Kidney damage and associated risk factors in rural and urban sub-Saharan Africa (AWI-Gen): a cross-sectional population study
Summary: Background: Rapid epidemiological health transitions occurring in vulnerable populations in Africa that have an existing burden of infectious and non-communicable diseases predict an increased risk and consequent prevalence of kidney disease. However, few studies have characterised the tru...
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-12-01
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| Series: | The Lancet Global Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X19304437 |
| _version_ | 1828402639565488128 |
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| author | Jaya A George, PhD Jean-Tristan Brandenburg, PhD June Fabian, MD Nigel J Crowther, ProfPhD Godfred Agongo, MPhil Marianne Alberts, ProfPhD Stuart Ali, PhD Gershim Asiki, PhD Palwende R Boua, MSc F Xavier Gómez-Olivé, PhD Felistas Mashinya, PhD Lisa Micklesfield, PhD Shukri F Mohamed, MPH Freedom Mukomana, MSc Shane A Norris, ProfPhD Abraham R Oduro, MBChB Cassandra Soo, MSc Hermann Sorgho, PhD Alisha Wade, DPhil Saraladevi Naicker, ProfPhD Michèle Ramsay, ProfPhD |
| author_facet | Jaya A George, PhD Jean-Tristan Brandenburg, PhD June Fabian, MD Nigel J Crowther, ProfPhD Godfred Agongo, MPhil Marianne Alberts, ProfPhD Stuart Ali, PhD Gershim Asiki, PhD Palwende R Boua, MSc F Xavier Gómez-Olivé, PhD Felistas Mashinya, PhD Lisa Micklesfield, PhD Shukri F Mohamed, MPH Freedom Mukomana, MSc Shane A Norris, ProfPhD Abraham R Oduro, MBChB Cassandra Soo, MSc Hermann Sorgho, PhD Alisha Wade, DPhil Saraladevi Naicker, ProfPhD Michèle Ramsay, ProfPhD |
| author_sort | Jaya A George, PhD |
| collection | DOAJ |
| description | Summary: Background: Rapid epidemiological health transitions occurring in vulnerable populations in Africa that have an existing burden of infectious and non-communicable diseases predict an increased risk and consequent prevalence of kidney disease. However, few studies have characterised the true burden of kidney damage and associated risk factors in Africans. We investigated the prevalence of markers for kidney damage and known risk factors in rural and urban settings in sub-Saharan Africa. Methods: In this cross-sectional population study (Africa Wits-International Network for the Demographic Evaluation of Populations and their Health Partnership for Genomic Studies [AWI-Gen]), we recruited unrelated adult participants aged 40–60 years from four rural community research sites (Nanoro, Burkina Faso; Navrongo, Ghana; Agincourt and Dikgale, South Africa), and two urban community research sites (Nairobi, Kenya; and Soweto, South Africa). Participants were identified and selected using random sampling frames already in use at each site. Participants completed a lifestyle and medical history questionnaire, had anthropometric and blood pressure measurements taken, and blood and urine samples were collected. Markers of kidney damage were defined as low estimated glomerular filtration rate (eGFR; <60 mL/min per 1·73 m2), presence of albuminuria (urine albumin creatinine ratio >3 mg/mmol); or chronic kidney disease (low eGFR or albuminuria, or both). We calculated age-adjusted prevalence of chronic kidney disease, low eGFR, and albuminuria by site and sex and used logistic regression models to assess risk factors of kidney damage. Findings: Between August, 2013, and August, 2016, we recruited 10 702 participants, of whom 8110 were analysable. 4120 (50·8%) of analysable participants were male, with a mean age of 49·9 years (SD 5·8). Age-standardised population prevalence was 2·4% (95% CI 2·1–2·8) for low eGFR, 9·2% (8·4–10·0) for albuminuria, and 10·7% (9·9–11·7) for chronic kidney disease, with higher prevalences in South African sites than in west African sites (14·0% [11·9–16·4] in Agincourt vs 6·6% [5·5–7·9] in Nanoro). Women had a higher prevalence of chronic kidney disease (12·0% [10·8–13·2] vs 9·5% [8·3–10·8]) and low eGFR (3·0% [2·6–3·6] vs 1·7% [1·3–2·3]) than did men, with no sex-specific differences for albuminuria (9·9% [8·8–11·0] vs 8·4% [7·3–9·7]). Risk factors for kidney damage were older age (relative risk 1·04, 95% CI 1·03–1·05; p<0·0001), hypertension (1·97, 1·68–2·30; p<0·0001), diabetes (2·22, 1·76–2·78; p<0·0001), and HIV (1·65, 1·36–1·99; p<0·0001); whereas male sex was protective (0·85, 0·73–0·98; p=0·02). Interpretation: Regional differences in prevalence