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

Wisdom P Nakanga, Josephine E Prynn, Louis Banda, Robert Kalyesubula, Laurie A Tomlinson, Moffat Nyirenda, Amelia C Crampin, Wisdom P Nakanga, Josephine E Prynn, Louis Banda, Robert Kalyesubula, Laurie A Tomlinson, Moffat Nyirenda, Amelia C Crampin

Abstract

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

Keywords: Epidemiology; Kidney Disease; Sub Saharan Africa.

Conflict of interest statement

No competing interests were disclosed.

Copyright: © 2019 Nakanga WP et al.

Figures

Figure 1.. Map of Malawi Showing location…
Figure 1.. Map of Malawi Showing location rural Karonga and urban Lilongwe.
Figure 2.. Conceptual framework of exposures potentially…
Figure 2.. Conceptual framework of exposures potentially contributing to low estimated glomerular filtration rate (eGFR).
Figure 3.. Age specific prevalence of low…
Figure 3.. Age specific prevalence of low estimated glomerular filtration rate (eGFR) in the rural site.
Figure 4.. Age-specific prevalence of low estimated…
Figure 4.. Age-specific prevalence of low estimated glomerular filtration rate (eGFR) in the urban study site.

References

    1. Ephraim RK, Biekpe S, Sakyi SA, et al. : Prevalence of chronic kidney disease among the high risk population in South-Western Ghana; a cross sectional study. Can J Kidney Health Dis. 2015;2(1):40. 10.1186/s40697-015-0076-3
    1. Jayasekara KB, Dissanayake DM, Sivakanesan R, et al. : Epidemiology of chronic kidney disease, with special emphasis on chronic kidney disease of uncertain etiology, in the north central region of Sri Lanka. J Epidemiol. 2015;25(4):275–80. 10.2188/jea.JE20140074
    1. Garcia-Garcia G, Jha V, Tao Li PK, et al. : Chronic kidney disease (CKD) in disadvantaged populations. Clin Kidney J. 2015;8(1):3–6. 10.1093/ckj/sfu124
    1. Adeniyi AB, Laurence CE, Volmink JA, et al. : Prevalence of chronic kidney disease and association with cardiovascular risk factors among teachers in Cape Town, South Africa. Clin Kidney J. 2017;10(3):363–369. 10.1093/ckj/sfw138
    1. Hill NR, Fatoba ST, Oke JL, et al. : Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One. 2016;11(7):e0158765. 10.1371/journal.pone.0158765
    1. Kaze FF, Meto DT, Halle MP, et al. : Prevalence and determinants of chronic kidney disease in rural and urban Cameroonians: a cross-sectional study. BMC Nephrol. 2015;16(1):117. 10.1186/s12882-015-0111-8
    1. Sumaili EK, Cohen EP, Zinga CV, et al. : High prevalence of undiagnosed chronic kidney disease among at-risk population in Kinshasa, the Democratic Republic of Congo. BMC Nephrol. 2009;10:18. 10.1186/1471-2369-10-18
    1. Glaser N, Deckert A, Phiri S, et al. : Comparison of Various Equations for Estimating GFR in Malawi: How to Determine Renal Function in Resource Limited Settings? PLoS One. 2015;10(6):e0130453. 10.1371/journal.pone.0130453
    1. Glaser N, Phiri S, Bruckner T, et al. : The prevalence of renal impairment in individuals seeking HIV testing in Urban Malawi. BMC Nephrol. 2016;17(1):186. 10.1186/s12882-016-0403-7
    1. Singh M, Magula NP, Hariparshad S, et al. : A comparison of urban and rural patients with chronic kidney disease referred to Inkosi Albert Luthuli Central Hospital in Durban, South Africa. African Journal of Nephrology. 2017;20(1):34–38. 10.21804/20-1-1358
    1. Rajapakse S, Shivanthan MC, Selvarajah M: Chronic kidney disease of unknown etiology in Sri Lanka. Int J Occup Environ Health. 2016;22(3):259–264. 10.1080/10773525.2016.1203097
    1. Abd ElHafeez S, Bolignano D, D'Arrigo G, et al. : Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review. BMJ Open. 2018;8(1):e015069. 10.1136/bmjopen-2016-015069
    1. Crampin AC, Kayuni N, Amberbir A, et al. : Hypertension and diabetes in Africa: design and implementation of a large population-based study of burden and risk factors in rural and urban Malawi. Emerg Themes Epidemiol. 2016;13:3. 10.1186/s12982-015-0039-2
    1. Price AJ, Crampin AC, Amberbir A, et al. : Prevalence of obesity, hypertension, and diabetes, and cascade of care in sub-Saharan Africa: a cross-sectional, population-based study in rural and urban Malawi. Lancet Diabetes Endocrinol. 2018;6(3):208–222. 10.1016/S2213-8587(17)30432-1
    1. Sankoh O, Sharrow D, Herbst K, et al. : The INDEPTH standard population for low- and middle-income countries, 2013. Glob Health Action. 2014;7:23286. 10.3402/gha.v7.23286
    1. Singh NP, Ingle GK, Saini VK, et al. : Prevalence of low glomerular filtration rate, proteinuria and associated risk factors in North India using Cockcroft-Gault and Modification of Diet in Renal Disease equation: an observational, cross-sectional study. BMC Nephrol. 2009;10:4. 10.1186/1471-2369-10-4
    1. Kalyesubula R, Hau JP, Asiki G, et al. : Impaired renal function in a rural Ugandan population cohort [version 2; peer review: 1 approved, 1 approved with reservations]. Wellcome Open Res. 2019;3:149 10.12688/wellcomeopenres.14863.2
    1. Lebov JF, Valladares E, Peña R, et al. : A population-based study of prevalence and risk factors of chronic kidney disease in León, Nicaragua. Can J Kidney Health Dis. 2015;2:6. 10.1186/s40697-015-0041-1
    1. Trevisan R, Dodesini AR: The Hyperfiltering Kidney in Diabetes. Nephron. 2017;136(4):277–280. 10.1159/000448183
    1. Delanaye P, Glassock RJ, De Broe ME: Epidemiology of chronic kidney disease: think (at least) twice! Clin Kidney J. 2017;10(3):370–374. 10.1093/ckj/sfw154
    1. : Hypertension and diabetes in Africa: design and implementation of a large population-based study of burden and risk factors in rural and urban Malawi. Emerg Themes Epidemiol.2016;13: 10.1186/s12982-015-0039-2 3 10.1186/s12982-015-0039-2
    1. : Prevalence of chronic kidney disease among the high risk population in South-Western Ghana; a cross sectional study. Can J Kidney Health Dis.2015;2: 10.1186/s40697-015-0076-3 40 10.1186/s40697-015-0076-3
    1. : Prevalence of chronic kidney disease in diabetic adult out-patients in Tanzania. BMC Nephrol.2013;14: 10.1186/1471-2369-14-183 183 10.1186/1471-2369-14-183

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