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

Prevalence and Risk Factors of Chronic Kidney Disease in the General Population in Abidjan, Côte d'Ivoire: A Cross-sectional Study

Chronic kidney disease (CKD) is a major cause of morbidity and mortality worldwide, but few studies are available on CKD in Cote d'Ivoire. We aimed to assess the prevalence of CKD and identify its associated factors in the general population in Abidjan in 2016 in a cross-sectional study that included 1418 subjects. We did not receive laboratory data for 38 subjects, including serum creatinine data. Of the 1380 remaining subjects, 138 cases of CKD were included in the study (10% prevalence). We observed a female predominance (sex ratio = 0.81), and the mean age was 43.7 ± 14.5 years. Histories of hypertension (HTN) (29.7%) and diabetes (10.1%) were reported. The main clinical signs were high blood pressure (51.4%), obesity (21%), proteinuria (37.9%), and hematuria (37.4%). The glomerular filtration rate (GFR) was <60 mL/min in 8.2% of cases according to the Modification of Diet in Renal Disease equation, in 8.6% according to the CKD Epidemiology Collaboration equation, and in 12.6% according to the Cockroft-Gault (CG) equation. The other laboratory signs were hyperglycemia (51.4%), hypercholesterolemia (34.1%), and hyperlipidemia (21%). In the multivariate analysis, factors such as female sex (P = 0.013), age >55 years (P = 0.02), a history of HTN (P = 0.001), hypercholesterolemia (P = 0.010), and hyperlipidemia (P = 0.009) were associated with the risk of CKD. The prevalence of CKD was high in our study. The CG equation should not be used to estimate the GFR in the general population. Prevention involves managing modifiable risk factors.

Prevalence of chronic kidney disease and associated factors among patients with underlying chronic disease at Dessie Referral Hospital, East Amhara Region, Ethiopia

Background

Chronic kidney disease is defined as a reduction in glomerular filtration rate below 60 ml/min per 1.73 m2 and presence of albuminuria over a period of time. Globally, 10%-15% of populations are affected by chronic kidney disease. Studies conducted in Jimma, Addis Ababa, and the Tigray region were conducted on a single chronic disease and did not include human immune viruses. In addition, there has been no such study conducted in the Amhara region. Therefore, the aim of this study was to determine the magnitude and associated factors of chronic kidney disease among chronic patients who are followed up at an outpatient department.

Methods

An institutional-based cross-sectional study of 480 chronic patients was conducted at Dessie Referral Hospital, Dessie, Ethiopia between 15 March and 16 April 2020. Data were entered into Epidata and exported to SPSS version 25 for analysis. Binary logistic regression models were performed to identify factors associated with chronic kidney disease. The variables with a p-value ≤0.25 were considered to be a candidate for multivariable logistic regression. A p-value ≤0.05 was considered a statistically significant association.

Results

The magnitude of chronic kidney disease among the study participants was 21.3%. Variables such as hypertension [adjusted odds ratio (AOR): 2.6, 95% CI: 1.58-4.27], use of non-steroidal anti-inflammatory drugs (AOR: 2.4, 95% CI: 1.41-3.97), smoking (AOR: 4.4, 95% CI: 2.65-7.34), routine physical activity (AOR: 0.6, 95% CI: 0.35-0.94), and obesity (AOR: 3.0, 95% CI: 1.76-5.05) were significantly associated with the chronic kidney disease.

Conclusion

This study found that the magnitude of chronic kidney disease in the study area was high. Hypertension, use of non-steroidal anti-inflammatory drugs, smoking, routine physical activity, and obesity were found to be significant factors for chronic kidney disease.

A Rare Presentation of a Bi-Maxillary Brown Tumour due to Secondary Hyperparathyroidism

Brown tumours are localized bone lesions, seen in patients with high parathyroid hormone levels. This can be due to primary hyperparathyroidism, which occurs more often in neoplasms of the parathyroid gland or due to secondary hyperparathyroidism more often seen as a result of renal impairment. Facial involvement is rare, with most reports focusing on long and axial bones. However, the mandibular bone is often the only bone affected. Here, we report a rare case of a bi-maxillary attainment of brown tumour in a patient with secondary hyperparathyroidism due to chronic kidney disease.

