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

Smartphone-enabled medical diagnostics and environmental monitoring for rural Africa

Africa has made significant progress in healthcare metrics over the past two decades. However, providing access and quality of healthcare to people living in rural regions remains a challenge. In this respect, so-called mobile health (mHealth) and smartphone-enabled diagnostics methods could be of great use in providing services, both necessary and novel, to rural populations. This review provides a basic background for understanding various concepts behind smartphone-enabled methods and summarizes existing examples in the fields of medical diagnostics and environmental monitoring. The aim is to engage young African students to contribute to the field but also to provide decision makers with ideas on low-cost solutions for rural healthcare.

Latent Toxoplasma gondii infection and associated risk factors among patients with chronic kidney disease: a registry-based study

BACKGROUND

Patients with chronic kidney disease (CKD) are susceptible to acquiring opportunistic parasites due to acquired immunodeficiency caused by uremia. Therefore, the present case-control study attempted to determine the prevalence of T. gondii infection and also associated risk factors among patients with CKD under hemodialysis and healthy controls who were registered at the Iranian National Registry Center for Toxoplasmosis (INRCT) in Mazandaran Province, northern Iran.

METHODS

212 cases with CKD and 200 healthy controls were enrolled in this study. Informed consent as well as a questionnaire were obtained from all subjects. Blood samples were collected from each participant and the serum was screened for anti-Toxoplasma antibodies (IgG and IgM). PCR assay was performed to detect circulating T. gondii in the blood samples of patients and controls using the primer pair targeting the RE gene.

RESULTS

Out of 412 participants, 67.92% of patients and 15.5% of control subjects were positive for anti-Toxoplasma IgG, but all participants were negative for anti-Toxoplasma IgM. Also, considering PCR assays with RE target, the prevalence of T. gondii infection was 24.1% in case subjects, while none of the control subjects tested positive. Among the PCR positive, 34 (66.7%) had Toxoplasma IgG positivity. The results from the multiple multinomial logistic regression revealed that the seroprevalence of anti-T. gondii IgG antibodies in patients with CKD was 3.12 times higher than in healthy controls (OR = 3.12; 95% CI = 0.43, 14.8; P < 0.001). Also, there was a significant association between seroprevalence of T. gondii infection and age, having a cat at home, and level of glomerular filtration rate (GFR) in these patients.

CONCLUSION

Our findings demonstrate a highly significant association between latent T. gondii infection and CKD, mostly in the late stages. Thus, regular screening for T. gondii infection in these patients is strongly recommended to prevent the reactivation of latent infections. A combination of serological screening, chemoprophylaxis, and PCR follow-up for patients at risk of reactivation should effectively reduce the likelihood of latent infection reactivation.

CLINICAL TRIAL NUMBER

Not applicable.

Ultrasound characteristics and correlation with estimated glomerular filtration rate in patients with chronic kidney disease: A facility-based cross-sectional study

ObjectiveTo evaluate grayscale sonographic characteristics and their correlation with the estimated glomerular filtration rate.Methodology: This cross-sectional study included 103 patients with stage III and above chronic kidney disease. Correlation between ultrasonography measurements and estimated glomerular filtration rate was performed. Differences in the mean estimated glomerular filtration rate were evaluated using one-way analysis of variance.ResultsThe mean (± SD) estimated glomerular filtration rate was 34.47 ± 15.81 mL/min/1.73 m2 (range: 9.6-45.9 mL/min/1.73 m2). The mean (± SD) average renal length was 8.97 ± 1.42 cm. The mean parenchymal and cortical thicknesses were 1.36 ± 0.45 and 0.85  ± 0.27 cm, respectively. There was a significant correlation between the estimated glomerular filtration rate and the average renal length, relative renal length, and parenchymal thickness (r = 0.26, p = 0.009; r = 0.25, p = 0.01; and r = 0.25, p = 0.01, respectively). A statistically significant negative correlation was observed between renal echogenicity and estimated glomerular filtration rate (p < 0.001).ConclusionA correlation was noted between the degree of renal function loss and sonographic findings. This indicates that ultrasound can be used in combination with other modalities for the diagnosis, assessment, and monitoring of chronic kidney disease.

Ambient Air Pollution and Chronic kidney disease risk in Deltan communities: A Policy Brief, 2023

Chronic kidney disease (CKD) is a persistent, devastating, yet neglected, non-communicable disease, particularly in developing and emerging countries. The traditional risk factors for CKD, such as hypertension and diabetes have received relatively ample attention but do not sufficiently explain the high burden of CKD. Ambient air pollution is an emerging environmental risk factor for CKD; however, epidemiological data and evidence are lacking for susceptible populations in developing countries. The Niger Delta region of Nigeria is a petrochemical hub known for environmental degradation, including air pollution, and thus, serves as a good case study for investigating the association between air pollution and CKD. This brief is based on an exploratory mixed-methods study conducted in four communities situated near an oil and gas refinery in Warri, Nigeria, to explore perceived and actual air pollution risks and determine whether long-term exposure to ambient air pollution is associated with CKD. Air pollutant concentrations measured in partnership with citizen scientists using portable air sensors, showed that all except one air pollutant (ozone) exceeded the WHO acceptable limits in all four communities. PM 2.5 ranged from 22.8 to 28.0 μg/m 3, PM 10, 40.6 to 55.5 μg/m 3, and CO 2, 584-652 ppm. The overall prevalence of CKD was 12.3% but even higher (18%) in a socially deprived semi-urban community closest to the oil refinery. Hypertension, diabetes, other behavioral risk factors, and exposures associated with CKD were prevalent in the four communities and environmental health information was lacking. A multifaceted approach is required to mitigate air pollution and the associated NCD risks in the region. The government needs to invest in air monitoring services, cleaner technologies, and environmental risk communication through various media channels. We strongly recommend public inclusion in planning, designing, and implementing educational interventions. Lastly, environmental risk factors such as air pollution should feature prominently in strategic plans for NCD prevention.

The Development and Testing of an Educational Video for Patients With End Stage Kidney Disease Receiving Dialysis in Two Tertiary Hospitals in Cape Town

OBJECTIVES

Medical nutrition therapy plays a crucial role in managing end-stage kidney disease. Nutrition education should be comprehensible, positive, and actionable. Storytelling can provide context, aid comprehension and retention of new information, and foster a sense of connection among patients. The study aimed to develop a video based on the "Healthy Eating in Kidney Disease" infographic and to test the knowledge of patients before and after watching the video. The study investigated the association between factors such as the number of years receiving dialysis, income, and education level on pre- and postvideo scores.

METHODS

This experimental before-after study developed an animated nutrition education video based on the South African-based infographic "Healthy Eating for Kidney Disease" in collaboration with an animator and the researchers. The video was designed in animated format in English, Afrikaans, and isiXhosa. The developed video was used to test participants' knowledge by using the same questionnaire before and after watching the video.

RESULTS

The developed video was tested on 125 participants undergoing peritoneal dialysis or hemodialysis. Participants had a mean age of 42.06 (±standard deviation 10.99) years. Predominantly, participants used isiXhosa (n = 62, 50.8%) as their primary language, followed by Afrikaans and English. Most participants (65.6%; n = 82) exhibited adequate prevideo knowledge scores, with a mean score of 67.73%. Postvideo, the majority (59.2%; n = 74) achieved good knowledge scores with a mean of 82.32%. Noteworthy improvements were observed in knowledge categories postintervention, reflecting a significant positive change (P < .001), with a mean increase of 14.59%.

CONCLUSION

The educational animated video for end-stage kidney disease patients was successfully developed and tested. The results indicated the video's effectiveness in enhancing participants' knowledge. Although no correlations emerged between knowledge scores and demographic factors, the study suggests that video-based education holds promise in encouraging behavioural changes and improving health outcomes.

Prevalence and associated factors of acute kidney injury in Ethiopia, systematic review and meta-analysis

Acute kidney injury, characterized by a sudden decline in glomerular filtration rate, presents a significant global health challenge, with its high prevalence exacerbated by hypertension and limited healthcare access. This systematic review and meta-analysis examined 19 studies encompassing 11,955 participants to assess acute kidney injury prevalence and associated factors in hospitalized patients in Ethiopia. The overall pooled prevalence of acute kidney injury was found to be 3.20% (95% CI 2.91-3.48), with considerable heterogeneity (I2 = 99.3%; p < 0.001). Subgroup analyses identified elevated rates of acute kidney injury in studies conducted post-2020 (31.656%, 95% CI 24.465-38.848), particularly in the Oromia region (41.622%, 95% CI 11.873-71.372), and smaller study sample (< 400) (44.524%, 95% CI 30.117-58.932). Hypertension, congestive heart failure, sepsis, chronic kidney diseases, and nephrotoxicity emerged as significant risk factors. Regular monitoring of renal function through blood and urine analyses is crucial for early detection and management of acute kidney injury, particularly in high-risk groups. Addressing healthcare disparities and reducing nephrotoxic medication use are essential strategies to mitigate acute kidney injury incidence and improve kidney health outcomes worldwide.

The systemic inflammatory response index is associated with chronic kidney disease in patients with hypertension: data from the national health and nutrition examination study 1999-2018

BACKGROUND

Studies have shown that in hypertensive patients, chronic kidney disease (CKD) is associated with a poor prognosis. Inflammation is a highly important factor in the progression of CKD. Detecting systemic inflammation and intervening promptly in patients with hypertension may help reduce the risk of CKD. The systemic inflammatory response index (SIRI) is a tool used to measure the systemic inflammatory response, but its relationship with CKD in patients with hypertension remains uncertain.

METHODS

We utilized data from the National Health and Nutrition Examination Survey (NHANES), which was conducted between 1999 and 2018. The analysis included a total of 20,243 participants, categorized into three groups based on SIRI tertiles. Logistic regression analysis and restricted cubic spline analysis were used to examine the relationship between the SIRI and CKD.