and risks of chronic kidney disease in sub-Saharan Africa relate in part to varying stages of sociodemographic and epidemiological health transitions across the area. Public health policy should focus on integrated strategies for screening, prevention, and risk factor management in the broader non-communicable disease and infectious diseases framework. Funding: National Human Genome Research Institute, Office of the Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Environmental Health Sciences, the Office of AIDS Research, and National Institute of Diabetes and Digestive and Kidney Diseases, all of the National Institutes of Health, and the South African Department of Science and Technology. |
| first_indexed | 2024-12-10T10:05:26Z |
| format | Article |
| id | doaj.art-3ec30aa779ee4ade9d9267e6a24950cb |
| institution | Directory Open Access Journal |
| issn | 2214-109X |
| language | English |
| last_indexed | 2024-12-10T10:05:26Z |
| publishDate | 2019-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Global Health |
| spelling | doaj.art-3ec30aa779ee4ade9d9267e6a24950cb2022-12-22T01:53:16ZengElsevierThe Lancet Global Health2214-109X2019-12-01712e1632e1643Kidney damage and associated risk factors in rural and urban sub-Saharan Africa (AWI-Gen): a cross-sectional population studyJaya A George, PhD0Jean-Tristan Brandenburg, PhD1June Fabian, MD2Nigel J Crowther, ProfPhD3Godfred Agongo, MPhil4Marianne Alberts, ProfPhD5Stuart Ali, PhD6Gershim Asiki, PhD7Palwende R Boua, MSc8F Xavier Gómez-Olivé, PhD9Felistas Mashinya, PhD10Lisa Micklesfield, PhD11Shukri F Mohamed, MPH12Freedom Mukomana, MSc13Shane A Norris, ProfPhD14Abraham R Oduro, MBChB15Cassandra Soo, MSc16Hermann Sorgho, PhD17Alisha Wade, DPhil18Saraladevi Naicker, ProfPhD19Michèle Ramsay, ProfPhD20Department of Chemical Pathology, National Health Laboratory Service and University of Witwatersrand, Johannesburg, South Africa; Correspondence to: Dr Jaya A George, Department of Chemical Pathology, National Health Laboratory Service and University of Witwatersrand, Johannesburg 2193, South AfricaSydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaWits Donald Gordon Medical Centre, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaDepartment of Chemical Pathology, National Health Laboratory Service and University of Witwatersrand, Johannesburg, South AfricaDivision of Human Genetics, National Health Laboratory Service and University of Witwatersrand, Johannesburg, South Africa; Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Navrongo Health Research Centre, Navrongo, GhanaDepartment of Pathology and Medical Science, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South AfricaSydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaAfrican Population and Health Research Center, Nairobi, KenyaDivision of Human Genetics, National Health Laboratory Service and University of Witwatersrand, Johannesburg, South Africa; Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Sante, Nanoro, Burkina FasoMRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaDepartment of Pathology and Medical Science, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South AfricaMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaAfrican Population and Health Research Center, Nairobi, KenyaSydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaNavrongo Health Research Centre, Navrongo, GhanaSydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaClinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Sante, Nanoro, Burkina FasoMRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaSchool of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaDivision of Human Genetics, National Health Laboratory Service and University of Witwatersrand, Johannesburg, South Africa; Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaSummary: Background: Rapid epidemiological health transitions occurring in vulnerable populations in Africa that have an existing burden of infectious and non-communicable diseases predict an increased risk and consequent prevalence of kidney disease. However, few studies have characterised the true burden of kidney damage and associated risk factors in Africans. We investigated the prevalence of markers for kidney damage and known risk factors in rural and urban settings in sub-Saharan Africa. Methods: In this cross-sectional population study (Africa Wits-International Network for the Demographic Evaluation of Populations and their