Chronic kidney disease and associated factors among adult population in Southwest Ethiopia

In Ethiopia, data on the burden and determinants of chronic kidney disease (CKD) in the general population is limited. This community-based study was conducted to assess the burden and associated factors of CKD among adults in Southwest Ethiopia. The study was conducted from August 23, 2018-October 16, 2018. Study participants were selected using a random sampling method. A structured questionnaire was used to collect relevant data. Blood pressure and anthropometric indices were measured following standard procedures. About 5 ml of urine sample was collected and the dipstick test was performed immediately. A blood sample of 3-5ml was collected for serum creatinine and blood glucose level determination. The three commonest estimators of glomerular filtration rate and the National Kidney Foundation Kidney Disease Outcomes Quality Initiative were used to define and stage CKD. Data were analyzed using SPSS 21. Multivariable logistic regression was employed and p-value <0.05 was used to indicate statistically significant results. A total of 326 participants with a mean age of 39.9(SD±11.2) years were enrolled in the study. The proportions of female participants (59.8%) were relatively higher than male participants (40.2%). The mean eGFR using CKD-EPI, CG and MDRD was 124.34 (SD±23.8) mL/min/1.73m², 110.67(SD±33.0) mL/min/1.73m² and 131.29 (SD±32.5) mL/min/1.73m² respectively. The prevalence of CKD was 7.4% using CKD-EPI & MDRD and 8% using CG. Similar finding using CKD-EPI & MDRD may indicate that either CKD-EPI or MDRD can be used to estimate GFR in this study area. In the age and sex-adjusted logistic regression model, hypertension was significantly associated with CKD using CKD-EPI & MDRD and age ≥40 years old was significantly associated with CKD using CG. Behavioral characteristics and other traditional risk factors were not significantly associated with CKD in the current study. The prevalence of CKD was high in the study area. Only hypertension and age ≥40 years old were significantly associated with CKD. More of the increased prevalence of CKD in the current study remained unexplained and deserves further study.

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

Background

Kidney dysfunction is common in patients with heart failure (HF) and has been associated with poor outcomes. This study aimed to determine the prevalence, correlates, and prognosis of kidney dysfunction in patients with HF in Cameroon, an understudied population.

Methods

We conducted a cross-sectional study in consecutive patients hospitalized with HF between June 2016 and November 2017 in the Buea Regional Hospital, Cameroon. Kidney dysfunction was defined as an estimated glomerular filtration rate < 60 ml/min/1.73m². Prognostic outcomes included death and prolonged hospital stay (> 7 days). We also performed a sensitivity analysis excluding racial considerations.

Results

Seventy four patients (86.1% of those eligible) were included. Their median age was 60 (interquartile range: 44–72) years and 46.0% (n = 34) were males. Half of patients (n = 37) had kidney dysfunction. Correlates of kidney dysfunction included previous diagnosis of HF (adjusted odds ratio [aOR]4.3, 95% CI: 1.1–17.5) and left ventricular hypertrophy (aOR3.4, 95% CI: 1.1–9.9). Thirty-six (48.9%) had prolonged hospital stay, and seven (9.5%) patients died in hospital. Kidney dysfunction was not associated with in-hospital death (aOR 0.4, 95% CI: 0.1–2) nor prolonged hospital stay (aOR 2.04, 0.8–5.3). In sensitivity analysis (excluding racial consideration), factors associated with Kidney dysfunction in HF were; anemia (aOR: 3.0, 95% CI: 1.1–8.5), chronic heart failure (aOR: 4.7, 95% CI: 0.9–24.6), heart rate on admission < 90 bpm (aOR: 3.4, 95% CI: 1.1–9.1), left atrial dilation (aOR: 3.2, 95% CI: 1.04–10), and hypertensive heart disease (aOR: 3.1, 95% CI: 1.2–8.4). Kidney dysfunction in HF was associated with hospital stay > 7 days (OR: 2.6, 95% CI: 1–6.8).

Conclusion

Moderate-to-severe kidney dysfunction was seen in half of the patients hospitalized with HF in our setting, and this was associated with a previous diagnosis of HF and left ventricular hypertrophy. Kidney dysfunction might not be the main driver of poor HF outcomes in this population. In sensitivity analysis, this was associated with anemia, chronic heart failure, heart rate on admission less than 90 bpm, left atrial dilatation, and hypertensive heart disease. Kidney dysfunction was associated with hospital stay > 7 days.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-021-02641-2.

[Prevalence of chronic kidney disease in Antananarivo, Madagascar]

INTRODUCTION

Chronic kidney disease is defined as an inability of the kidney to perform its normal functions and which persists beyond three months. Nowadays, the estimated glomerular filtration rate based on plasmatic creatinine level remains the gold standard to assess renal function. In Madagascar, we miss national data concerning the epidemiology of chronic kidney disease probably due to the complexity of carrying out the serum creatinine assays. The recent availability of creatinometer using a creatinine strip test with capillary creatinine facilitated the determination of the creatinine level in epidemiological study.