RESULTS

In patients with hypertension, there was a notable relationship between the SIRI and the odds of developing CKD. After full adjustment, there was a 31% greater likelihood of developing CKD associated with each incremental increase of 1 unit in the SIRI (OR: 1.31, 95% CI: 1.24-1.39, p < 0.001). The groups with greater SIRI values exhibited greater odds of developing CKD than did the T1 group (T2: OR: 1.20, 95% CI: 1.04-1.38, p = 0.015; T3: OR: 1.69, 95% CI: 1.47-1.94, p < 0.001).

CONCLUSION

A high SIRI is associated with an increased risk of CKD in hypertensive patients. The greater the SIRI is, the greater the risk of CKD in hypertensive patients.

Prevalence of chronic kidney disease and associated factors among adult diabetic patients: a hospital-based cross-sectional study

Background

Chronic kidney disease (CKD) has a significant impact on public health with a high morbidity and death rate. Most diabetic patients, in the course of their lives, develop diabetic kidney disease. In the least developed nations, its size is outstripping itself. This study aimed to determine the prevalence of chronic kidney disease and associated factors among adult diabetic patients.

Methods

A hospital-based cross-sectional study was conducted on 328 adult diabetic patients from 1 December 2023 to 4 April 2024 at the Ayder Comprehensive Specialized Hospital, northern Ethiopia. A systematic random sampling method was utilized to select the study participants. Pretested structured questionnaires were used to collect sociodemographic, economic, and behavioral/lifestyle factors. Medical records were also reviewed to collect clinical data. Creatinine analysis was performed by kinetic alkaline picrate method and Chronic Kidney Disease Epidemiology Collaboration 2021 equation was used to calculate the glomerular filtration rate from the serum creatinine, age, and sex. Proteinuria was determined by using the dipstick semiquantitative method. Data were entered and analyzed using SPSS version 29. A variable with a p-value of <0.25 in bivariate logistic regression analyses was analyzed in multivariate logistic regression to identify the associated factors. In multivariable logistic regression, a variable was deemed statistically significant if it had a p-value <0.05. Associations were presented as odds ratio (OR) along with 95% confidence intervals (CIs).

Results

The prevalence of chronic kidney diseases in adult diabetic patients was 26.5% (95% CI, 21.8%-31.7%). About 5.2%, 12.5%, 7.3%, 0.9%, and 0.6% had stage 1-5 chronic kidney diseases, respectively. Hypertension [adjusted OR (AOR) = 2.390; 95% CI, 1.394-4.099, p = 0.002], >10-year duration of diabetes (AOR = 2.585; 95% CI, 2.321-5.807; p = 0.001), and family history of kidney diseases (AOR = 2.884; 95% CI, 1.338-6.218; p = 0.007) were associated factors of chronic kidney diseases.

Conclusions

The study revealed that one in four diabetic patients had chronic kidney disease. Special attention should be given to patients with family history of CKD, long duration on diabetes, and concomitant hypertension.

Prevalence of chronic kidney disease among young people living with HIV in Sub Saharan Africa: A systematic review and meta-analysis

BACKGROUND

Globally, the prevalence of chronic kidney disease (CKD) is increasing among young people living with HIV (YPLHIV), with inconsistent estimates. Aggregated data on the prevalence of CKD are needed in sub-Saharan Africa (SSA) to inform strategies for early diagnosis and management. We conducted a systematic review and meta-analysis to estimate the pooled prevalence of CKD among YPLHIV in SSA.

METHODS

We searched Medline/PubMed, EMBASE, African Index Medicus, and African Journals Online for articles reporting the prevalence of CKD among YPLHIV in SSA using predefined search strategies up to 15th January 2024. The reference lists of identified articles were checked for additional eligible studies. The eligibility criteria were studies among YPLHIV aged 10-24 years reporting CKD prevalence defined by either glomerular filtration rate (GFR), albumin-to-creatinine ratio (ACR) or proteinuria. We used a narrative synthesis to report differences between the included studies. The DerSimonian-Laird random effects model was used to pool the CKD prevalence, and heterogeneity was assessed using the Cochrane Q-test and I-squared values. We assessed the risk of bias in each article using the Joanna Briggs Institute checklist and publication bias in a funnel plot and Egger's test.

RESULTS

Of 802 retrieved articles, 15 fulfilled the eligibility criteria and were included in the meta-analysis. Of these, 12 (80%) were cross-sectional studies that used estimated GFR to diagnose CKD. Only one study followed the standard definition of CKD. The pooled CKD prevalence from 15 studies was 12% (95% CI 6.0-19.5%), ranging from 0.8% to 53.1% according to the definition used, with a high degree of heterogeneity (I2 = 97.7%, p<0.001). The included studies were of moderate quality, with no evidence of publication bias. Sensitivity analysis showed that the findings were robust to the methodological and analytic approach.

CONCLUSION

CKD prevalence among YPLHIV is moderately high and highly heterogeneous across SSA. The standard definition of CKD should be used to enable estimation of CKD prevalence in different studies and settings. HIV programs enrolling YPLHIV should routinely screen for CKD to ensure early diagnosis and management.

TRIAL REGISTRATION

PROSPERO registration number: CRD42022347588.

Higher prevalence of kidney function impairment among older people living with HIV in Uganda

BACKGROUND

People living with HIV (PLWH) are at risk of kidney function impairment due to HIV-related inflammation, antiretroviral therapy (ART), diabetes mellitus, and hypertension. Older persons may experience a higher burden of chronic kidney disease (CKD) as kidney function declines with increasing age. There is a paucity of data comparing the prevalence of kidney function impairment in older PLWH to that in people without HIV in sub-Saharan Africa.

METHODS

We conducted a cross-sectional study among people aged ≥ 60 years living with and without HIV in Kampala, Uganda who were matched 1:1 by community location. We collected data on sociodemographics, comorbidities, and HIV-related clinical characteristics. We defined kidney function impairment as an estimated glomerular filtration rate(eGFR) < 60mls/min/1.73m2 with or without proteinuria. We constructed multivariable logistic regression models to study associations between participant characteristics and kidney function impairment.

RESULTS

We enrolled 278 people (median age 66 years); 50% were PLWH, and 51.8% were female. Among PLWH, 33.1% (95% CI: 25.7-41.4%) had kidney function impairment versus 12.9% (95% CI: 8.3-19.7%) among people without HIV, (p-value < 0.01). The prevalence of proteinuria among PLWH versus people without HIV was 43.9% (95% CI:35.8-52.3%) versus 19.4% (95% CI:13.6-26.9%) p-value < 0.01. Living with HIV (OR = 3.89(95% CI: 2.04-7.41), p-value < 0.01), older age (OR = 1.13, (95% CI:1.07-1.20), p-value < 0.01), female sex (OR = 1.95, (95% CI:1.06-3.62), p-value = 0.03) and a prior diagnosis of hypertension (OR = 2.19(95% CI:1.02-4.67), p-value = 0.04) were significantly associated with kidney function impairment.

CONCLUSIONS

HIV infection is strongly associated with kidney function impairment among older PLWH. Prioritizing routine measurements of kidney function and proteinuria in older PLWH will enable early detection and institution of measures to reduce the progression of kidney disease.

Prevalence of nephropathy among diabetic patients in North American region: A systematic review and meta-analysis

BACKGROUND

Nephropathy is one of the most common microvascular impediments of diabetes mellitus. In this study, we aimed to estimate the prevalence of nephropathy in diabetic patients across the North American region.

METHODS

Eligible studies were screened out from 3 electronic databases, for example, PubMed, Google Scholar, and ScienceDirect using specific search keywords based on the eligibility criteria. Extracting the data from the included studies publication bias, quality assessment, outlier investigation, and meta-analysis was done followed by the subgroup analysis. A total of 11 studies met the study inclusion criteria. Meta-analysis was performed with the extracted data.

RESULTS

Pooled prevalence of 28.2% (95% confidence interval [CI]: 19.7-36.7) with a high rate of heterogeneity (I2 = 100%) was identified. The pooled prevalence of nephropathy among diabetic patients in the United States of America, Canada, and Mexico was 24.2% (95% CI: 13.8-34.5), 31.2% (95% CI: 25.8-36.5), and 31.1% (95% CI: 20.8-41.5), respectively.

CONCLUSION

The prevalence of nephropathy among diabetic patients was found lower in the United States of America as compared to Canada and Mexico. Besides, the pooled prevalence of the North American region was found to be lower as compared to the African, European, and Asian regions. Minimizing the pathogenic factors, sufficient diagnostic, healthcare facilities, and awareness are recommended to improve the situation.

Kidney damage and associated risk factors in the rural Eastern Cape, South Africa: A cross-sectional study

BACKGROUND

The colliding epidemic of infectious and non-communicable diseases in South Africa could potentially increase the prevalence of kidney disease in the country. This study determines the prevalence of kidney damage and known risk factors in a rural community of the Eastern Cape province, South Africa.

METHODS

This observational cross-sectional study was conducted in the outpatient department of the Mbekweni Community Health Centre in the Eastern Cape between May and July 2022. Relevant data on demography, medical history, anthropometry and blood pressure were obtained. The glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration Creatinine (CKD-EPICreatinine) equation and the re-expressed four-variable Modification of Diet in Renal Disease (MDRD) equation, without any adjustment for black ethnicity. Prevalence of kidney damage was defined as the proportion of individuals with low eGFR (<60mL/min per 1.73m2). The presence of proteins in the spot urine samples was determined with the use of test strips. We used the logistic regression model analysis to identify the independent risk factors for significant kidney damage.

