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High prevalence of undiagnosed chronic kidney disease among at-risk population in Kinshasa, the Democratic Republic of Congo.

Sumaili EK, Cohen EP, Zinga CV, Krzesinski JM, Pakasa NM, Nseka NM - BMC Nephrol (2009)

Bottom Line: Only 6% of individuals with hypertension having CKD had reduced BP to lower than 130/80 mmHg.Therefore, CKD should be addressed through the development of multidisciplinary teams and improved communication between traditional health care givers and nephrology services.Attention to CKD risk factors must become a priority.

View Article: PubMed Central - HTML - PubMed

Affiliation: Nephrology Unit, University of Kinshasa, Kinshasa, Democratic Republic of Congo. skiswaya@yahoo.fr

ABSTRACT

Background: There is limited knowledge of Chronic Kidney Disease (CKD) among high risk populations, especially in the developing countries. We report our study of testing for CKD in at-risk subjects.

Methods: In a cross-sectional study, 527 people from primary and secondary health care areas in the city of Kinshasa were studied from a random sample of at-risk out-patients with hypertension, diabetes, obesity, or HIV+. We measured blood pressure (BP), blood glucose level, proteinuria, body mass index, and estimated glomerular filtration rate (eGFR by MDRD equation) using calibrated creatinine levels based on one random measurement. The associations between health characteristics, indicators of kidney damage (proteinuria) and kidney function (<60 ml/min/1.73 m2) were also examined.

Results: The prevalence of CKD in this study was 36%, but only 12% were aware of their condition. 4% of patients had stage 1 CKD, 6% stage 2, 18% stage 3, 2% stage 4, and 6% had stage 5. 24 hour quantitative proteinuria (>300 mg/day) was found in 19%. In those with the at-risk conditions, the % of CKD was: 44% in patients with hypertension, 39% in those with diabetes; 16% in the obese and 12% in those who were HIV+. 82% of those with a history of diabetes had elevated serum glucose levels at screening (>or= 126 mg/dl). Only 6% of individuals with hypertension having CKD had reduced BP to lower than 130/80 mmHg. In multivariate analysis, diabetes, proteinuria and hypertension were the strongest determinants of CKD 3+.

Conclusion: It appears that one out of three people in this at-risk population has undiagnosed CKD and poorly controlled CKD risk factors. This growing problem poses clear challenges to this developing country. Therefore, CKD should be addressed through the development of multidisciplinary teams and improved communication between traditional health care givers and nephrology services. Attention to CKD risk factors must become a priority.

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Prevalence (%) of CKD among selected populations by stage of CKD. Abbreviations: DMHTN = patients with diabetes and hypertension, HTN = hypertensive, HIV+ = person having human immunodeficiency virus infection antibody positive, FHKD = family history of kidney disease; CKD = chronic kidney disease. CKD is defined either kidney damage (proteinuria ≥ 300 mg/day) or kidney function (eGFR < 60 ml/min/1.73 m2).
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Figure 1: Prevalence (%) of CKD among selected populations by stage of CKD. Abbreviations: DMHTN = patients with diabetes and hypertension, HTN = hypertensive, HIV+ = person having human immunodeficiency virus infection antibody positive, FHKD = family history of kidney disease; CKD = chronic kidney disease. CKD is defined either kidney damage (proteinuria ≥ 300 mg/day) or kidney function (eGFR < 60 ml/min/1.73 m2).

Mentions: In addition, the prevalence of CKD among subjects at-risk according to K/DOQI stage is shown in figure 1. In those with the at-risk conditions, the prevalence of CKD was: 45% in patients with DM and HTN, 26% in patients with HTN, 16% in the obese and 12% in those who were HIV+. In persons having FH-KD, CKD was found in 8%. Table 3 shows the 24-hour quantitative urine protein, dipstick abnormalities in the urine (proteinuria, pyuria and hematuria) and elevated creatinine (men > 1.6 mg/dl and women > 1.4 mg/dl) according to K/DOQI stage.