PATIENTS AND METHODS

This simple technique allowed us to plan a pilot study in Antananarivo, the capital of Madagascar. The main objective was to assess the prevalence of chronic kidney disease determined from capillary creatinine level. The secondary objective was to determine the factors associated with chronic kidney disease in Madagascar. It is an analytical cross-sectional study over a period of three months. Chronic kidney disease is defined as a decrease of the glomerular filtration rate of capillary creatinine less than 60mL/min/1.73m² and calculated with Chronic Kidney Disease Epidemiology formula (CKD-EPI). The minimum number of studied population has been assessed and settled at 210 people. Cluster sampling was performed for randomization of participants.

RESULTS

At the end of the study, 210 people were randomized for screening. The average age was 40 years old with 14.9 as standard deviation. The sex ratio (male/female) was 1.76. The prevalence of chronic kidney disease was 13.8% with extreme values of 9,1 and 18.5. With chronic kidney disease, high blood pressure (hypertension) and diabetes were found respectively in 41.3 and 17.2%. Chronic kidney disease affected mainly in 72.4% of population aged 25 to 54 years old.

CONCLUSION

This is the first study in Africa to screen chronic kidney disease using a creatinine strip test. This prevalence is relatively different compared to other African countries. The limits of the study are the absence of a subsequent control and/or double control of the creatinine, which definitively confirms the chronicity of kidney disease, the absence evaluation of the urinary sediments to determine proteinuria. Nevertheless, the results of our study can be used as data awaiting the results of a multicenter studies. To determine the national prevalence of chronic kidney disease, screening in the six provinces is currently in progress.

The Chronic Kidney Disease in Africa (CKD-Africa) collaboration: lessons from a new pan-African network

Chronic kidney disease (CKD) is a global public health problem, seemingly affecting individuals from low-income and-middle-income countries (LMICs) disproportionately, especially in sub-Saharan Africa. Despite the growing evidence pointing to an increasing prevalence of CKD across Africa, there has not been an Africa-wide concerted effort to provide reliable estimates that could adequately inform health services planning and policy development to address the consequences of CKD. Therefore, we established the CKD in Africa (CKD-Africa) Collaboration. To date, the network has curated data from 39 studies conducted in 12 African countries, totalling 35 747 participants, of which most are from sub-Saharan Africa. We are, however, continuously seeking further collaborations with other groups who have suitable data to grow the network. Although many successful research consortia exist, few papers have been published (with none from Africa) detailing the challenges faced and lessons learnt in setting up and managing a research consortium. Drawing on our experience, we describe the steps taken and the key factors required to establish a functional collaborative consortium among researchers in Africa. In addition, we present the challenges we encountered in building our network, how we managed those challenges and the benefit of such a collaboration for Africa. Although the CKD-Africa Collaboration is focused primarily on CKD research, many of the lessons learnt can be applied more widely in public health research in LMICs.

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.

[Burnout syndrome in hemodialysis health workers in Cameroon: Prevalence and associated factors]

BACKGROUND

Hemodialysis medical staffs usually work in a stressful environment. In low resource countries, professional conditions are worse and can lead to burnout syndrome. The aim of this study was to determine the prevalence of burnout syndrome and its associated factors in hemodialysis health care workers in Cameroon.

PATIENTS AND METHODS

We conducted a cross sectional study in all hemodialysis centers from Cameroon between January to August 2017. The Maslach Burnout Inventory was used for assessment of burnout level. Burnout syndrome was defined as the presence of emotional exhaustion, depersonalization or decreased professional achievement.

RESULTS

A total of 92 health workers (women 60%; n=55) among 105 identified were recorded. The median age was 42 years. Most of the workers were nurses (78.5%) and 8.5% were nephrologists. Burnout syndrome was found in 76 (82.6%) workers, 35 (38%) had emotional exhaustion, 44 (48%) depersonalization and 57 (62%) decreased professional achievements. Burnout was significantly more prevalent in overcrowded centers (100% vs. 47%; P<0.001). Hemodialysis position<5 years was less prevalent in participants with emotional exhaustion and depersonalization. Desire to change position (OR 19.61 [2.074-185.4]; P=0,009) was associated with burnout syndrome.

CONCLUSION

Burnout syndrome is very common among Cameroonian hemodialysis medical staff. Improvement of work conditions, limiting posting in hemodialysis to less than 5 years and change of position when requested may be potential preventive measures.