RESULTS

The mean (±standard deviation) age of the 389 participants was 52.3 (± 17.5) years, with 69.9% female. The prevalence of significant kidney damage was 17.2% (n = 67), as estimated by the CKD-EPICreatinine, with a slight difference by the MDRD equation (n = 69; 17.7%), while the prevalence of proteinuria was 7.2%. Older age was identified as a significant risk factor for CKD, with an odds ratio (OR) = 1.08 (95% confidence interval [CI]: 1.06-1.1, p < 0.001). Hypertension was strongly associated with proteinuria (OR = 4.17, 95% CI 1.67-10.4, p<0.001).

CONCLUSIONS

This study found a high prevalence of kidney damage (17.2%) and proteinuria (7.97%) in this rural community, largely attributed to advanced age and hypertension, respectively. Early detection of proteinuria and decreased renal function at community health centres should trigger a referral to a higher level of care for further management of patients.

Circadian blood pressure variability and associated factors among chronic kidney disease patients at Nekemte Town public Hospitals, West Oromia, Ethiopia: a comparative cross-sectional study

OBJECTIVE

This study aimed to assess the pattern of circadian blood pressure variability (CBPV) and associated factors among chronic kidney disease (CKD) patients admitted to Nekemte Town public Hospitals.

DESIGN

A hospital-based comparative cross-sectional study was conducted among 130 CKD patients from 01 October to 02 December 2022. Comparisons were performed between the groups using an independent t-test for CBPV (24-hour blood pressure (BP), daytime BP and night-time BP). The dipping pattern was compared by the χ2 test. Multiple logistic regression was used to determine the factors associated with non-dipping patterns in patients with hypertensive CKD (HCKD).

SETTING

Two public hospitals in the Nekemte town, Western Ethiopia.

PARTICIPANTS

The participants were two independent groups. Group I (HCKD=65) and group II (normotensive CKD (NCKD)=65).

RESULTS

The mean 24-hour SD of systolic blood pressure (SBP) was significantly different between HCKD and NCKD patients, 10.17±6.12 mm Hg versus 0.5.4±2.7 mm Hg, respectively (95% CI 0.02 to 1.77, p=0.043). The prevalence of SBP non-dippers was greater among HCKD than NCKD patients (83% vs 63%). Mean 24-hour SBP (95% CI 1.50 (1.15 to 1.96), p=0.003) and estimated glomerular filtration rate (eGFR) (95% CI 2.92 (1.21 to 47.06), p=0.038) were independently associated with non-dipping SBP in HCKD patients.

CONCLUSION

Compared with NCKD patients, HCKD patients had significantly greater CBPV. Compared with dippers, non-dippers had a lower mean eGFR.

Evaluation of eGFR methods in a sub-Saharan African community-based pediatric population

BACKGROUND

Accurate assessment of the estimated glomerular filtration rate (eGFR) plays a pivotal role in the early detection, management, and optimal medication dosing for chronic kidney disease (CKD). However, validation of eGFR, utilizing cystatin C-based equations, is limited in African children and adolescents with CKD. We evaluate the agreement of eGFR equations incorporating both cystatin C and creatinine in this specific population.

METHODS

This community-based study assessed CKD in children (2-15 years) using cystatin C and serum creatinine. eGFR agreement with the reference was evaluated with Bland-Altman plots, ROC curves, and Lin's CCC, using the Under-25 serum creatinine-cystatin C equation as the reference standard. Pairwise ROC comparisons assess the statistical differences in estimation equation agreement.

RESULTS

Among 666 children (mean age, 7.8 ± 3.8 years; 48.6% male), CKD prevalence was 11.6% (95% CI, 9.2-14.2%). Notably, the Chehade equation, using combined biomarkers, aligned best with the reference, displaying the lowest mean deviation (- 0.59; 95% CI, - 1.19 to 0.01), superior agreement (P10, 91.0%; P30, 96.70%), and highest discriminatory power (0.989). In contrast, CKD-EPI 2012 cystatin C had the highest mean deviation (- 35.90) and lowest discriminatory power (0.79). Equations combining creatinine and cystatin C (Schwartz, Chehade, Full Age Spectrum) demonstrated strong positive Lin's CCC with CKiD U25 creatinine-cystatin C, while Bouvet showed a notably weak correlation (Lin's CCC, 0.22).

CONCLUSION

In African children with CKD, the Chehade, CKiD Under 25 creatinine-based equations, and the Full Age Spectrum equations show promise for CKD diagnosis. However, a measured GFR is essential to identifying the most accurate eGFR equation in this population.

Prevalence and progression of chronic kidney disease among adults undergoing creatinine testing in South African public healthcare facilities: a study leveraging data from South Africa's National Health Laboratory Service (NHLS)

Background

Chronic kidney disease (CKD) has emerged as a substantial global health challenge, with a marked rise in associated mortality. However, it often goes undetected until advanced stages, particularly in low-income and middle-income countries such as South Africa. We investigated the prevalence and progression of CKD in South Africa, utilising a subset of data from the National Health Laboratory Services Multi-morbidity Cohort.

Methods

This study was a retrospective analysis of adults aged 18-85 years who underwent initial creatinine laboratory testing at government hospitals and clinics from January 2012 to January 2016. CKD was assessed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, excluding the race factor, with a cut-off of CKD-EPI<60 mL/min/1.73 m2. Lab-diagnosed CKD was defined as two estimated glomerular filtration rate measurements <60 mL/min/1.73 m2 at least 90 days apart. Cox regression and survival curves were used to estimate HRs and rates of progression.

Results

Among 6 106 521 adults tested between 2012 and 2016, 1.5% (95% CI 1.4% to 1.5%) were diagnosed with CKD, with the majority in stage 3. Over follow-up (median: 2 years, IQR: 0.8-3.6 years), 28.2% (95% CI 27.7% to 28.6%) of patients diagnosed as stage 3a progressed to a more severe disease state. Among patients who were in stage 3b at diagnosis, 29.6% (95% CI 29.0% to 30.1%) progressed and 33.3% (95% CI 32.5% to 34.1%) of stage 4 patients progressed. We estimated a 48% higher adjusted hazard of CKD progression for individuals with diabetes (adjusted HR 1.48, 95% CI 1.41 to 1.57) compared with those without. Advancing age also increased the risk, particularly for those aged >50 years.

Conclusions

This study underscores the urgency for early detection and management of CKD in South Africa, particularly for high-risk individuals. Strengthening primary healthcare systems and raising CKD awareness are vital for improved patient outcomes and to alleviate the burden on healthcare resources. Early intervention can delay CKD progression, thus reducing the need for costly treatments like dialysis and transplantation.

Perspectives of Chronic Kidney Disease Patients on Readiness for Advance Care Planning at Komfo Anokye Teaching Hospital, Ghana

This study examined the impact of advance care planning (ACP) on the quality of life for patients with chronic kidney disease (CKD) at Komfo Anokye Teaching Hospital in Ghana. It specifically investigated patients' perspectives on their readiness for ACP. Utilizing a qualitative descriptive design, one-on-one interviews were conducted with CKD patients at the renal clinic, employing a semi-structured interview guide for thematic analysis of audio data. The findings revealed a gap in understanding among CKD patients, with participants acknowledging their vulnerability to renal failure, often linked to a medical history of diabetes and hypertension. Despite recognizing potential outcomes such as dialysis dependency or death, some patients retained hope for a cure, relying on faith. The initial kidney failure diagnosis induced shock and distress, leading many patients to prefer the comfort and familiarity of home-based care, including dialysis. Meanwhile, a minority favored hospital care to protect their children from psychological trauma. Most patients deemed legal preparations unnecessary, citing limited assets or a lack of concern for posthumous estate execution. These insights emphasize the necessity for targeted education and support in ACP to enhance patient outcomes in chronic kidney disease care and end-of-life planning.

Lack of Association of Vascular Risk Factors with HIV-Associated Neurocognitive Disorders in cART-Treated Adults Aged ≥ 50 Years in Tanzania

HIV-associated neurocognitive disorders (HAND) are highly prevalent in those ageing with HIV. High-income country data suggest that vascular risk factors (VRFs) may be stronger predictors of HAND than HIV-disease severity, but data from sub-Saharan Africa are lacking. We evaluated relationships of VRFs, vascular end-organ damage and HAND in individuals aged ≥ 50 in Tanzania. c-ART-treated individuals were assessed for HAND using consensus criteria. The prevalence of VRFs and end organ damage markers were measured. The independent associations of VRFs, end organ damage and HAND were examined using multivariable logistic regression. Data were available for 153 individuals (median age 56, 67.3% female). HAND was highly prevalent (66.7%, 25.5% symptomatic) despite well-managed HIV (70.5% virally suppressed). Vascular risk factors included hypertension (34%), obesity (10.5%), hypercholesterolemia (33.3%), diabetes (5.3%) and current smoking (4.6%). End organ damage prevalence ranged from 1.3% (prior myocardial infarction) to 12.5% (left ventricular hypertrophy). Measured VRFs and end organ damage were not independently associated with HAND. The only significant association was lower diastolic BP (p 0.030, OR 0.969 (0.943-0.997). Our results suggest that vascular risk factors are not major drivers of HAND in this setting. Further studies should explore alternative aetiologies such as chronic inflammation.

Higher prevalence of kidney function impairment among older people living with HIV in Uganda

Background

People living with HIV (PLWH) are at risk of kidney function impairment due to HIV-related inflammation, antiretroviral therapy (ART), diabetes mellitus, and hypertension. Older persons may experience a higher burden of chronic kidney disease (CKD) as kidney function declines with increasing age. There is a paucity of data comparing the prevalence of kidney function impairment in older PLWH to that in HIV-uninfected people in sub-Saharan Africa.