High prevalence of undiagnosed chronic kidney disease among at-risk population in Kinshasa, the Democratic Republic of Congo.

Sumaili EK, Cohen EP, Zinga CV, Krzesinski JM, Pakasa NM, Nseka NM - BMC Nephrol (2009)

Prevalence (%) of CKD among selected populations by stage of CKD. Abbreviations: DMHTN = patients with diabetes and hypertension, HTN = hypertensive, HIV+ = person having human immunodeficiency virus infection antibody positive, FHKD = family history of kidney disease; CKD = chronic kidney disease. CKD is defined either kidney damage (proteinuria ≥ 300 mg/day) or kidney function (eGFR < 60 ml/min/1.73 m2).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2724413&req=5

Figure 1: Prevalence (%) of CKD among selected populations by stage of CKD. Abbreviations: DMHTN = patients with diabetes and hypertension, HTN = hypertensive, HIV+ = person having human immunodeficiency virus infection antibody positive, FHKD = family history of kidney disease; CKD = chronic kidney disease. CKD is defined either kidney damage (proteinuria ≥ 300 mg/day) or kidney function (eGFR < 60 ml/min/1.73 m2).
Mentions: In addition, the prevalence of CKD among subjects at-risk according to K/DOQI stage is shown in figure 1. In those with the at-risk conditions, the prevalence of CKD was: 45% in patients with DM and HTN, 26% in patients with HTN, 16% in the obese and 12% in those who were HIV+. In persons having FH-KD, CKD was found in 8%. Table 3 shows the 24-hour quantitative urine protein, dipstick abnormalities in the urine (proteinuria, pyuria and hematuria) and elevated creatinine (men > 1.6 mg/dl and women > 1.4 mg/dl) according to K/DOQI stage.

Bottom Line: Only 6% of individuals with hypertension having CKD had reduced BP to lower than 130/80 mmHg.Therefore, CKD should be addressed through the development of multidisciplinary teams and improved communication between traditional health care givers and nephrology services.Attention to CKD risk factors must become a priority.

View Article: PubMed Central - HTML - PubMed

Affiliation: Nephrology Unit, University of Kinshasa, Kinshasa, Democratic Republic of Congo. skiswaya@yahoo.fr

ABSTRACT

Background: There is limited knowledge of Chronic Kidney Disease (CKD) among high risk populations, especially in the developing countries. We report our study of testing for CKD in at-risk subjects.

Methods: In a cross-sectional study, 527 people from primary and secondary health care areas in the city of Kinshasa were studied from a random sample of at-risk out-patients with hypertension, diabetes, obesity, or HIV+. We measured blood pressure (BP), blood glucose level, proteinuria, body mass index, and estimated glomerular filtration rate (eGFR by MDRD equation) using calibrated creatinine levels based on one random measurement. The associations between health characteristics, indicators of kidney damage (proteinuria) and kidney function (<60 ml/min/1.73 m2) were also examined.

Results: The prevalence of CKD in this study was 36%, but only 12% were aware of their condition. 4% of patients had stage 1 CKD, 6% stage 2, 18% stage 3, 2% stage 4, and 6% had stage 5. 24 hour quantitative proteinuria (>300 mg/day) was found in 19%. In those with the at-risk conditions, the % of CKD was: 44% in patients with hypertension, 39% in those with diabetes; 16% in the obese and 12% in those who were HIV+. 82% of those with a history of diabetes had elevated serum glucose levels at screening (>or= 126 mg/dl). Only 6% of individuals with hypertension having CKD had reduced BP to lower than 130/80 mmHg. In multivariate analysis, diabetes, proteinuria and hypertension were the strongest determinants of CKD 3+.

Conclusion: It appears that one out of three people in this at-risk population has undiagnosed CKD and poorly controlled CKD risk factors. This growing problem poses clear challenges to this developing country. Therefore, CKD should be addressed through the development of multidisciplinary teams and improved communication between traditional health care givers and nephrology services. Attention to CKD risk factors must become a priority.

Show MeSH
Related in: MedlinePlus