Birth weight and renal markers in children aged 5-10 years in Cameroon: a cross-sectional study

Background

A relationship exists between birth weight (BW) and glomerular filtration rate (GFR) in postnatal kidney. Willing to fill a gap of knowledge in sub-Saharan Africa, we assessed the effect of BW on blood pressure (BP), proteinuria and GFR among Cameroonians children.

Methods

This was a cross-sectional hospital-based study from January to April 2018 at the Yaounde Gynaeco-Obstetric and Paediatric Hospital (YGOPH). We recruited low BW (LBW) [< 2500 g], normal BW (NBW) [2500-3999 g] and high BW (HBW) [> 4000 g] children, aged 5–10 years, born and followed-up at YGOPH. We collected socio-demographic, clinical (weight, height, BP), laboratory (proteinuria, creatinine), maternal and birth data. The estimated GFR was calculated using the Schwartz equation.

Results

We included 80 children (61.2% boys) with 21 (26.2%) LBW, 45 (56.2%) NBW and 14 (15.5%) HBW; the median (interquartile range) age was 7.3 (6.3–8.1) years and 17 (21.2%) were overweight/obese. Two (2.5%) children, all with a NBW (4.4%), had an elevated BP whereas 2 (2.5%) other children, all with a LBW (9.5%), had hypertension (p = 0.233). Seven (8.7%) children had proteinuria with 19, 2.2 and 14.3% having LBW, NBW and HBW, respectively (p = 0.051). Equivalent figures were 18 (22.5%), 14.3, 24.2 and 28.6% for decreased GFR, respectively (p = 0.818). There was a trend towards an inverse relationship between BW and BP, proteinuria and GFR (p > 0.05).

Conclusion

Proteinuria is more pronounced in childhood with a history of LBW and HBW while LBW children are more prone to develop hypertension. Regular follow-up is needed to implement early nephroprotective measures among children with abnormal BW.

Chronic kidney disease in Cameroon: a scoping review

OBJECTIVES

This scoping review sought to summarize available data on the prevalence, associated factors, etiology, comorbidities, treatment, cost and mortality of chronic kidney disease (CKD) in Cameroon.

METHODS

We searched PubMed, Scopus and African Journals Online from database inception to 31 March, 2020 to identify all studies published on the prevalence, associated factors, etiology, comorbidities, treatment, cost and mortality of CKD in Cameroon.

RESULTS

Thirty studies were included. The prevalence of CKD varied from 3 to 14.1 and 10.0%-14.2% in rural and urban areas, respectively. The prevalence of CKD in patients with hypertension, diabetes mellitus, and human immunodeficiency virus was 12.4-50.0, 18.5%, and 3.0-47.2%, respectively. Hypertension (22.3-59.1%), chronic glomerulonephritis (15.8-56.2%), and diabetes mellitus (15.8-56.2%) were the most common causes of CKD. The cause was unknown in 13.5-17.0% of the cases. Advanced age, hypertension, diabetes mellitus, and obesity were frequent associated factors. Hemodialysis was the main treatment modality in patients with End Stage Renal Disease (ESRD). The monthly cost of management of non-dialyzed CKD was 163 US dollars. The one-year mortality rate of ESRD was 26.8-38.6%.

CONCLUSION

Chronic kidney disease affects about one in 10 adults in the general population in Cameroon. Patients with hypertension, diabetes mellitus, and human immunodeficiency virus bear the greatest burden of CKD in Cameroon. Advanced age, hypertension, diabetes mellitus, and obesity are major factors associated with CKD. Chronic kidney disease in Cameroon is associated with high morbidity and mortality and huge economic cost on the patient.

The epidemiology of chronic kidney disease (CKD) in rural East Africa: A population-based study

Background

Chronic kidney disease (CKD) may be common among individuals living in sub-Saharan Africa due to the confluence of CKD risk factors and genetic predisposition.

Methods

We ascertained the prevalence of CKD and its risk factors among a sample of 3,686 participants of a population-based HIV trial in rural Uganda and Kenya. Prevalent CKD was defined as a serum creatinine-based estimated glomerular filtration rate <60 mL/min/1.73m² or proteinuria (urine dipstick ≥1+). We used inverse-weighting to estimate the population prevalence of CKD, and multivariable log-link Poisson models to assess the associations of potential risk factors with CKD.

