. microRNAs constitute a recently identified class of endogenous short non-coding single-stranded RNA oligonucleotides that regulate gene expression post-transcriptionally. Quantification of urinary microRNAs offers an alternative approach to the identification of chronic kidney disease biomarkers.

A single-center 7-year experience with end-stage renal disease care in Nigeria-a surrogate for the poor state of ESRD care in Nigeria and other sub-saharan african countries: advocacy for a global fund for ESRD care program in sub-saharan african countries

Background. A single-center ESRD care experience in a Nigerian teaching hospital is presented as a surrogate case to demonstrate the prevailing ESRD care situation in Nigeria and most SSA countries. Methods. The data of 320 consecutive ESRD patients undergoing maintenance haemodialysis treatment during a seven-year period were retrospectively analyzed. Results. Over 80% of the subjects funded dialysis treatments from direct out of pocket payment. The mean duration on dialysis before dropout was 5.2 ± 7.6 weeks, with majority 314 (98.1%) of the patients unable to sustain dialysis above 12 weeks. Total dialysis sessions during the 7-year period was 1476 giving an average weekly dialysis session of 0.013 (0.05 hour/week) per patient per week. One hundred and twenty-eight (40%) patients died within 90 days of entry into dialysis care. Conclusions. ESRD care in this single centre was characterized by gross dialysis inadequacy and case fatality due to the inability to access and afford care. The opportunities for kidney transplantation are also very low. Poverty and the absence of government support for ESRD care are responsible for the poor outcomes. A global focus on ESRD care in SSA countries has thus become imperative.