Methods

We conducted a cross-sectional study among people aged ≥ 60 years living with and without HIV in Kampala, Uganda who were matched 1:1 by community location. We collected data on sociodemographics, comorbidities, and HIV-related clinical characteristics. We defined kidney function impairment as an estimated glomerular filtration rate(eGFR) < 60mls/min/1.73m2 with or without proteinuria. We constructed multivariable logistic regression models to study associations between participant characteristics and kidney function impairment.

Results

We enrolled 278 people (median age 66 years); 50% were PLWH, and 51.8% were female. Overall, the prevalence of kidney function impairment was 23.0% (95% CI:18.4%-28.4%); 33.1% (95% CI: 25.7%-41.4%) versus 12.9% (95% CI: 8.3%-19.7%) among people living with and without HIV (p-value < 0.01). The prevalence of proteinuria among PLWH versus people without HIV was 43.9% (95% CI:35.8%-52.3%) versus 19.4% (95% CI:13.6%-26.9%) p-value < 0.01. Living with HIV (OR = 3.89(95% CI: 2.04-7.41), p-value < 0.01), older age (OR = 1.13, (95% CI:1.07-1.20), p-value < 0.01), female sex (OR = 1.95, (95% CI:1.06-3.62), p-value = 0.03) and a prior diagnosis of hypertension (OR = 2.19(95% CI:1.02-4.67), p-value = 0.04) were significantly associated with kidney function impairment.

Conclusions

HIV infection is strongly associated with kidney function impairment among older PLWH. Prioritizing routine measurements of kidney function and proteinuria in older PLWH will enable early detection and institution of measures to reduce the progression of kidney disease.

Prevalence of chronic kidney disease and its associated factors among diabetes mellitus patients in Dessie Referral Hospital, South Wollo, Ethiopia

Diabetes mellitus shares a large proportion of kidney failure. Despite many patients suffering from diabetes mellitus and its complications in Dessie City, no study was conducted in the study area that shows the prevalence and associated factors of chronic kidney disease among diabetes mellitus patients. Therefore, this study aims to assess the prevalence of chronic kidney disease and its associated factors among adult diabetes mellitus patients attending Dessie Referral Hospital, South Wollo, Northeast Ethiopia. An institutional-based cross-sectional study was conducted at Dessie Referral Hospital among 267 randomly selected adult diabetic patients. Data were collected using questionnaires administered by interviewers. The glomerular filtration rate was estimated from serum creatinine levels. Data were entered into Epi-data version 4.6 and analyzed using SPSS version 26 software. Multi-variable logistic regression was used to determine the strength of association for the associated factors of chronic kidney disease. Variables with a p value < 0.05 were used to ascertain statistically significant associations. A total of 267 diabetic patients participated in this study. About 104 (39%) of the respondents were female and from the total, 133 (48.1%) were hypertensive. The overall prevalence of chronic kidney disease in this study was 31.5% (95% CI 25.3-37.1%). Being older (p-value = 0.003) and having hypertension (p-value = 0.043) were significant factors for chronic kidney disease among diabetes mellitus patients. This study found a high prevalence (31.5%) of chronic kidney disease among diabetic patients. Older age, having hypertension, and elevated serum creatinine were statistically significant associated factors of chronic kidney disease among patients with diabetes mellitus. Thus, clinicians should be aware of the high prevalence of chronic kidney disease in Dessie City. Moreover, emphasis should be given for old age and hypertension as contributing factors to the high prevalence in diabetic patients.

Temporal trends in prevalence and disability of chronic kidney disease caused by specific etiologies: an analysis of the Global Burden of Disease Study 2019

BACKGROUND

The prevalence of disability in CKD is high. In this context the aim of the present study was to assess the  temporal trends of prevalence and disability progression for chronic kidney disease (CKD) caused by specific etiologies.

METHODS

Using data from the Global Burden of Diseases Study (GBD) 2019, we examined the age-standardized rates of CKD prevalence and disability-adjusted life-years for different etiologies, including Type 1/2 diabetes mellitus (T1DM/T2DM), glomerulonephritis, and hypertension. We also calculated the average annual percentage changes to assess trends. Additionally, we utilized the joinpoint regression model to identify significant shifts over time.

RESULTS

From 1990 to 2019, the global prevalence of CKD due to various etiologies exhibited an overall increasing trend, albeit with fluctuations. Notably, CKD due to T1DM, glomerulonephritis, and hypertension consistently demonstrated a significant upward trend across all continents, while the prevalence of CKD due to T2DM varied across continents. In terms of disability-adjusted life-years, CKD due to T2DM and hypertension exhibited a significant rising trend over the past 30 years. However, changes in age standardized disability-adjusted life-years for CKD due to different etiologies were not consistent across continents, with an upward trend observed in The Americas and a contrasting trend in Asia. Furthermore, both age-standardized prevalence rate and age standardized disability-adjusted life-year trends for CKD varied significantly across 204 countries and territories. Additionally, a negative association was observed between the Socio-demographic Index and the disability progression of CKD.

CONCLUSION

The prevalence and disability burden of CKD caused by specific etiologies show substantial heterogeneity worldwide, highlighting significant disparities in the distribution of CKD. It is crucial to implement geographic and personalized strategies in different regions to alleviate the burden of CKD effectively.

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.

Chronic kidney disease of unknown aetiology in Africa: A review of the literature

During the last two decades, an epidemic of a severe form of chronic kidney disease (CKD) unrelated to traditional risk factors (diabetes and hypertension) has been recognized in low- to middle-income countries. CKD of unknown aetiology (CKDu) mainly affects young working-age adults, and has become as an important and devastating public health issue. CKDu is a multifactorial disease with associated genetic and environmental risk factors. This review summarizes the current epidemiological evidence on the burden of CKDu and its probable environmental risk factors contributing to CKD in Africa. PubMed/Medline and the African Journals Online databases were searched to identify relevant population-based studies published in the last two decades. In the general population, the burden of CKD attributable to CKDu varied from 19.4% to 79%. Epidemiologic studies have established that environmental factors, including genetics, infectious agents, rural residence, low socioeconomic status, malnutrition, agricultural practise and exposure to agrochemicals, heavy metals, use of traditional herbs, and contaminated water sources or food contribute to the burden of CKD in the region. There is a great need for epidemiological studies exploring the true burden of CKDu and unique geographical distribution, and the role of environmental factors in the development of CKD/CKDu.

Prevalence of chronic kidney disease in Tunisian diabetics: the TUN-CKDD survey

BACKGROUND

In Tunisia, the prevalence of diabetes mellitus increased from 15.5% on 2016 to 23% by 2023. While Chronic Kidney Disease (CKD) stills the most dreaded complications of diabetes, studies on the prevalence of chronic kidney disease non-dialysis diet are scarce. The aim of this study was to assess the prevalence of chronic kidney disease among the Tunisian diabetic population based on investigators' specialty, demographic criteria (gender, age, duration of diabetes and geographic distribution) and diagnosis criteria (albuminuria and/or eGFR).

METHODS

This observational, multicentric, and cross-sectional study enrolled all diabetic subjects from all regions of Tunisia with at least 3 months of follow-up before the inclusion date, from 09 January to 08 February 2023. CKD diagnosis was established based on the KDIGO guidelines. The study was carried out at medical departments and ambulatory clinics of different healthcare providers. Baseline data were collected by investigators using an electronic case report form (eCRF). Continuous variables were described by means, median, standard deviation, and quartiles. Categorical data were tabulated in frequencies and percentages.

RESULTS

The overall prevalence of CKD among the 10,145 enrolled patients with diabetes mellitus was 38.7% with a 95%CI [37.8-39.6%]. 50.9% were male, with a mean age of 67.5 (± 11.3) years. The mean diabetes duration was 16.1 years (± 8.9). The highest CKD prevalence was noted among nephrologists (82.2%), while it was similar between the cardiologists and the primary care physicians (30.0%). CKD prevalence was highest among males (43.0% versus 35.1%) and increased proportionally with patients' age and diabetes duration. CKD was more frequent in the Mid-East Area when compared to other regions (49.9% versus 25.3 to 40.1% in other regions). Albuminuria was present within 6.6% of subjects with CKD, and it was found an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² within 13.3% of subjects wit h CKD. 18.9% had both criteria.

CONCLUSIONS

In Tunisia, CKD among diabetics had a prevalence of 38.7%, approaching European prevalence. The prevalence discrepancy worldwide of CKD can be improved with a larger population size and by implementing standardized practices.

Early kidney damage in diabetic adolescents with increased blood pressure and glomerular hyperfiltration

BACKGROUND

The early impact of type 1 diabetes mellitus (DM1), increased blood pressure and glomerular hyperfiltration (GHF) on kidney damage in adolescents using two urinary markers of kidney injury - neutrophil gelatinase-associated lipocalin (uNGAL) and transferrin (uTransf) - was assessed.

METHODS

The study group consisted of 80 adolescents with DM1, of whom 42 were patients with increased blood pressure (IBP), and 38 were patients with normal blood pressure (NBP). Blood pressure was assessed by 24-hour ambulatory blood-pressure monitoring. All patients showed estimated glomerular-filtration rates (eGFRs) above 90 mL/min/1.73 m2. The control group consisted of 19 healthy, age and gender-matched adolescents.

RESULTS

All diabetic children showed a significant increase in uNGAL (P<0.001). This increase was not related to blood pressure. The uNGAL was elevated in all patients with normal albuminuria, normal eGFR and NBP. The concentration of uTransf was not increased in the entire studied group and was not related to blood pressure. Children with GHF had significantly higher levels of both uTransf (P=0.010) and uNGAL (P<0.001). In patients with GHF, blood pressure was normal. Patients with IBP showed a significantly higher value for triglycerides (r=0.247; P=0.032) and a longer duration of diabetes (r=0.264; P=0.019).