Results

The estimated CKD prevalence was 6.8% (95% CI 5.7–8.1%) overall and varied by region, being 12.5% (10.1–15.4%) in eastern Uganda, 3.9% (2.2–6.8%) in southwestern Uganda and 3.7% (2.7–5.1%) in western Kenya. Risk factors associated with greater CKD prevalence included age ≥60 years (adjusted prevalence ratio [aPR] 3.5 [95% CI 1.9–6.5] compared with age 18–29 years), HIV infection (aPR 1.6 [1.1–2.2]), and residence in eastern Uganda (aPR 3.9 [2.6–5.9]). However, two-thirds of individuals with CKD did not have HIV, diabetes, or hypertension as risk factors. Furthermore, we noted many individuals who did not have proteinuria had dipstick positive leukocyturia or hematuria.

Conclusion

The prevalence of CKD is appreciable in rural East Africa and there are considerable regional differences. Conventional risk factors appear to only explain a minority of cases, and leukocyturia and hematuria were common, highlighting the need for further research into understanding the nature of CKD in sub-Saharan Africa.

Assessment of the Effect of HAART on Renal Function of HIV Patients Attending the Bamenda Regional Hospital, Cameroon

Background:

Management of HIV involves a life-long administration of a cocktail of antiretroviral drugs, some of which have been known for their nephrotoxicity. Despite the increasing access to this combination therapy, Highly Active Antiretroviral Therapy (HAART) information on its renal effect is still scarce and contradictory. The aim of this study was to assess the effect of HAART on the renal function of HIV-infected patients attending the Bamenda Regional Hospital, Cameroon.

Methods:

This was a comparative hospital-based cross-sectional study involving HIV positive and negative individuals who visited the Day clinic of the Bamenda Regional Hospital during the study period. Spectrophotometry was used to quantify the renal markers. Glomerular Filtration Rate was determined by the 24 hours creatinine clearance method. Blood urea nitrogen was calculated from serum urea concentrations. Renal impairment was then classified according to the National Kidney Foundation clinical practice guideline. Data were analysed on SPSS version 21 using Student t-test, ANOVA, and Pearson’s correlation. The level of significance was set at p<0.05.

Results:

A total of 201 participants were enrolled in this study, of which 144(71.6%) were females. Their ages ranged between 22 to 60 years with a mean age of 37.4 ± 9.6 years. The participants were divided into 3 study groups; HIV negative, HAART-naïve and the HAART experienced groups. The HAART experienced group had a significantly higher mean BUN and BUN-Creatinine ratio (p= 0.001 and 0.003 respectively) as well as the least creatinine clearance (p= 0.017) when compared to the other groups meanwhile the HAART-naive group had a significantly higher mean urine protein (p= 0.026) when compared to the other two categories. There was no association between renal dysfunction and the HAART regimen as well as adherence to treatment.

Conclusion:

This study demonstrated that though the participants on HAART had decreased renal function, the mean Creatinine clearance was not statistically different from that of the participants not yet on HAART. this is indicative that the decreased renal function could be as a result of the devastating effect of HIV. It further demonstrates no association between decreased renal function to the type of HAART regimen used, duration on HAART as well as the patient’s adherence to treatment.

How to estimate glomerular filtration rate in sub-Saharan Africa: design and methods of the African Research into Kidney Diseases (ARK) study

BACKGROUND

Chronic kidney disease (CKD) is a substantial cause of morbidity and mortality worldwide with disproportionate effects in sub-Saharan Africa (SSA). The optimal methods to estimate glomerular filtration rate (GFR) and therefore to determine the presence of CKD in SSA are uncertain. We plan to measure iohexol excretion to accurately determine GFR in Malawi, South Africa and Uganda. We will then assess the performance of existing equations to estimate GFR and determine whether a modified equation can better improve estimation of GFR in sub-Saharan Africa.

METHODS

The African Research on Kidney Disease (ARK) study is a three-country study embedded within existing cohorts. We seek to enrol 3000 adults > 18 years based on baseline serum creatinine. Study procedures include questionnaires on socio-demographics and established risk factors for kidney disease along with anthropometry, body composition, blood pressure, blood chemistry and urine microscopy and albuminuria. We will measure GFR (mGFR) by plasma clearance of iohexol at 120, 180 and 240 min. We will compare eGFR determined by established equations with mGFR using Bland-Altman plots. We will use regression methods to estimate GFR and compare the newly derived model with existing equations.

DISCUSSION

Through the ARK study, we aim to establish the optimal approach to estimate GFR in SSA. The study has the advantage of drawing participants from three countries, which will increase the applicability of the findings across the region. It is also embedded within established cohorts that have longitudinal information and serial measures that can be used to characterize kidney disease over a period of time. This will help to overcome the limitations of previous research, including small numbers, selected population sub-groups, and lack of data on proteinuria. The ARK collaboration provides an opportunity for close working partnerships across different centres, using standardized protocols and measurements, and shared bio-repositories. We plan to build on the collaboration for this study for future work on kidney disease in sub-Saharan Africa, and welcome additional partners from across the continent.

