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Abstract: TH-PO1052

CKD Epidemiology in Rural East Africa: The SEARCH-CKD Study

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Muiru, Anthony Ndichu, University of California San Francisco, San Francisco, California, United States
  • Elly, Assurah Wandago, KEMRI-SEARCH Study, MBITA, Kenya
  • Kabami, Jane, Infectious Diseases Research Collaboration, Kampala, Uganda
  • Atukunda, Mucunguzi, Infectious Diseases Research Collaboration, Kampala, Uganda
  • Charlebois, Edwin, University of California San Francisco, San Francisco, California, United States
  • Havlir, Diane, University of California San Francisco, San Francisco, California, United States
  • Estrella, Michelle M., University of California, San Francisco and San Francisco VA Medical Center, San Francisco, California, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States

Group or Team Name

  • Sustainable East Africa Research on Community Health (SEARCH) Collaboration
Background

Little is known about CKD epidemiology among individuals living in Sub Saharan Africa (SSA) who may have heightened burden of kidney disease similar to African Americans due to shared genetic susceptibility. Non-infectious diseases and ongoing HIV epidemic can lead to significant CKD burden in SSA. Assessment of CKD burden in this region thus far has been limited by small studies or focus in urban areas. We sought to comprehensively ascertain the burden of CKD and its risk factors in rural areas, where most of the population resides.

Methods

We conducted a home-based assessment of CKD and its risk factors among a stratified random sub-sample of a large ongoing, population-based HIV test-and-treat trial in rural Uganda and Kenya (SEARCH study, NCT01864603). Prevalent CKD was defined as an eGFR <60 mL/min/1.73m2 or dipstick proteinuria ≥1+. Exposures of interest including traditional risk factors for CKD (hypertension, diabetes and HIV), were measured at mobile community health campaigns according to the SEARCH study protocol. We used household census population and sampling weights to estimate the community-based prevalence of CKD. To assess the association of potential risk factors with CKD, we used multivariable log-link Poisson models.

Results

We enrolled 5,035 participants from 30 communities (median age 41 [IQR 31-53], 64% female). The overall CKD prevalence was 8.0% (95% CI 7.2-9.0%), and varied by region: Eastern Uganda, 13.0% (11.1-15.2%), Kenya, 7.1% (5.8-8.6%) and Western Uganda, 3.7% (2.7-5.1%). Over half (52%) of persons with CKD did not have hypertension, diabetes, or HIV. Independent risk factors associated with higher CKD prevalence included being from Eastern Uganda (prevalence ratio [PR] 1.97; 95% CI 1.50-2.60), increasing age (PR 1.03; 95% CI 1.02-1.04) and HIV infection (PR 1.58; 95% CI 1.28-1.97).

Conclusion

In rural East African communities, the prevalence of CKD is high and varies by region considerably. While HIV was associated with greater CKD prevalence, over half of the CKD cases could not be attributed to HIV, hypertension or diabetes. Further research and interventions are needed to address the burden of CKD in this vulnerable population where chronic dialysis and transplant are often unavailable.