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

PLoS One. 2018 Oct 31;13(10):e0205326. doi: 10.1371/journal.pone.0205326. eCollection 2018.

Abstract

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

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara / epidemiology
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / pathology
  • Communicable Diseases / complications
  • Communicable Diseases / epidemiology*
  • Communicable Diseases / pathology
  • Creatinine / metabolism
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / pathology
  • Female
  • Glomerular Filtration Rate / physiology
  • Humans
  • Hypertension / complications
  • Hypertension / pathology
  • Kidney / physiopathology
  • Male
  • Middle Aged
  • Noncommunicable Diseases / epidemiology*
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / epidemiology*
  • Renal Insufficiency, Chronic / pathology
  • Risk Factors
  • Tanzania / epidemiology
  • Young Adult

Substances

  • Creatinine

Grants and funding

The study was supported by a project fund from the University Hospital Basel (VFWAWF-Pool - section medicine) and the “Freiwillige Akademische Gesellschaft Basel (FAG)”. The sponsors did not influence study design, or collection, analysis and interpretation of data, writing of the report or the decision to submit the report for publication. Parts of the results of our study were presented as abstract and poster at the Swiss Society of Nephrology (SGN) at December 2017 in Fribourg/Switzerland.