Investigation of the Causes and Risk Factors of Previous End-Stage Renal Disease in Kidney Transplant Recipients

BACKGROUND

Chronic kidney disease (CKD) is a pathophysiological process with many etiologic causes, often leading to end-stage renal disease (ESRD). The distribution of the causes that lead to ESRD varies by country, race, and sex. Renal failure may be prevented by determining these differences and reducing the risk factors.

OBJECTIVE

The purpose of the study was to determine the causes and risk factors of previous ESRD in kidney transplant (KT) recipients.

METHODS

In this descriptive, cross-sectional study, 393 KT recipients fitting the study criteria gave written consent to participate. Data were collected in face-to-face interviews at the Transplant Center using survey forms prepared by the researchers.

RESULTS

According to a multivariate logistic regression analysis of the dependent variable of ESRD diagnosis age of KT recipients, the factors affecting ESRD diagnosis age were found to be job (Odds ratio (OD) = 5.76; 95% CI [2.291-14.481]), diabetes mellitus (DM) (OD = 2.94; 95% CI [1.143-7.571]), polycystic kidney disease (PKD) (OD = 4.55; 95% CI [1.737-11.919]), hypertension (HT) (OD = 3.53; 95% CI [2.132-5.854]), family history of ESRD (OD = 0.57; 95% CI [0.341-0.963]), surgical procedure history (OD = 1.93; 95% CI [1.150-3.230]), and stress level (OD = 5.86, 95% CI [2.212-15.528]).

CONCLUSION

It is important that we determine the changeable risk factors related to ESRD development in order to prepare strategies aimed at preventing ESRD, the frequency and prevalence of which is gradually increasing. Modifiable risk factors should be identified, particularly in KT recipients, to preserve the functions of the transplanted kidney.

Blood pressure and burden of hypertension in Cameroon, a microcosm of Africa: a systematic review and meta-analysis of population-based studies

OBJECTIVE

To estimate national and geography-based variations in blood pressure and burden of hypertension in Cameroon, generally called 'miniature Africa'.

METHODS

PubMed, Medline, EMBASE, CINHAL, Web of Science, Popline, Scopus and BDSP were searched through November 2018, for hypertension studies among Cameroonians aged at least 18 years. Hypertension was measured as SBP at least 140 mmHg or DBP at least 90 mmHg. Random-effects meta-analysis was used.

RESULTS

Twenty studies involving 46 491 participants met inclusion criteria. Overall hypertension prevalence was 30.9% [95% confidence interval (CI) 27.0-34.8]: 29.6% (24.1-35.1) and 32.1% (27.2-37.1) in 1994-2010 and 2011-2018, respectively. Of hypertensive participants, only 24.4% (18.9-30.0) - 31.6% (21.0-42.3) and 20.8% (14.0-27.7) in 1994-2010 and 2011-2018, respectively - were aware of their status, 15.1% (10.6-19.6) were taking antihypertensive medications and 8.8% (5.7-11.9) - 10.4% (7.5-13.3) and 8.3% (4.4-12.3) in 1994-2010 and 2011-2018, respectively - were controlled. Hypertension prevalence varied by sex: 34.3% (30.0-38.6) for men and 31.3% (26.5-36.1) for women; ethnicity: from 3.3% (0.4-6.2) among Pygmies to 56.6% (49.4-63.8) among Bamileke; urbanity: 25.4% (17.1-33.7) for rural and 31.4% (27.3-35.5) for urban dwellers; agroecological zone: from 35.1% (28.9-41.3) in Tropical highlands to 28% (20.1-35.9) in Guinea-Savannah; and subnational region: from 36.3% (27.8-44.9) in the West to 17.1% (9.9-44.2) in the South.

CONCLUSION

Cameroon's hypertension prevalence is high and increasing whereas awareness, treatment and control are low and declining. Emerging patterns call urgently for effective campaigns to raise hypertension awareness alongside strategies for hypertension prevention and BP control.

Epidemiology of Overweight and Obesity in Adults Living in Cameroon: A Systematic Review and Meta-Analysis

OBJECTIVE

This study aimed to summarize current data on overweight and obesity among adults living in Cameroon.

METHODS

PubMed, Embase, Web of Science, Global Index Medicus, African Journals Online, and local databases were searched for population-based cross-sectional studies conducted in the general population from January 2000 to December 2017. A random-effects model was used to pool data.

