PLoS ONE (Jan 2020)

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

  • Anthony N Muiru,
  • Edwin D Charlebois,
  • Laura B Balzer,
  • Dalsone Kwarisiima,
  • Assurah Elly,
  • Doug Black,
  • Samuel Okiror,
  • Jane Kabami,
  • Mucunguzi Atukunda,
  • Katherine Snyman,
  • Maya Petersen,
  • Moses Kamya,
  • Diane Havlir,
  • Michelle M Estrella,
  • Chi-Yuan Hsu

DOI
https://doi.org/10.1371/journal.pone.0229649
Journal volume & issue
Vol. 15, no. 3
p. e0229649

Abstract

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