CONCLUSIONS

Diabetes is the leading risk factor for early kidney injury. However, increased blood pressure does not lead to kidney damage, at least in the early stage of DM1. The uNGAL is the early indicator of kidney injury and increases in patients with normal albuminuria, normal glomerular filtration and normal blood pressure. Glomerular hyperfiltration seems to be a marker of diabetic-kidney involvement.

The Awareness, Prevalence, and Risk Factors of Chronic Kidney Disease Among Diabetes Mellitus and Hypertensive Patients in the Aseer Region, Saudi Arabia

Background and objective Given its ever-increasing burden, chronic kidney disease (CKD) represents a significant public health threat. CKD is characterized by a gradual alteration in the kidney's normal glomerular filtration rate, which results in the progressive loss of kidney function over a period of time ranging from a few months to years. Diabetes mellitus (DM) and hypertension (HTN) are well-known risk factors for developing CKD and end-stage renal failure. In light of this, this study aimed to assess the awareness, prevalence, and risk factors of CKD in patients with diabetes and those with HTN in the Aseer region, the Kingdom of Saudi Arabia. Methods A correlational cross-sectional study was conducted among a sample of people across Saudi Arabia. The data collection was conducted via an online questionnaire circulated on social media platforms. The study questionnaire included socioeconomic and demographic information and medical history of DM, HTN, and CKD. Also, patients' awareness of and attitude towards CKD were assessed. Results A total of 301 diabetic or hypertensive patients fulfilling the inclusion criteria completed the study questionnaire. Of them, 174 (57.8%) were aged less than 55 years, while 127 (42.2%) were aged more than 55 years; 200 (66.4%) patients were males. A total of 94 (31.2%) study patients were diabetic, 64 (21.3%) were hypertensive, and 143 (47.5%) were both diabetic and hypertensive; 226 (75.1%) study patients had an overall good awareness of CKD while only 75 (24.9%) showed a poor awareness level. Higher awareness was associated with patients' age, education, and having CKD, DM, or HTN (p<0.05). Conclusion Our findings revealed that CKD was not common among study patients, and its prevalence was found to be less than estimated based on many studies in the literature. Also, diabetic and hypertensive patients showed a higher than satisfactory level of awareness of CKD, especially young patients with high levels of education.

Incidence and predictors of chronic kidney disease among patients with diabetes treated at governmental hospitals of Harari Region, eastern Ethiopia, 2022

Background

Chronic kidney disease (CKD) is the leading cause of morbidity and mortality in diabetic patients. However, limited evidence is available about its incidence and predictors in Ethiopia, specifically in the Harari region.

Methods

A retrospective follow-up study was conducted among 520 diabetes patients who followed their treatment at governmental hospitals in the Harari region between 1 September 2012, and 30 May 2022. The risk of developing CKD was calculated with a 95% CI, and the risk was stratified by type of diabetes mellitus. Predictors of CKD were determined using the Gompertz regression model with the baseline Cox model.

Results

Data from 494 patients were included in the final analysis with 26 (5%) excluded. A total of 51 patients (10.32%) developed CKD over the 10-year follow-up period with an incidence rate of 2.16 cases (95% CI 1.64-2.84) per 100 person-years of observation. The risk of CKD was increased by three times (AHR: 3.09, 45 95% CI: 1.56, 6.14) among patients older than 60 years and by more than three times (AHR: 3.53, 95% CI: 1.43, 8.71) among patients with diabetes mellitus for longer than 5 years of stay with the diabetes mellitus. Moreover, the risk of CKD was increased four-fold among patients with high-density lipoprotein cholesterol (HDL-C) levels <40 mg/dL (AHR: 3.84, 95% CI, 1.80-8.18) and those with positive baseline proteinuria (AHR: 3.77, 95% CI: 1.43-8.71).

Conclusion

We found that one in ten diabetic patients had developed CKD within 10 years of the diabetes mellitus diagnosis. Advanced age, longer duration of diabetes, lower baseline HDL-C level, and proteinuria had increased the hazards of developing CKD. We recommend a more focused follow-up of older adult patients with advanced disease status at baseline for optimal control of diabetes mellitus that prevents its furthering to CKD.

Prevalence of and factors associated with uncontrolled hypertension among patients with early chronic kidney disease attending tertiary hospitals in Dodoma, Tanzania: a cross-sectional study

OBJECTIVE

To determine the prevalence of uncontrolled hypertension and its associated factors among patients with early chronic kidney disease (CKD) attending medical outpatient clinics at tertiary hospitals in Dodoma, Tanzania.

DESIGN

Cross-sectional study.

SETTING

Two tertiary hospitals in Dodoma, Tanzania.

PARTICIPANTS

The participants in this study were adult patients (≥18 years) with early CKD stages (1, 2 and 3) who were attending nephrology and medical outpatient clinics from November 2020 to March 2021. Patients who had been attending the clinic for at least 3 months, had baseline clinical data on their files, had estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2 and who provided written informed consent were eligible. A total of 352 patients were enrolled, of whom 182 were men and 170 were women.

OUTCOME MEASURE

The dependent variable was uncontrolled hypertension among patients with early CKD, based on blood pressure measurements.

RESULTS

The prevalence of hypertension was 58.5% (206 of 352) and the prevalence of uncontrolled hypertension was 58.3% (120 of 206). Among patients with uncontrolled hypertension, 88.3% (106 of 120) had CKD stage 3, 80.2% (96 of 120) reported non-adherence to antihypertensives, 76.7% (92 of 120) were overweight or obese, 72.5% (87 of 120) reported current alcohol use and 26.7% (32 of 120) had diabetes mellitus. Factors that contributed to higher odds of uncontrolled hypertension were: age ≥50 years (OR=5.17, 95 % CI 2.37 to 13.33, p=0.001), alcohol use (OR=11.21, 95% CI 3.83 to 32.84, p=0.001), non-adherence to antihypertensives (OR=10.19, 95% CI 4.22 to 24.61, p=0.001), overweight/obesity (OR=6.28, 95% CI 2.54 to 15.53, p=0.001) and CKD stage 3 (OR=3.52, 95% CI 1.32 to 9.42, p=0.012).

CONCLUSION

Uncontrolled hypertension was highly prevalent among patients with early CKD in this setting and was associated with age, current alcohol use, non-adherence to antihypertensives, overweight/obesity and declining eGFR.

Prevalence and predictors of chronic kidney disease among type 2 diabetic patients worldwide, systematic review and meta-analysis

BACKGROUND

Diabetes is a complicated, chronic condition that requires ongoing medical attention as well as multiple risk-reduction measures beyond glucose control. The prevalence of chronic kidney disease (CKD) is highly variable in different parts of the world due to various environmental, ethnic, socioeconomic, and rural-urban differences. Diabetes is the leading cause of CKD. This study aimed to estimate the global prevalence of CKD and its associated factors among type 2 diabetes(T2DM) patients, provide scientific evidence for a better understanding of the burden of CKD among diabetes mellitus type 2 patients, and design interventional strategies.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist guideline was followed for this review and meta-analysis. The electronic databases (Pub Med, Cochrane Library, Google Scholar, and grey literature) were searched to retrieve articles by using keywords. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used to assess the quality of studies. The meta-analysis was conducted using STATA 17 software. The Meta logistic regression was computed to present the pooled prevalence and Odds ratio (OR) of the determinate factors with a 95% confidence interval (CI).

RESULTS

In this systematic review and meta-analysis 20 studies were done in 13 different countries. The pooled magnitude of chronic kidney disease among type 2 DM patients was 27% (95% CI 21%, 33%). The prevalence of chronic kidney disease differs across countries, with the maximum in the USA and the lowest in the United Arab Emirates. Patients with CKD have an elevated risk of severe renal and cardiovascular morbidity and mortality. Renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide 1 receptor agonists, and, more recently, non-steroidal mineralocorticoid receptor antagonists are among the medications that have been demonstrated to slow the progression of CKD. In this systematic review and meta-analysis increased age, obesity, having a history of type 2 diabetes mellitus, smoking history, presence of hypertension, and cardiac heart disease were factors significantly associated with the presence of chronic kidney disease among type 2 diabetic patients.

CONCLUSIONS

The prevalence of chronic kidney disease among type 2 diabetes mellitus patients was high based on the included 20 articles. The review reported that old age, hypertension, cardiac disease, smoking, obesity, and duration of diabetes mellitus was predictor variable for chronic kidney disease among type 2 diabetic patients. Therefore, in order to lower the morbidity and mortality from chronic kidney disease among type 2 diabetic patients, it is advised to develop both preventive and curative intervention strategies, such as raising awareness, creating a supportive environment, and prescribing appropriate medication at an early stage.

Efficiency of Platelet Transfusion in Patients with Moderate-to-Severe Chronic Kidney Disease and Thrombocytopenia

There have been relatively few studies revealing a decreased platelet count in chronic kidney disease (CKD). Although this hematological abnormality is not as well documented as renal anemia, platelet functions are altered in the uremic environment and there is an increased risk of bleeding. The aim of this study was to assess the effectiveness of the administration of platelet concentrate in CKD based on how patient prognosis was influenced by platelet transfusion therapy. The study monitored 104 patients with CKD and thrombocytopenia who received platelet transfusion during their hospitalization in the period from 2015 to 2021. The complete blood cell count, serum urea and creatinine, and inflammatory status were tested upon admission. The number of transfused platelet units were considered for each patient. A Kruskal-Wallis H test showed that for one transfused platelet unit, the distribution of the number of platelets (×103/µL) was the same across the categories of associated diagnoses, which was seen as possible risk factors for thrombocytopenia, including liver cirrhosis and urosepsis. With a single exception, all patients exceeded the critical threshold of 20 × 103/µL and 14 patients remained under 50 × 103/µL. Even though our patients exceeded the critical threshold of platelet numbers, in patients with multiple comorbidities, severe, uncontrolled hemorrhages could not be prevented in 4.83% of cases.