RESULTS

Overall, 26 studies (55,155 participants) were included. The prevalence of overweight was 26.0% (95% CI: 17.6%-35.3%) based on BMI. Furthermore, the overall prevalence of obesity was 15.1% (95% CI: 9.3%-22.1%) based on BMI, 16.4% (95% CI: 10.8%-22.8%) based on waist circumference ≥ 102 cm for males and ≥ 88 cm for females, 36.7% (95% CI: 26.8%-47.2%) based on waist circumference ≥ 94 cm for males and ≥ 80 cm for females, 32.6% (95% CI: 26.9%-38.7%) based on waist to hip ratio ≥ 0.90 for males and ≥ 0.85 for females, and 31.9% (95% CI: 27.8%-36.2%) based on percent body fat ≥ 25% for males and ≥ 35% for females. Overall, the burden was higher in females compared with males; there was no difference between urban and rural settings or between studies conducted in 2000 to 2009 and 2010 to 2016.

CONCLUSIONS

The burden of overweight and obesity is high among adults in Cameroon, putting many at increased risk for developing associated metabolic and cardiovascular complications.

Prevalence of positive chronic kidney Disease screening in professional male long haul drivers at risk of cardiovascular Disease in Lagos, Nigeria: a cross-section study

BACKGROUND

Professional drivers are known to be at high risk for cardiovascular disease (CVD) on account of the higher prevalence co-occurring risk factors they harbour. Chronic kidney disease (CKD) and CVD share similar risk factors. Both impact each other adversely. The renal profile of professional drivers in Nigeria is not well characterised. We decided to study the prevalence of positive CKD screening amongst professional male long distance drivers in Lagos, Southwest Nigeria so as to quantify the burden and its predictors.

METHODS

Two hundred and ninety-three drivers were recruited. Details of their socio-demographic characteristics were obtained. Their anthropometric indices, blood pressure, fasting plasma blood glucose and lipid profile were measured. Serum creatinine was measured and estimated glomerular filtration rate, eGFR, was calculated with Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Urinary Albumin Creatinine Ratio (UACR) was determined. A 10 year CVD risk of the subjects was calculated with the Framingham Risk Score (FRS).

RESULTS

Mean age of the study population was 44.8 + 9.7 years. The prevalence of alcohol use and smoking were 71.0 and 19.5% respectively. One hundred and twenty-one (62.8%) of the subjects were either overweight or obese while 70(24.1%) had abdominal obesity. The prevalence of hypertension and diabetes were 39.7 and 13.9% respectively. Prevalence of CKD by eGFR< 60 ml/min/1.73m2 or UACR > 30 mg/g was 51.7% (95% CI; 46.0-57.5). The odds for CKD increased with lower HDL-c levels; OR 3.5 (95% CI, 1.1-11.2; p = 0.03) and longer duration of professional driving > 20 years; OR 2.4(95% CI, 1.5-4.0).

CONCLUSION

Professional male long distance drivers in addition to having very high prevalence of clustering of both CVD and CKD risk factors have a significant burden of asymptomatic CKD. UACR appears to be an earlier marker of CKD in this population. Health awareness promotion and aggressive risk factor reduction are advocated as ways to reduce this burden.

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.

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.

Physiological and psychosocial stressors among hemodialysis patients in the Buea Regional Hospital, Cameroon

INTRODUCTION

End Stage Renal Disease (ESRD) is an irreversible kidney condition and hemodialysis is the most frequent treatment option used for this condition. However, hemodialysis also has a detrimental impact on the quality of life and the individuals' physical and psychosocial wellbeing. The main objective of this study was to identify physiological and psychosocial stressors faced by patients undergoing hemodialysis in the Buea Regional Hospital in Cameroon.

METHODS

A cross-sectional study was carried out (December 2016 - January 2017) among patients undergoing hemodialysis at the Buea regional hospital. Data were collected with the use of a structured questionnaire and analyzed using SPSS version 21.0. Quantitative variables were expressed as frequencies, percentages and means.

RESULTS

Among the patients undergoing hemodialysis, 28 (70.0%) were below 5-year dialysis while 12 (30.0%) had been on dialysis for five years and more. 21(52.5%) were male and 19(47.5%) female. Half of the patients were married 20(50%), 13(32.5%) were single, 6(15%) were divorced, and one (2.5%) was a widower. Also, 28 (70.0%) were below 5-year dialysis while 12 (30.0%) had been on dialysis for five years and more. All participants experienced at least one or more physiological and psychosocial stressors. Among physiological stressors, the most frequent were feeling tired (97%), followed by arterial and venous stick (88%) while itching (49.5%) was the least noted physiological stressor. Among psycho-social stressors, the most recurrent were transportation to and from the hospital (99.5%), cost of treatment (99.5%) and Limits on time and place of vacation (99%), followed by Limitation in physical activities, frequent hospitalizations, the length of time on dialysis, uncertainty about the future, changes in life style, increased dependence and sleep disturbances.

