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Prevalence and Severity of Chronic Kidney Disease in Haiti
Nicholas L S Roberts1,2, Jean L Pierre3, Vanessa Rouzier3
1Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York.
Insights
Chronic kidney disease (CKD) affects 14% of adults in urban Haiti, strongly linked to diabetes and hypertension. Treatment rates for CKD remain critically low, highlighting urgent needs for improved healthcare infrastructure and management.
Area of Science:
- Global Health
- Nephrology
- Epidemiology
Background:
- Chronic kidney disease (CKD) is a significant global health concern, particularly in lower-income countries, yet population-based epidemiological data are scarce.
- Understanding CKD prevalence and risk factors in underrepresented regions is crucial for targeted public health interventions.
- This study addresses the lack of epidemiological data on CKD in urban Haiti.
Purpose of the Study:
- To determine the prevalence of CKD and its stages in a Haitian adult population.
- To identify key factors associated with CKD in this cohort.
- To assess the proportion of CKD patients receiving guideline-recommended treatment.
Main Methods:
- Cross-sectional analysis of data from 2424 adults in the Haiti Cardiovascular Disease Cohort.
- CKD defined by reduced estimated glomerular filtration rate (eGFR) or elevated urinary albumin-to-creatinine ratio (UACR) per KDIGO guidelines.
- Multivariable logistic regression used to identify associated risk factors for CKD.
Main Results:
- The age-standardized prevalence of CKD was 14%, with reduced eGFR in 3% and elevated UACR in 11% of participants.
- Diabetes (aOR 4.1) and hypertension (aOR 2.9) were significantly associated with CKD.
- Only 12% of participants with CKD and albuminuria were on recommended treatments (ACE inhibitors/ARBs).
Conclusions:
- CKD is highly prevalent in urban Haitian adults and strongly associated with diabetes and hypertension.
- Low rates of guideline-recommended treatment for CKD indicate a critical gap in clinical management.
- Strengthening healthcare infrastructure and nephrology care is essential in Haiti to address the CKD burden.
Background:
CKD is a major cause of morbidity and mortality in lower-income countries. However, population-based studies characterizing the epidemiology of CKD in these settings are lacking. The study objective was to describe the epidemiology of CKD in a population-based cohort in urban Haiti, including estimates of the prevalence by CKD stage, the magnitude of associated factors with CKD, and the proportion on guideline-recommended treatment.
Methods:
We assessed the prevalence of CKD and associated risk factors in the population-based Haiti Cardiovascular Disease Cohort. We analyzed cross-sectional data from 2424 adults who completed a clinical examination, risk factor surveys, and laboratory measurements for serum creatinine, urinary albumin, and urinary creatinine. We compared our results with US estimates from the National Health and Nutrition Examination Survey. CKD was defined as either a reduced eGFR <60 ml/min per 1.73 m 2 or urinary albumin-to-creatinine ratio ≥30 mg/g according to the Kidney Disease Improving Global Outcomes guidelines. Multivariable logistic regression identified associated factors with CKD.
Results:
The mean age was 42 years, 57% of participants were female, and 69% lived in extreme poverty on ≤1 US dollar per day. The age-standardized prevalence of CKD was 14% (95% confidence interval [CI], 12% to 15%). The age-standardized prevalence of reduced eGFR and elevated urinary albumin-to-creatinine ratio was 3% (95% CI, 2% to 4%) and 11% (95% CI, 10% to 13%), respectively. Diabetes (adjusted odds ratio, 4.1; 95% CI, 2.7 to 6.2) and hypertension (adjusted odds ratio, 2.9; 95% CI, 2.0 to 4.2) were significantly associated with CKD. Only 12% of participants with CKD and albuminuria were on guideline-recommended agents, such as angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers.
Conclusions:
In a large population-based cohort of Haitian adults, CKD was highly associated with both diabetes and hypertension. The proportion of participants with CKD on treatment was low, underscoring the need for strengthening clinical management and nephrology care health infrastructure in Haiti.
Clinical Trial Registry Name And Registration Number:
A Longitudinal Cohort Study to Evaluate Cardiovascular Risk Factors and Disease in Haiti, NCT03892265 .
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