Genes, environment, and African ancestry in cardiometabolic disorders

The past two decades have been characterized by a substantial global increase in cardiometabolic diseases, but the prevalence and incidence of these diseases and related traits differ across populations. African ancestry populations are among the most affected yet least included in research. Populations of African descent manifest significant genetic and environmental diversity and this under-representation is a missed opportunity for discovery and could exacerbate existing health disparities and curtail equitable implementation of precision medicine. Here, we discuss cardiometabolic diseases and traits in the context of African descent populations, including both genetic and environmental contributors and emphasizing novel discoveries. We also review new initiatives to include more individuals of African descent in genomics to address current gaps in the field.

Burden and predictors of diabetic kidney disease in an adult Ugandan population with new-onset diabetes

BACKGROUND

Despite the growing evidence of diabetic kidney disease (DKD) in adult patients with long-standing diabetes in sub-Saharan Africa, data on its burden and correlates in adult African patients with new-onset diabetes are limited. We, therefore, undertook this study to determine the burden and predictors of DKD in an adult population with new-onset diabetes in Uganda.

METHODS

We collected data on the relevant sociodemographic, clinical, anthropometric, and metabolic characteristics in 519 participants with newly diagnosed diabetes recruited from seven tertiary hospitals. A spot mid-stream urine sample was collected for determination of the urine albumin creatinine ratio (UACR) using Clinitek® microalbumin strips and a point-of-care Clinitek® status analyser. The estimated glomerular filtration rate (e-GFR) was determined using the Chronic Kidney Disease Epidemiology formula. The presence of DKD was defined as a spot UACR ≥ 3 mg/mmol with or without an e-GFR < 60 ml/min/1.73m2.

RESULTS

The median (IQR) age, UACR, and e-GFR of the participants were 48 years (39-57), 2.27 mg/mmol (1.14-3.41), and 121.8 ml/min/1.73m2 (105.4-133.9). UACR ≥ 3 mg/mmol and e-GFR < 60 ml/min/1.73m2 was noted in 175 (33.7%) and 7 (1.4%) participants, respectively. DKD was documented in 175 participants (33.7%). Compared with those without DKD, participants with DKD were more likely to be ≥ 50 years of age (53.7% vs. 43%, p = 0.02) and to have co-existing hypertension at the time of diagnosis (40.6% vs. 30.1%, p = 0.02). On multivariate analysis, self-reported hypertension comorbidity (OR 1.76 95% CI 1.24-2.48, p = 0.002) and body mass index (BMI) ≥ 30 kg/m2 (OR 0.61 95% CI 0.41-0.91, p = 0.02) were noted to independently predict DKD.

CONCLUSION

In this study population, DKD was relatively common and was independently associated with self-reported hypertension comorbidity and BMI ≥ 30 kg/m2.

The prevalence of chronic kidney disease among type 2 diabetes mellitus patients in central South Africa

BACKGROUND

 Type 2 diabetes mellitus (T2DM) is a leading cause of chronic kidney disease (CKD). The prevalence of CKD among T2DM patients in Africa is 22.0%. The cut-off age for dialysing diabetic patients in the resource-limited state sector in South Africa is 50 years. Type 2 diabetes mellitus patients who develop CKD are likely to be excluded from chronic dialysis and rely on control of risk factors, including blood pressure and blood glucose levels, to prevent CKD progression. We aimed to determine the prevalence of CKD among T2DM patients attending the diabetes clinic at Pelonomi Academic Hospital, Bloemfontein.

METHODS

 In this retrospective cross-sectional study, medical records of patients (January 2016 and December 2018) were reviewed to collect demographic and clinical information.

RESULTS

 In total, 244 records were reviewed. Sixty-one (25.0%, 95% confidence interval [CI]: 20% - 30.8%) T2DM patients had CKD. The rate of CKD was slightly higher in males (n = 24/81; 29.6%) compared with females (n = 37/163; 22.7%). Most patients with CKD (n = 58; 95.1%) were 50 years of age. Only 17.8% of patients achieved a glycosylated haemoglobin (HbA1c) of 7.0%. Blood pressure was controlled in 14.3% of hypertensive patients. Renin-angiotensin-aldosterone system inhibitors were used by 78.6% of patients.

CONCLUSION

 A high prevalence of clinically significant CKD among T2DM patients with poor prospects of chronic dialysis in a resource-limited setting was observed. The risk factors for CKD development and progression should be adequately managed in T2DM patients.Contribution: This study emphasises the need for further research and innovation to improve outcomes of T2DM patients with CKD in resource-constrained settings.

Screening of Chronic Kidney Disease in Adults: A 10 years' Experience in North Indian City on World Kidney Day

Chronic kidney disease (CKD) is a complex disease that is asymptomatic in its early stages. Its delayed recognition may predispose patients to adverse outcomes. Early detection and management of kidney disease through screening programs is widely recommended. In the present study, we conducted a screening program at a hospital set up on World Kidney Day for 10 years to detect patients with CKD. The current study constituted 1324 apparently healthy adults, aged >18 years. Information on age, sex, height, weight, history of diabetes mellitus (DM) and hypertension (HTN), and familial history of kidney disease was recorded. Systolic and diastolic blood pressure, random blood sugar; urinalysis, and serum creatinine (Cr) levels were measured. The study outcome was the presence of CKD. Binary logistic regression analysis was applied to find the predictors of CKD. The median age of the study subjects was 40 years. CKD was found in 35.6% of subjects. Age, DM, HTN, and abnormal Cr levels were associated with increasing risk of CKD. The main objective of the present study was to identify the extent of risk relative to the co-factors of CKD and thereby target those who are potentially modifiable, like DM, to intervene at the earliest possible stage to treat the current disease condition and prevent the future health impairment.

Diagnostic value of neutrophil gelatinase-associated lipocalin (NGAL) as an early biomarker for detection of renal failure in hypertensives: a case-control study in a regional hospital in Ghana

BACKGROUND

Renal failure is one of the most serious vascular effects of hypertension. For better therapy and prevention of complications, early kidney disease identification in these patients is absolutely essential. However, current studies have proposed plasma Neutrophil Gelatinase Associated Lipocalin (pNGAL) to be a better biomarker comparative to serum creatinine (SCr). This study assessed the diagnostic utility of plasma neutrophil gelatinase-associated lipocalin (pNGAL) as a biomarker for early nephropathy diagnosis in hypertensive individuals.

METHODS

This hospital-based case-control study comprised 140 hypertensives and 70 healthy participants. A well-structured questionnaire and patient case notes were used to document relevant demographic and clinical information. 5 ml of venous blood sample was taken to measure fasting blood sugar levels, creatinine, and plasma NGAL levels. All data were analyzed using the Statistical Package for Social Sciences (SPSS release 20.0, copyrite©SPSS Inc.) and a p-value < 0.05 was considered statistically significant.

RESULTS

In this study the plasma neutrophil gelatinase-associated lipocalin (NGAL) levels were significantly higher in cases compared to controls. Hypertensive cases also had significantly higher waist-circumference compared to the control group. The median fasting blood sugar level was significantly higher in cases compared to controls. This study established the use of Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Cockcroft and Gault formula (CG) as the most accurate predictive equations for assessing renal dysfunction. The threshold for NGAL above which renal impairment can be assessed was found to be 109.4 ng/ml (sen-91%, spec. - 68%), 120 ng/ml (sen- 100%, spec- 72%) and 118.6 ng/ml (sen- 83%, spec- 72%) for MDRD, CKD-EPI and CG equations respectively. The prevalence of CKD was 16.4%, 13.6% and 20.7% respectively using the MDRD, CKD-EPI and CG.

CONCLUSION

From this study, pNGAL is a better indicator of kidney impairment in the early stages of CKD as compared with sCr in general hypertensive population.

Chronic Kidney Disease Burden in Low-Resource Settings: Regional Perspectives

The burden of chronic kidney disease (CKD) has increased exponentially worldwide but more so in low- and middle-income countries. Specific risk factors in these regions expose their populations to an increased risk of CKD, such as genetic risk with APOL1 among populations of West African heritage or farmers with CKD of unknown etiology that spans various countries across several continents to immigrant/indigenous populations in both low- and high-income countries. Low- and middle-income economies also have the double burden of communicable and noncommunicable diseases, both contributing to the high prevalence of CKD. The economies are characterized by low health expenditure, sparse or nonexistent health insurance and welfare programs, and predominant out-of-pocket spending for medical care. This review highlights the challenges in populations with CKD from low-resource settings globally and explores how health systems can help ameliorate the CKD burden.

The prevalence of chronic kidney disease in South Africa - limitations of studies comparing prevalence with sub-Saharan Africa, Africa, and globally

BACKGROUND

Chronic kidney disease (CKD) is a globally significant non-communicable disorder. CKD prevalence varies between countries and within a country. We compared the prevalence rates of CKD in South Africa with sub-Saharan Africa, Africa, and globally.

METHODS

We registered a systematic review with the International Prospective Register of Systematic Reviews for prevalence studies reporting CKD stages III-V from 2013 to 2021. The analysis sought to explain any significant differences in prevalence rates. The R statistical package was used for data analysis. Comparisons included measures of effect size due to the large sample sizes analysed. We also compared sex differences in prevalence rates, common aetiologies, and type of study methodologies employed.

RESULTS

Eight studies were analysed, with two from each region. The matched prevalence rates of CKD between the various regions and South Africa showed significant differences, except for one comparison between South Africa and an African study [p = 0.09 (95% CI - 0.04-0.01)]. Both sub-Saharan African studies had a higher prevalence than South Africa. One study in Africa had a higher prevalence, while the other had a lower prevalence, whilst one Global study had a higher prevalence, and the other had a lower prevalence compared to South Africa. The statistical differences analysed using the Cramer's V test were substantially less than 0.1. Thus, differences in comparisons were largely due to differences in sample sizes rather than actual differences.

