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Kidney disease in Uganda: a community based study
Robert Kalyesubula1,2,3, Joaniter I Nankabirwa4, Isaac Ssinabulya4,5
1School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. rkalyesubula@gmail.com.
Insights
Chronic kidney disease (CKD) is prevalent in central Uganda, affecting over 21% of the population. Female gender, older age, and high socioeconomic status were linked to increased CKD risk, contrary to traditional risk factors.
Area of Science:
- Nephrology
- Public Health
- Epidemiology
Background:
- Chronic kidney disease (CKD) poses a significant health burden in Sub-Saharan Africa (SSA).
- Existing research on CKD in SSA predominantly focuses on HIV-infected individuals and urban healthcare settings.
- This study investigates CKD prevalence and risk factors within community-based populations in central Uganda.
Purpose of the Study:
- To determine the prevalence of chronic kidney disease (CKD) in a community setting in central Uganda.
- To identify predictors associated with CKD in this population.
- To explore potential differences in CKD risk factors compared to previously documented findings.
Main Methods:
- A cross-sectional study was conducted in the Wakiso district utilizing multi-stage sampling.
- Data collection included demographic information, medical history (alcohol, diabetes, hypertension, smoking), and physical measurements (BMI).
- Renal function was assessed via creatinine levels and urinalysis, with CKD estimated using the Cockcroft-Gault formula and logistic regression employed for analysis.
Main Results:
- A total of 955 participants were enrolled, with a median age of 31 years; 67% were female.
- The prevalence of abnormal renal function was 21.4%, with CKD stages 1 and 2 being most common.
- Female gender, age over 30, and high socioeconomic status were associated with increased CKD risk; a BMI > 25 kg/m² showed a protective effect. Notably, HIV, diabetes, smoking, and alcohol intake were not significantly associated with CKD.
Conclusions:
- This study reveals a high prevalence of kidney disease in the community of central Uganda.
- Unexpectedly, traditional CKD risk factors such as HIV, diabetes, smoking, and alcohol consumption were not significantly associated with CKD in this population.
- Further research is warranted to understand the unique determinants of CKD in this region and to inform targeted public health interventions.
Background:
Chronic kidney disease (CKD) is a major cause of morbidity and mortality in Sub-Saharan Africa (SSA). The majority of studies on CKD in SSA have been conducted among HIV-infected populations and mainly from large health facilities. We determined the prevalence of CKD and its predictors among populations in communities in central Uganda.
Methods:
A cross-sectional study was conducted in Wakiso district using multi-stage sampling. Data was collected on age, sex, socio-economic status, history of alcohol intake, diabetes mellitus, hypertension and smoking. Measurement of blood pressure, weight and height to determine body mass index (BMI) and investigations including HIV testing, fasting blood sugar, creatinine and urinalysis were conducted. Logistic regression was used to estimate the strength of the association between variables and the presence of CKD estimated using the Cockcroft Gault formula.
Results:
A total of 955 participants aged 18-87 years were enrolled into the study. The median age was 31 years (Interquartile range 24-42) and majority (67%) were female. Up to 21.4% (204/955) had abnormal renal function with CKD stage 1 in 6.2% (59/955), stage 2 in 12.7% (121/955), stage 3 in 2.4% (23/955), CKD stage 4 in 0% and CKD stage 5 in 0.1% (1/995). Female gender OR 1.8 (95% Confidence Interval [CI] 1.2-2.8), age >30 years OR 2.2(95% CI 1.2-3.8) and high social economic status OR 2.1 (95% CI 1.3-3.6) were associated with increased risk of CKD while BMI > 25Kg/m2 was protective against CKD OR 0.1 (95% CI 0.04-0.2). Traditional risk factors such as HIV-infection, diabetes mellitus, smoking and alcohol intake were not found to be significantly associated with CKD.
Conclusion:
We found a high prevalence of kidney disease in central Uganda. Interestingly the traditional risk factors associated with CKD previously documented, were not associated with CKD.