CONCLUSION

The topic of stressors is of importance among patients receiving dialysis, as these affect their psycho-social and physiological wellbeing. Thus, nephrologists, nurses and family members play an important role in providing patients with effective psycho-social and physiological support.

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.

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.

Urbanization and kidney function decline in low and middle income countries

Urbanization is expected to increase in low and middle-income countries (LMICs), and might contribute to the increased disease burden. The association between urbanization and CKD is incompletely understood among LMICs. Recently, Inoue et al., explored the association of urbanization on renal function from the China Health and Nutrition Survey. The study found that individuals living in an urban environment had a higher odds of reduced renal function independent of behavioral and cardiometabolic measures, and this effect increased in a dose dependent manner. In this commentary, we discuss the results of these findings and explain the need for more surveillance studies among LMICs.

A survey of non-communicable diseases and their risk factors among university employees: a single institutional study

Background

The incidence of non-communicable diseases(NCDs) is rising globally, with its attendant morbidity andmortality, especially in developing countries. This study evaluatedthe prevalence of NCDs and their risk factors amongmembers of a university community.

Methods

All employees of the university were invited to the University health clinic for screening, using the World Health Organisation’s STEPwise approach to NCDs.

Results

A total of 883 (521; 59.0% males) employees with a mean age of 44 ± 10 years were studied. The median (IQR) number of NCD risk factors was three (two to three) per participant. The most common NCD risk factors were inadequate intake of fruit and vegetables (94.6%; 95% CI: 92.8–95.9), physical inactivity (77.8%; 95% CI: 74.9–80.5%) and dyslipidaemia (51.8%; 95% CI: 48.4–51.6%). Others included obesity (26.7%; 95% CI: 23.9–29.8%), alcohol use (24.0%; 95% CI: 21.3–27.0%) and cigarette smoking (2.9%; 95% CI: 2.0–4.3). Hypertension was the most common NCD (48.5%; 95% CI: 45.1–51.8%), followed by chronic kidney disease (13.6%; 95% CI: 11.4–16.1) and diabetes mellitus (8.0%; 95% CI: 6.4–10.1). There was no gender-specific difference in the prevalence of NCDs.

Conclusion

This study identified that NCDs and their modifiable risk factors are highly prevalent in this community. Workplace policy to support the adoption of healthy living is needed.

Kidney disease in Uganda: a community based study

Background

Chronic kidney disease (CKD) is a major cause of morbidity and mortality in Sub-Saharan Africa (SSA). The majority of studies on CKD in SSA have been conducted among HIV-infected populations and mainly from large health facilities. We determined the prevalence of CKD and its predictors among populations in communities in central Uganda.

Methods

A cross-sectional study was conducted in Wakiso district using multi-stage sampling. Data was collected on age, sex, socio-economic status, history of alcohol intake, diabetes mellitus, hypertension and smoking. Measurement of blood pressure, weight and height to determine body mass index (BMI) and investigations including HIV testing, fasting blood sugar, creatinine and urinalysis were conducted. Logistic regression was used to estimate the strength of the association between variables and the presence of CKD estimated using the Cockcroft Gault formula.

Results

A total of 955 participants aged 18–87 years were enrolled into the study. The median age was 31 years (Interquartile range 24–42) and majority (67%) were female. Up to 21.4% (204/955) had abnormal renal function with CKD stage 1 in 6.2% (59/955), stage 2 in 12.7% (121/955), stage 3 in 2.4% (23/955), CKD stage 4 in 0% and CKD stage 5 in 0.1% (1/995). Female gender OR 1.8 (95% Confidence Interval [CI] 1.2–2.8), age >30 years OR 2.2(95% CI 1.2–3.8) and high social economic status OR 2.1 (95% CI 1.3–3.6) were associated with increased risk of CKD while BMI > 25Kg/m² was protective against CKD OR 0.1 (95% CI 0.04–0.2). Traditional risk factors such as HIV-infection, diabetes mellitus, smoking and alcohol intake were not found to be significantly associated with CKD.

Conclusion

We found a high prevalence of kidney disease in central Uganda. Interestingly the traditional risk factors associated with CKD previously documented, were not associated with CKD.