CONCLUSION

Variable prevalence rates between regions included disparities in sample size, definitions of CKD, lack of chronicity testing and heterogeneous laboratory estimations of eGFR. Improved consistency and enhanced methods for diagnosing and comparing CKD prevalence are essential.

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

BACKGROUND

Chronic kidney disease (CKD) is a major public health issue worldwide and is an important contributor to the overall non-communicable disease burden. Chronic kidney disease is usually asymptomatic, and insidiously and silently progresses to advanced stages in resource limited settings.

METHODOLOGY

A prospective longitudinal study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2022. Demographic and clinical data were extracted from the ongoing continuous clinic records, as well as measurements of vital signs and interviews at baseline and at follow up. Patients provided urine and blood samples for laboratory investigations as standard of care at study entry (0) and at 24 months, and were followed up prospectively for two (2) years. Data were descriptively and inferentially entered into REDcap and analysed using STATA version 17, and multivariable logistic regression analysis was used to identify predictors of CKD progression.

RESULTS

A total of 312 patients were enrolled into the study, 297 (95.2%) patients completed the study, 10 (3.2%) patients were lost to follow and 5 (1.6%) patients died during the study period. The prevalence of CKD progression was 49.5%, while that of CKD remission was 33% and CKD regression was 17.5%. For patients with CKD progression the median age at baseline was 58 (46-67) years, the median eGFR was 37 (32-51) mL/min/1.73 m2, median urine protein creatinine ratio (uPCR) was 0.038 (0.016-0.82) g/mmol and the median haemoglobin (Hb) was 13.1 (11.7-14.4) g/dl; 95.2% had hypertension, 40.1% patients had diabetes mellitus and 39.5% had both hypertension and diabetes mellitus. Almost half (48.3%) of patients with CKD progression had severely increased proteinuria and 45.6% had anaemia. Variables associated with higher odds for CKD progression after multivariable logistic regression analysis were severely increased proteinuria (OR 32.3, 95% CI 2.8-368.6, P = 0.005), moderately increased proteinuria (OR 23.3, 95% CI 2.6-230.1, P = 0.007), hypocalcaemia (OR 3.8, 95% CI 1.0-14.8, P = 0.047), hyponatraemia (OR 4.5, 95% CI 0.8-23.6, P = 0.042), anaemia (OR 2.1, 95% CI 1.0-4.3, P = 0.048), diabetes mellitus (OR 1.8, 95% CI 0.9-3.6, P = 0.047), elevated HbA1c (OR 1.8, 95% CI 1.2-2.8, P = 0.007) and current smoking (OR 2.8, 95% CI 0.9-8.6, P = 0.049).

CONCLUSION

Our study identified a higher prevalence of CKD progression in a prospective longitudinal study of black patients with CKD compared with literature reports. CKD Progression was associated with proteinuria, diabetes mellitus, elevated HbA1c, anaemia, hypocalcaemia, hyponatraemia and current smoking in a cohort of black patients with CKD who had controlled hypertension and diabetes mellitus at baseline.

Causes of chronic kidney disease in the general population of Iran: A systematic review and meta-analysis

Chronic kidney disease is a significant public health problem worldwide. However, the causes of chronic kidney disease in Iran are unclear. This systematic review and meta-analysis identified the causes of chronic kidney disease in the general population of Iran. International databases (PubMed, Web of Science, Scopus, and Google Scholar) and national databases (Scientific Information Database and Magiran) were searched for studies published until March 1, 2018. The quality of the studies was assessed using the checklist developed by Hoy et al. Of 2518 retrieved studies, 26 studies involving 34,683 patients with chronic kidney disease stages 1 to 5 were included in the meta-analysis. The mean age of the cohort was 53.6±15.02 years. The results of the random-effects model showed that the three leading causes of chronic kidney disease were diabetes, hypertension, and glomerulonephritis, with an overall prevalence of 27.7%, 27.6%, and 6.4%, respectively. These results indicate the importance of addressing these risk factors at the national level to reduce disease prevalence.

Prospective cohort study to identify prevalence, risk factors and outcomes of infection associated kidney disease in a regional hospital in Malawi

OBJECTIVES

Acute kidney injury (AKI) is a common and severe complication of community acquired infection, but data on impact in sub-Saharan Africa (SSA) are lacking. We determined prevalence, risk factors and outcomes of infection associated kidney disease in adults in Malawi.

DESIGN

A prospective cohort study of adults admitted to hospital with infection, from February 2021 to June 2021, collecting demographic, clinical, laboratory and ultrasonography data.

SETTING

Adults admitted to a regional hospital in Southern Region, Malawi.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcomes were prevalence of kidney disease and mortality by Cox proportional hazard model. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Secondary outcomes were risk factors for AKI identified by logistic regression and prevalence of chronic kidney disease at 3 months.

RESULTS

We recruited 101 patients presenting to hospital with infection. Median age was 38 years (IQR: 29-48 years), 88 had known HIV status of which 53 (60%) were living with HIV, and of these 42 (79%) were receiving antiretroviral therapy. AKI was present in 33/101 at baseline, of which 18/33 (55%) cases were severe (KDIGO stage 3). At 3 months, 28/94 (30%) participants had died, while 7/61 (11%) of survivors had chronic kidney disease. AKI was associated with older age (age: 60 years vs 40 years, OR: 3.88, 95% CI 1.82 to 16.64), and HIV positivity (OR: 4.08, 95% CI 1.28 to 15.67). Living with HIV was independently associated with death (HR: 3.97, 95% CI 1.07 to 14.69).

CONCLUSIONS

Kidney disease is common among hospitalised adults with infection in Malawi, with significant kidney impairment identified at 3 months. Our study highlights the difficulty in diagnosing acute and chronic kidney disease, and the need for more accurate methods than creatinine based estimated glomerular filtration rate (eGFR) equations for populations in Africa. Patients with kidney impairment identified in hospital should be prioritised for follow-up.

Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa

Background

The prevalence of chronic kidney disease (CKD) is increasing worldwide; black patients have an increased risk of developing CKD and end stage kidney disease (ESKD) at significantly higher rates than other races.

Methods

A cross sectional study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2020. Demographic and clinical data were extracted from the ongoing kidney outpatient clinic records and interviews, and were filled in a questionnaire. Patients provided blood and urine for laboratory investigations as standard of care, and data were descriptively and inferentially entered into REDcap and analysed using STATA version 17. Multivariable logistic regression analysis was used to identify demographic and clinical variables associated with advanced CKD.

Results

A total of 312 black patients with CKD were enrolled in the study with a median age of 58 (IQR 46–67) years; 58% patients had advanced CKD, 31.5% of whom had grossly increased proteinuria, 96.7% had hypertension, 38.7% had diabetes mellitus and 38.1% had both hypertension and diabetes mellitus. In patients with advanced CKD, the median age was 61 (IQR 51–69) years, eGFR 33 (30–39) mL/min/1.73 m2, serum bicarbonate 22 (IQR 20–24), haemoglobin 12.9 (IQR 11.5–14.0) g/dl and serum uric acid 0.43 (IQR 0.37–0.53). The prevalence of metabolic acidosis was 62.4%, anemia 46.4% and gout 30.9% among those with advanced CKD, while the prevalence of metabolic acidosis and anaemia was 46.6% and 25.9% respectively in those with early CKD. Variables with higher odds for advanced CKD after multivariable logistic regression analysis were hypertension (OR 3.3, 95% CI 1.2–9.2, P = 0.020), diabetes mellitus (OR 1.8, 95% CI 1.1–3.3, P = 0.024), severe proteinuria (OR 3.5, 95% CI 1.9–6.5, P = 0.001), angina (OR 2.5, 95% CI 1.2–5.1, P = 0.008), anaemia (OR 2.9, 95% CI 1.7–4.9, P = 0.001), hyperuricemia (OR 2.4, 95% CI 1.4–4.1, P = 0.001), and metabolic acidosis (OR 2.0, 95% CI 1.2–3.1, P = 0.005). Other associations with advanced CKD were loss of spouse (widow/widower) (OR 3.2, 95% CI 1.4–7.4, P = 0.006), low transferrin (OR 2.4, 95% CI 1.1–5.1, P = 0.028), hyperkalemia (OR 5.4, 95% CI 1.2–24.1, P = 0.029), use of allopurinol (OR 2.4, 95% CI 1.4–4.3, P = 0.005) and doxazosin (OR 1.9, 95% CI 1.2–3.1, P = 0.006).

Conclusion

Hypertension and diabetes mellitus were strongly associated with advanced CKD, suggesting a need for primary and secondary population-based prevention measures. Metabolic acidosis, anemia with low transferrin levels, hyperuricemia and hyperkalemia were highly prevalent in our patients, including those with early CKD, and they were strongly associated with advanced CKD, requiring clinicians and dietitians to be proactive in supporting the needs of CKD patients in meeting their daily dietary requirements towards preventing and slowing the progression of CKD.