Health Partnership for Genomic Studies [AWI-Gen]), we recruited unrelated adult participants aged 40–60 years from four rural community research sites (Nanoro, Burkina Faso; Navrongo, Ghana; Agincourt and Dikgale, South Africa), and two urban community research sites (Nairobi, Kenya; and Soweto, South Africa). Participants were identified and selected using random sampling frames already in use at each site. Participants completed a lifestyle and medical history questionnaire, had anthropometric and blood pressure measurements taken, and blood and urine samples were collected. Markers of kidney damage were defined as low estimated glomerular filtration rate (eGFR; <60 mL/min per 1·73 m2), presence of albuminuria (urine albumin creatinine ratio >3 mg/mmol); or chronic kidney disease (low eGFR or albuminuria, or both). We calculated age-adjusted prevalence of chronic kidney disease, low eGFR, and albuminuria by site and sex and used logistic regression models to assess risk factors of kidney damage. Findings: Between August, 2013, and August, 2016, we recruited 10 702 participants, of whom 8110 were analysable. 4120 (50·8%) of analysable participants were male, with a mean age of 49·9 years (SD 5·8). Age-standardised population prevalence was 2·4% (95% CI 2·1–2·8) for low eGFR, 9·2% (8·4–10·0) for albuminuria, and 10·7% (9·9–11·7) for chronic kidney disease, with higher prevalences in South African sites than in west African sites (14·0% [11·9–16·4] in Agincourt vs 6·6% [5·5–7·9] in Nanoro). Women had a higher prevalence of chronic kidney disease (12·0% [10·8–13·2] vs 9·5% [8·3–10·8]) and low eGFR (3·0% [2·6–3·6] vs 1·7% [1·3–2·3]) than did men, with no sex-specific differences for albuminuria (9·9% [8·8–11·0] vs 8·4% [7·3–9·7]). Risk factors for kidney damage were older age (relative risk 1·04, 95% CI 1·03–1·05; p<0·0001), hypertension (1·97, 1·68–2·30; p<0·0001), diabetes (2·22, 1·76–2·78; p<0·0001), and HIV (1·65, 1·36–1·99; p<0·0001); whereas male sex was protective (0·85, 0·73–0·98; p=0·02). Interpretation: Regional differences in prevalence and risks of chronic kidney disease in sub-Saharan Africa relate in part to varying stages of sociodemographic and epidemiological health transitions across the area. Public health policy should focus on integrated strategies for screening, prevention, and risk factor management in the broader non-communicable disease and infectious diseases framework. Funding: National Human Genome Research Institute, Office of the Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Environmental Health Sciences, the Office of AIDS Research, and National Institute of Diabetes and Digestive and Kidney Diseases, all of the National Institutes of Health, and the South African Department of Science and Technology.http://www.sciencedirect.com/science/article/pii/S2214109X19304437 |
| spellingShingle | Jaya A George, PhD Jean-Tristan Brandenburg, PhD June Fabian, MD Nigel J Crowther, ProfPhD Godfred Agongo, MPhil Marianne Alberts, ProfPhD Stuart Ali, PhD Gershim Asiki, PhD Palwende R Boua, MSc F Xavier Gómez-Olivé, PhD Felistas Mashinya, PhD Lisa Micklesfield, PhD Shukri F Mohamed, MPH Freedom Mukomana, MSc Shane A Norris, ProfPhD Abraham R Oduro, MBChB Cassandra Soo, MSc Hermann Sorgho, PhD Alisha Wade, DPhil Saraladevi Naicker, ProfPhD Michèle Ramsay, ProfPhD Kidney damage and associated risk factors in rural and urban sub-Saharan Africa (AWI-Gen): a cross-sectional population study The Lancet Global Health |
| title | Kidney damage and associated risk factors in rural and urban sub-Saharan Africa (AWI-Gen): a cross-sectional population study |
| title_full | Kidney damage and associated risk factors in rural and urban sub-Saharan Africa (AWI-Gen): a cross-sectional population study |
| title_fullStr | Kidney damage and associated risk factors in rural and urban sub-Saharan Africa (AWI-Gen): a cross-sectional population study |
| title_full_unstemmed | Kidney damage and associated risk factors in rural and urban sub-Saharan Africa (AWI-Gen): a cross-sectional population study |
| title_short | Kidney damage and associated risk factors in rural and urban sub-Saharan Africa (AWI-Gen): a cross-sectional population study |
| title_sort | kidney damage and associated risk factors in rural and urban sub saharan africa awi gen a cross sectional population study |
| url | http://www.sciencedirect.com/science/article/pii/S2214109X19304437 |
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