Predictors of rapid progression of estimated glomerular filtration rate among persons living with diabetes and/or hypertension in Ghana: Findings from a multicentre study

In Ghana, the prevalence of chronic kidney disease (CKD) is 28.5% in diabetic hypertensive patients, 26.3% in hypertensives, and 16.1% in those with diabetes only. Trajectories of estimated glomerular filtration rate (eGFR) among patients with hypertension and diabetes are important for monitoring and instituting prompt interventions to prevent the development of CKD, especially in the face of limited access to renal replacement therapy. In this prospective multi‐center study conducted at five hospitals in Ghana, we assessed predictors of rapid eGFR progression among adults with hypertension and/or diabetes. Serum creatinine at baseline and 18 months were taken and eGFR determined using the CKD‐EPI formula. eGFR trajectory was defined as fast when the decline of GFR was ≥ 5 ml/min/1.73 m² per year. A multivariable logistic regression model was fitted to identify predictors of the fast progression of eGFR. Total 13% of 1261 participants met the criteria for rapid decline in eGFR. The adjusted odds ratio, aOR (95%CI), of four factors adversely associated with fast progression of eGFR were: increasing age 1.20 (1.03–1.14), partial health insurance coverage for medications 1.48 (1.05–2.08), history of smoking 1.91 (1.11–3.27), angiotensin‐receptor blockade use 1.55 (1.06–2.25) while metformin use was protective .56 (.35–.90). Proportion with eGFR <60 ml/min increased from 14% at baseline to 19% at month 18. Effective health insurance policies to improve medication access and avoidance of smoking are interventions that may mitigate the rising burden of CKD in individuals with diabetes mellitus and/or hypertension.

Prevalence of chronic kidney disease and associated factors among patients visiting renal unit of St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia: A cross-sectional study design

Objective:

This study aimed to assess the magnitude of chronic kidney disease among patients attending the renal unit of St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Methods:

Institution-based cross-sectional study was conducted among 620 randomly selected patients who visited St. Paul’s Hospital Millennium Medical College renal unit from 1 January to 31 December, 2019. Data on sociodemographic characteristics, clinical conditions, behavioral risk factors, electrolytes, and renal function tests were extracted from patients’ medical records. To enter and analyze data, EpiData 3.1 and SPSS 22 were used, respectively. Bivariable and multivariable logistic regression analyses were conducted to see the association between predictor variables and chronic kidney disease. Adjusted odds ratio at 95% confidence interval was used to describe significant association. A p-value <0.05 was considered to declare an association between chronic kidney disease and independent variables.

Results:

Of 620 patients, 139 (22.4%; 95% confidence interval: 19.2, 25.6) and 61 (9.8%; 95% confidence interval: 7.4, 12.3) had chronic kidney disease using cut-off value of 90 and 60 ml/min/1.73 m², respectively. Having urinary tract obstruction (adjusted odds ratio = 2.32; 95% confidence interval: 1.32, 4.06), hypertension (adjusted odds ratio = 4.06; 95% confidence interval: 2.50, 6.59), diabetes mellitus (adjusted odds ratio = 2.80; 95% confidence interval: 1.62, 4.85), cardiovascular disease (adjusted odds ratio = 2.54; 95% confidence interval: 1.60, 4.01), and age (adjusted odds ratio = 1.83; 95% confidence interval: 1.44, 3.57), family history of chronic kidney disease (adjusted odds ratio = 2.26; 95% confidence interval: 1.36, 3.75) were factors positively associated with having chronic kidney disease.

Conclusion:

Nearly, one out of five and one out of ten patients who visited the renal unit had chronic kidney disease using the two thresholds as a cut value. Patients with concomitant urinary tract obstruction, age, hypertension, diabetes mellitus, cardiovascular disease, and a family history of chronic kidney disease were more likely to develop chronic kidney disease. Regular screening for chronic kidney disease, optimal blood sugar, and blood pressure management should be practiced.

Prevalence of chronic kidney disease and associated factors among patients with chronic illness in Ethiopia: A systematic review and meta-analysis

Objective:

The main aim of this systematic review and meta-analysis is to provide summarized evidence on the prevalence of chronic kidney disease and associated factors among patients with chronic illness in Ethiopia.

Method:

Databases of MEDLINE/PubMed, Embase, Google Scholar, CINAHL, Cochrane library, and ScienceDirect were searched. In addition, gray literatures were searched manually from university repositories. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to select potential studies. Microsoft Excel 2013 sheet template was used to extract data. The quality of included studies was assessed by utilizing the Newcastle-Ottawa Scale. STATA software version 14.0 is used to compute the estimated pooled prevalence and associated factors of chronic kidney disease.

Result:

Twelve articles that fulfilled the inclusion criteria were included. The pooled estimate of chronic kidney disease among patients with chronic illnesses in Ethiopia is 21.71% (95% confidence interval: 17.67, 25.74). The highest prevalence of chronic kidney disease among patients with chronic illnesses is from Oromia (32.55% (confidence interval: 19.91, 45.19)). Glomerular filtration rate showed a comparable pooled prevalence from Cockroft-Gault and MDRD methods; 22.38% (confidence interval: 15.83, 28.92), 22.18 (confidence interval: 18.01, 26.34), respectively. Hypertensives become more likely to have chronic kidney disease compared with normotensive patients, (odds ratio = 3.01, 95% confidence interval: 1.33, 6.81).

Conclusion:

Prevalence of chronic kidney disease among chronic illness patients was significantly high. Hypertension is significantly associated with chronic kidney disease. Hence, we recommend that continuous screening of possible risk factors and proper follow-up and management strategies should be designed.

Mitochondrial Oxidative Stress and Cell Death in Podocytopathies

Podocytopathies are kidney diseases that are driven by podocyte injury with proteinuria and proteinuria-related symptoms as the main clinical presentations. Albeit podocytopathies are the major contributors to end-stage kidney disease, the underlying molecular mechanisms of podocyte injury remain to be elucidated. Mitochondrial oxidative stress is associated with kidney diseases, and increasing evidence suggests that oxidative stress plays a vital role in the pathogenesis of podocytopathies. Accumulating evidence has placed mitochondrial oxidative stress in the focus of cell death research. Excessive generated reactive oxygen species over antioxidant defense under pathological conditions lead to oxidative damage to cellular components and regulate cell death in the podocyte. Conversely, exogenous antioxidants can protect podocyte from cell death. This review provides an overview of the role of mitochondrial oxidative stress in podocytopathies and discusses its role in the cell death of the podocyte, aiming to identify the novel targets to improve the treatment of patients with podocytopathies.

Prevalence of chronic kidney disease stages 3-5 in low- and middle-income countries in Asia: A systematic review and meta-analysis

Chronic kidney disease (CKD) is a major public health problem in low- and middle-income countries (LMICs). Although CKD prevalence has been rapidly increasing in LMICs, particularly in Asia, quantitative studies on the current epidemiology of CKD in this region are limited. This study aimed to identify the prevalence of CKD stages 3-5 in LMICs in Asia, by subregion, country economy classification, identification of CKD, traditional and non-traditional risk factors. A systematic review and meta-analysis of observational studies was conducted through a literature search of seven electronic databases and grey literature search published until November 2021. The Newcastle-Ottawa quality assessment scale (NOS) was used to assess the risk of bias of each study. A random-effects model was used to estimate pooled prevalence. The protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42019120519). Of 4,548 potentially relevant records, 110 studies with moderate and high quality were included with 4,760,147 subjects. The average prevalence (95% CI) of CKD stages 3-5 in 14 LMICs in Asia was 11.2% (9.3-13.2%). The prevalence of CKD stages 3-5 was varied among subregions and country economic classification. CKD prevalence was 8.6% (7.2-10.2%) in east Asia, 12.0% (7.7-17.0%) in south-east Asia, 13.1% (8.7-18.2%) in western Asia, and 13.5% (9.5-18.0%) in south Asia. CKD prevalence was 9.8% (8.3-11.5%) in upper-middle-income countries and 13.8% (9.9-18.3%) in lower-middle-income countries. Prevalence of CKD stage 3-5 in LMICs in Asia is comparable to global prevalence. High level of heterogeneity was observed. Study of factors and interventions that lead to the delay of CKD progression is needed.

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.

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.

Risk factors associated with albuminuria in Rwanda: results from a STEPS survey

BACKGROUND

Non-communicable diseases (NCDs) are a growing burden which affects every part of the world, including developing countries. Chronic kidney disease (CKD) has varied etiology which can result from or complicate other NCDs such as diabetes and cardiovascular diseases. The growing prevalence of NCDs coupled with the increasing age in most developing countries, has seen a marked increase of CKD in these settings. CKD has been described as "the most neglected NCD" and greatly affects the quality of life of patients. It also places a huge economic burden on societies. However, few epidemiological data exist, particularly in sub-Saharan Africa. Assessment of the prevalence of albuminuria as a marker of kidney damage and CKD progression and its main risk factors was thus needed in Rwanda.

METHODS

This study analyzed data collected during the first STEPwise approach to NCD risk factor Surveillance (STEPS) survey in Rwanda, conducted from 2012 to 2013, to assess the prevalence of albuminuria. A multistage cluster sampling allowed to select a representative sample of the general population. Furthermore, descriptive, as well as univariable analyses and multiple logistic regression were performed to respond to the research question.

RESULTS

This survey brought a representative sample of 6,998 participants, among which 4,384 (62.65%) were female. Median age was 33 years (interquartile range, IQR 26-44), and over three quarters (78.45%) lived in rural areas. The albuminuria prevalence was 105.9 per 1,000 population. Overall, semi-urban and urban residency were associated with lower odds of CKD (odds ratio, OR 0.36, CI 0.23-0.56, p<0.001 and OR 0.34, CI 0.23-0.50, p<0.001, respectively) than rural status. Being married or living with a partner had higher odds (OR 1.44 (CI 1.03-2.02, p=0.031) and OR 1.62 (CI 1.06-2.48, p=0.026), respectively) of CKD than being single. Odds of positive albuminuria were also greater among participants living with human immunodeficiency virus (HIV) (OR 1.64, CI 1.09- 2.47, p=0.018). Gender, age group, smoking status and vegetable consumption, body mass index (BMI) and hypertension were not associated with albuminuria.

CONCLUSION

The albuminuria prevalence was estimated at 105.9 per 1,000 in Rwanda. Rural residence, partnered status and HIV positivity were identified as main risk factors for albuminuria. Increased early screening of albuminuria to prevent CKD among high-risk groups, especially HIV patients, is therefore recommended.